#462: Dr Nikita Kanani, Global Medical Director at Neko - Neko's Year 3 Prevention data & Insights from 80,000 scans

0:02Every year we still find about 1 % that life's threatening.

0:06Dr James Somauroo:That's very relatable because my last scan had a raging cholesterol. Unless we invest in prevention we will never deliver prevention. An NHS partnership, NECO and NHS, where anyone we see can get referred back into the NHS and get exceptional care.

0:25Dr James Somauroo:Geeta Kanani, welcome to the Health Tech Podcast. I'm so excited to be here. It's been a long time coming this, isn't it? It has actually, yeah. Loads and loads and loads for us to talk about. Firstly, we're going to talk about your background. Then we're going to talk about some of the stuff you've been doing at NECO. I've got all of your data here that I've been, and we're going to quiz you about your year three data. I'm ready for a quiz. Yeah, we're going to talk about that. I might use you as a GP to just go through my own scan results that I have this morning. I'm also here as an NHS GP, fully validated, don't worry.

0:55Dr James Somauroo:Fantastic, yeah, ideal. And then just looking at my stuff, yeah, we've got loads to talk about, right? parenting tips parenting tips absolutely yeah but let's start with your background okay so because I don't think I've actually heard you explain all this but I was reading your background on the train on the way in this morning and actually looking at everything that you've done and I knew it I knew you'd been part of NHS England and the whole Covid stuff and all of that I just I hadn't really appreciated or put it together that you you've been in some serious leadership positions in some serious times in what will go down as like human history pretty much which is wild um and now you're at neco seven billion valuation allegedly 700 million raise you're doing some crazy stuff but how where does all this begin because at some point you did medicine and a gp you were a medical student at some point in your life so did you see all of this in your future?

1:48I mean, maybe doing crazy stuff is just the header. Did I see it in my future? No. But when I look back with that beautiful kind of retrospective scope, it sort of makes sense. Dad was a refugee from Uganda, spent six months in a tent in Newham. Mum was an economic migrant from Kenya. Wow. Somehow navigated their teens here in the UK in Sunderland, where I'm now a visiting professor, which is beautiful. What a full circle. But anyway, became pharmacist, had a community pharmacy. So I actually grew up in their pharmacy, in the wire basket, on the side of the till, to the point that sort of families still knew me just as they were retiring sort of 40-odd years later.

2:30Grew up only speaking goodratti, went to nursery, and my mum dropped me off, and they were like, no, no, take her back. We don't, you don't understand who she is. But my point being, I grew up in a community full of other communities, And I think that very much means that what I do now and what I've done sort of, you know, the career you've described makes a little bit of sense, although it's always been a little crazy paving. And I was a medical student once. I was a medical student, unsurprisingly, who loved to do everything, every job, every exposure, every opportunity. But it was really when I was doing house jobs that I realized I could do more alongside my clinical career.

3:08So I've always stayed a practicing clinician, whether that was in hospital, medicine, general practice, and I'm still an NHS GP. And I love that. I really do. And there's more to do. There's always more to do, whether it's the person in front of you, the community, the population. So, yeah, eventually my career went from sort of local to local, sub-regional to regional to national. And that's where I ended up at NHS England for about six, seven years, carrying through kind of those different, yeah, pretty significant periods of time.

3:42Dr James Somauroo:Yeah. Building a heck of a lot of resilience, I imagine, as well. Yeah. We're still a good thin skin. I think it's a lovely mix. Yeah. I want to talk to you about that to begin with, because I don't think that could have been easy. I think everyone in those types of positions was doing everything for the first time. there was no playbook for how we were going to get through a pandemic and you find yourself in a leadership position of the entire country having to you know negotiate COVID testing for an entire population and do all of that stuff what was that like how did you have practically like how did you do that I mean still one of the darkest times of my career and my home life we we had incredible support and by that I mean both at work and at home um which sounds odd because we were all kind of tied up and hidden away at home um we were all doing it for the first time and I think that gave me enormous strength I would be in my pajamas at home on teams meetings or well it was a mix of teams and all sorts of modalities then and not as easy as it is now but two or three a.m in pajamas with all sorts of people around the country trying to make sure that we were ready for the next day then wake up a few hours later, get back into the NHS England offices, which we'd sort of commandeered for core personnel only, to make sure the next protocol was ready, the next approach, and make decisions that were genuinely the toughest I've ever had to make.

5:19Things that really still hit me. So NHS England was there to deploy whatever came out of sort of Cobra and Cabinet. But we were making decisions as well as making sure things happened in a kind of operationally robust way. And by that, I mean, we talked about things like, you know, when do we close general practice? Not fully close it, but close the doors to protect staff, to protect patients so that we, you know, reduce circulating COVID load within a practice. It was constantly making decisions that had impact one way or another, obviously at a country level. But one of the things was, you know, how do we protect general practice, the people within the teams, people who were coming into surgeries?

6:00let's close the doors let's triage which brought in digital triage which was fantastic you know it was it wasn't happening before then um but then we keep community pharmacy open and my mum was running our community pharmacy because my dad was shielding and my mum would call me and say will we get any PPE yet and I would say well not yet because we had to prioritize what was available so you know there was these kind of macro population level decisions and then really micro personal decisions but um how did I navigate it uh as I said people community even though it was virtually um the kids were still in primary school so um my daughter spent most of her six year ages six seven eight sat next to me so when I worked from home I would do kind of um a lot of our government facing cabinet facing meetings either at number 10 or at home and she would be building a diorama to showcase the fall of the Roman civilization and then listening to kind of you know Boris Johnson give a view on something we might need to do um so it wasn't um you know it was the most unusual of times um but the end of that year was proper shining light so um the one thing that it is worth really uh remembering is the week before Diwali when I was asked to join the vaccine program and we were planning to roll out the vaccination in 40 eventually 40 odd hospitals but because of the work I'd done around primary care and primary care networks there was a thesis that we could actually roll it out in primary care and get much more geographical coverage which means access which means immunity and and we did and within a few weeks we stood up a vaccine program that could deliver in all parts of primary care and I I remember having these A3 maps on the wall and trying to figure out like where else we needed to have vaccine centers.

7:52Because in the end we had three, four, five thousand. But at that point it was, you know, one by one. And I was looking at this space on the map and going, we need one there. And everyone's like, that's the Lake District. There's no one there. And I was like, I don't care. I want a vaccine center everywhere. Anyway. And then that was incredible because we had not just uptake, but we're able to work with ministers, with cabinet to actually, you know, encourage people to do something really meaningful with community so I spent six seven weeks with the prime minister on a Sunday going in every week um him in his pajamas because it was his home it was his home um talking to people he could have got dressed though come on well do you know it was stripy it was all stripy so it worked um but genuinely it was incredible because what was important about that was stuff that we've talked about before what convinces somebody to do something for their health it is not just because it's good for you or you're being told to that's a there's a whole bunch of other things so with faith groups it was about talking to faith leaders pastor agui who ran two three thousand black churches working with him about why this was important what else would we bring would we just have one intervention with the community would we make a promise and disappear which is what often happens or are we going to have a relationship over time over years and years and that was the sort of conversation that we put in pace and it was very much a legacy piece which really um which really uh struck me as the most important thing we should be doing in healthcare which makes sense as to why neko is so important

9:20Dr James Somauroo:to me now yeah that does make a lot of sense community relationships trust and actually you know going through faith leaders to access people that really don't trust the healthcare system all of these are things that i can certainly get on board with one thing that you said earlier actually was that you used the phrase which brought in digital triage you know that that element of just oh it just was a good idea so we just did it and then it worked and we were allowed to do it seemed like there was such a bizarre time for innovation to actually just oh if it makes sense let's just do it and you and I operate in in this evidence-based as clinicians anyway in this completely evidence-based world where getting anything done beyond the norm is just so difficult to do because of evidence and regulation all that sort of stuff which all has its place but i suppose seeing that level of innovation must have you must have got bitten by the bug in some way given the wave ended up because actually seeing what could then be done at massive scale so quickly yes there's kind of plotted the path to where you are now in some respect oh god i mean that is a great a great call so i think a couple of things i i did grow up on the re-modified N64.

10:37So I do think there was something about that kind of creating something, you know, within me. But interestingly, when we brought in digital triage through the pandemic, only weeks before I'd been negotiating, I'd been trying to negotiate its entry into general practice as we knew it then. And there was a lot of anxiety and a lot of concern and completely understandable, you know, both do we have the tech infrastructure? Is it safe? Will it work for clinicians? Will it work for patients? Very understandable questions. And genuinely weeks later, you know, the negotiating committee for general practice saying, we need this digital triage.

11:13We cannot just bring everybody in untriaged through our doors. So it was a very bizarre scenario. And I also had these amazing tech leaders, you know, calling up saying, we want to offer our services, our product for free will also help people on board. We will come together as a sort of like a consortium or a community of offers so I wasn't just looking at one or two I had 10 or 12 around the virtual table saying okay we could do that bit okay you do that bit we could do this bit so there's intense collaboration within the kind of private digital leadership community as well as a need you know a safety need within the wider kind of health community

11:53Dr James Somauroo:Yeah. Wow. So plot the path then to NECO. I had done six, seven years. I had just finished the vaccine program and then worked through a big merger program in the NHS through NHS England. And I stopped feeling like I could do the things that I feel I'm built to do. You know, you get pretty good sense after 10, 20 years that the areas where you're good, the areas where you're less good, where your energy comes from, how you help other people through complex change. and I knew I needed to step out before I could step back in. I'd settled five health secretaries for primary care as well. So I really felt like I'd done my time.

12:34Dr James Somauroo:But these days, that's actually not a good marker of a long span of time. It would have been five minutes. One a day, five days. So I really felt like I had more to learn as well about health innovation, about tech, about how to take people with me in a partnership session. sense and not just in the public sector. I wasn't looking to work in the private sector. I just needed to learn more, do more, have kind of tangible fast impact. Um, so two things happened. One, um, I set up a startup in women's health, which was phenomenal. It was the best experience ever. I absolutely loved it. I loved being a founder.

13:13I loved being, I loved growing something. I loved molding something around people, around communities, around women in this case. And secondly, I was introduced to Neko by a mutual friend, a friend who works with Daniel, said, this company is launching in the UK, you should come and get involved. And at that point, I had still have good relationships with stakeholders, regulators, etc. So I started working with Neko actually just as we were, well, before we were launching here in January. So I started working with Neko in January 2024. and then last year met Yalmor again just before the summer saw how fast we were growing and got the bug again and loved what we were doing not just in terms of growth but kind of very much balancing a quality of care and that member experience and I thought that was really phenomenal because we don't talk about that very much in the NHS and that's very understandable many incumbent systems have got so many pressures that what that member experiences isn't the top of the list but we know we know through design-led experience-based evidence that that experience is what keeps somebody engaged in coming back so the opportunity to work with Neko with incredible tech incredible people an organization that genuinely puts a person at the center of what's being designed well I mean it was a no-brainer so I've I've had a phenomenal journey with Neko both as advisor now as a substantive part of the team and we're growing in Sweden in the UK and around the world so later this month we'll be launching in in the US in New York.

14:52Dr James Somauroo:Amazing and there are some even more things that you do which will which I'll probably come to after chatting about this for a minute but okay let's talk about Neko so preventative health you're an NHS GP what did preventative health mean to you before joining NECO and what is it what has it meant to you since joining NECO and by the way reason I ask is obviously we did the event together which had so much interest from you know senior NHS people in primary care from so many GPs and one thing that I I think noticed in that room more than I noticed anything else was actually how like it sounds like i mean it sounds like i'm sort of making this up but like it was it was collaborative in the sense that there were so many gps that just went hold on a minute we can learn from you and perhaps you can learn from us and there's something to do in the middle here yeah and there's just a there's just a really interesting vibe to it that i think it changed people's perception of what preventative healthcare actually is from that longevity tech bro live forever billionaire like everything in that kind of venn diagram on that side of it anyway so then this kind of there are nhs health checks there is just looking after yourself there is only looking for what is actionable there's all the stuff over there on that side chronic disease and preventing that stuff there's all that on that side and there was a lot that got demystified in that room good but i'm interested in what you thought of it before and after and during and what your journey's been for it i mean it's a great question because i commissioned the nhs health check for years yeah okay so there's another lens there as well interesting yeah um but i'm a i'm a child that was brought up in an asian family yes in a pharmacy so i would see you know parcels of medicines being handed out but i also grew up where you know uh community and um movement and okay holdy dude would all be part of keeping well before you got unwell now we know that isn't always what plays out in south Asian communities but the philosophy around looking after yourself around keeping well was definitely um yeah part of part of my DNA so it very much felt like I was coming home to an organization that was building with prevention in mind I just didn't know what that was until I understood what Neko was it was taking everything that we've learned about prevention and that wide spectrum that you describe and kind of going that's over there lets us build up from the beginning the tech the data points the information we'd need to genuinely improve people's ability to be healthy and to get healthy for me that's why this intersection is so interesting um absolutely we get people coming in asking all the time about sort of methylated dna on the more longevity side and we ask people you know very much focus on systolic bp on the really kind of more traditional prevention side what's important here is that we offer something that is accessible to members and by that I mean any member that comes in no matter your starting point so wherever you start with us we can take you on a journey where year after year you can get better you can get more well you can get more healthy and that's what our data is showing us year after year the accessibility piece is really interesting because I've done a fair amount of work now on I suppose almost like academically looking at prevention and looking at the various governments that have suggested certain things with prevention and there was a point in time where a report was written and it and it basically said either you focus on it or you're going to struggle and then here we are 20 30 years later struggling quite literally and the accessibility being um part of it one of the points that i think i've learned in my work is that and research on this is that the like price point and how much it costs someone because let's be honest you you're in both worlds here if the nhs went on pays and that's where people do but that's often i think what people are fixated on and they and it becomes a binary yes of is it paid is it not yeah and paid actually runs into the tens hundreds of thousands or brian johnson's you know multiple millions a year spent on that side of thing and and it's and it's interesting to me that there are companies that are trying to really drag the price down and that r &d that's happening yeah on that private sector side then dragging the price down and that being something that was interesting to people at the event as well of going well actually that's people that then come off the NHS health check waiting list or it alerts them to it and they tell other people that it's so there's there's a lot there's a lot in there but as someone that clearly cares about community and accessibility and has a lot of NHS values to you where do you and this by the way is a question I got I got criticized after the event for for not letting you speak enough so that's part of the reason for Ashley to come on there I'd love to know how how you think about all of that uh it's such a tricky space isn't it um to your point if we think about access just about cost then we've missed the point and that's something we have to as an NHS person through and through I have to keep reminding myself cost always feels like an ugly piece an ugly word an ugly way to frame things the things I keep reminding our clinicians and I'm pointing because we're not far from our clinic is that this is our opportunity to offer not only excellent care and excellent information to our members in a way that helps them to get more and more well but to build a massive anonymized data set which will make the case for prevention and the report you're referring to an actual kind of global and national studies since have very clearly said that unless we invest in prevention we will never deliver prevention and the argument will be then well where's the data and there are no data sets that are as big as the data set that we're building our year three data for 2025 looked at more than 80 ,000 scans 80 ,000 scans that is a huge number and that's just year three alone um so for me and actually I talk about equity and equality a lot at home particularly with my daughter so it's quite you know it's quite interesting to kind of kind of tease this out what are we trying to do are we trying to make it affordable for everyone for the people who need it most so we're trying to remove kind of systemic injustice where people haven't accessed healthcare because of trust because of relationships and we've talked before that it isn't just price that stops people coming forward to have a health check or a vaccine or a prevention intervention whatever we want to call it it is about you know is that offer on my high street is it something that I've heard from someone meaningful now today someone meaningful is usually somebody on social media and um one of the reasons we have such an uh kind of all-encompassing uh social media presence is people who've come in and who talk about us because that encourages other people to come in and and experience the scan and the minute you're in it means that we can give you a baseline and start helping you become more and more well um interestingly when i talk to people about the price and I talk to our members a lot as you as you'd imagine the price often doesn't feel particularly prohibitive what people want is that holistic assessment so everything done in one place at one time and then brilliantly for a tech company and I think we've got this really uh interesting balance here amazing tech amazing experience and time with the clinician and more and more what I remember say is your tech was amazing your experience was great and I got time with your clinicians and they were knowledgeable and they had time for me and they could walk me through what was needed and that becomes a generational intervention and by that I mean somebody who didn't trust healthcare or the idea of early access to prevention-led services has time with a clinician with amazing data and goes away and tells other people.

23:16They tell their family, they tell their mum. My son just turned 18 and he had his first scan. At 18 he has arguably hundreds if not thousands of data points about himself in a way that you know we'd never would have had growing up um and i think that is what's going to change communities um and their relationship with health care and prevention do you see the day where say neco and the nhs are in a working relationship absolutely and i i'm so excited for it so i'm at our event as you know lots of people asked about what the relationship between private and public loads like like

23:53Dr James Somauroo:Like a genuine surprising volume of people. Yeah. Like multiple tens of people. Yes. Yeah. Asked for an intro to you. I mean, the queue is still so long and I'm still kind of working through how to have really meaningful relationships. I want to be a responsible private provider in this space and private partner. So we do. And I understand that I've been in the startup world, you know. Yeah. People coming in and disappearing. We can't do that. We have a responsibility to the NHS, to patients, to other clinicians. But we have a number of partnerships that we're working on. One that's definitely further ahead than the others, which, you know, at the right time, you'll hear about it first.

24:37But an NHS partnership, NECO and NHS, where anyone we see can get referred back into the NHS and get exceptional care. what that means is is that people um who come in through you know through their own means are not worrying about follow-up care in the private world if they feel they can't afford that they can get that follow-up care through the nhs but in a partnership way we're not just dumping stuff back into the nhs which we've been really cautious not to do and in fact we consume a lot of our own smoke you know the majority of people we see that need a follow-up of any sort we'll repeat the bloods at our cost we'll do the echo or the ecg we will work them up as far as we reasonably can we'll do the repeat skimmer skin images so people who then touch the nhs or indeed the private sector genuinely need that care that further diagnosis or treatment i'd appreciate that was

25:27Dr James Somauroo:so close to happen if you're talking about so what's the what's the difference that forgive this for being stupid question what's the difference then between what you just described than what happens now so when you talk about a partnership model are we talking about like an economic model here like what's that what so what what we're talking about with our most likely kind of a relationship that i'm talking about that this calendar year not you know pie in the sky next year in a few seasons or quarters the the idea is is that somebody who we see that needs nhs follow-up care so it might be with a dermatologist or a cardiologist or an endocrinologist given the things that you've seen in your scan, will get direct access to them.

26:07So still keeping the GP in the loop in terms of the information and the information flow, but not asking somebody to go back into their NHS practice. Then, you know, you've got a member of the GP team then having to review them again, do another bit of admin, put them back through into the service. You know, that is a boggy, rubbish experience for the member. But it's not great for general practice either. Even though we do all the referrals, we do all the paperwork. So this will kind of cut through all of that, make sure people can get seen, you know, within a standard two-week pathway if it's derm.

26:40So brilliant experience for the members. The clinicians that we've been talking to already love it because the people that we refer, so with dermatology, the people that we refer almost always, you know, turn into a melanoma that needs a removal. We have such great stats in terms of the people that we see the number needed to excise. so our our kind of global data if we look across the uk and sweden um we are we need to refer kind of maybe five five or six members for a melanoma to be found more globally if you look at general

27:14Dr James Somauroo:practice generally you're talking about 15 or 20 so we already have um nhs general practice teams who might have some of our staff working with us coming back to us and saying that our staff are now so well trained that they have the most exceptional kind of numbers needed to excise referral rates within the practice which is which is again phenomenal and so the partnership isn't just a partnership for the member our clinicians work in the NHS they refer in the NHS so it means that if we upskill our staff yeah UK the NHS has an added benefit as well that's a real unintended well not an unintended benefit an unpredicted benefit i think from i was pretty clear um and we've we've touched on this before the people who work with neco need to still have a foot in the nhs whether they're practicing general practice or somewhere else partly to understand the community the kind of existing pressures and demand but to take stuff back into the nhs as well we're starting to see the uh the fruit of that right you mentioned the data okay let's talk about some of the data so um when i looked through this and i looked at it last night i looked i read it again in more detail on the train this morning the main thing i got from it is that this kicks everyone into gear yeah i love that yes neko just kicks everyone into gear yeah and i think or maybe not even saying neko a scan or a view of your health clearly kicks people into gear people with chronic disease got kicked into gear more two and a half times more than those without something two and a half two and a half times more yeah right okay and but everyone comes back better off for that well not everyone but most things are improving across anything that is um kind of modifiable statistically significant thing things where the data is showing that an intervention makes a difference so systolic bp yeah your hdl going up your non-hdl going down you know across those things that we know make a difference yeah we can see that improvement and that's very relatable because my last scan had a raging cholesterol yeah that was not i didn't think anyway it was particularly conducive with my lifestyle turns out if i actually put a magnifying glass on my lifestyle you can't drink three three or four pints of whole milk a day and three or four pints yeah and happy yeah loved it and have loads of red meat yeah so blah blah blah like packs of doritos at a weekend because i deserve it which flavor uh i actually eat i i started going on the hard stuff like the the red was almost a gateway to them yeah yeah yeah purple yeah that's dangerous isn't it my kids have started making nachos with it and loading those up and i'm like Can you just stop here?

30:08You guys have use on your side. And the thing is, initially, in anesthetics, we call it tachyphylaxis.

30:15Dr James Somauroo:It starts off having a really big effect on you, and then you just crave it. You just get more and more used to it, but really hard. Okay. So, less milk, less red meat, less Doritos. Less all of that stuff. Basically, I cut out saturated fats completely. And this is from your last scan, which was last year? Which was last year in November. So, I cut saturated fats out completely. and a whopping reduction in cholesterol. Well done. Well done. That's amazing. No, thanks. Thanks. Also lost eight kilos. I was going to say, you're looking really trim. Well done. I didn't think I had it to lose. Then's I, obviously you did.

30:49Dr James Somauroo:It crept up on me. But what I'm saying is though, this matches my experience. Yeah. And what I also noted was that you've added in lipoprotein A. Yeah. Or apoprotein A, I should say. as well yeah um you've the test has to certainly broadened out it looked different there was a big screen in front of me with everything going on there was microvascular litter on my feet going yeah from your position as clinical in all of this um what how do you make those decisions as to what you add it's a really iterative thoughtful process which is exactly as it should be so some of it will come from innovation so things have been seen out there in the big wide world that just looks incredible has incredible data and outcomes already okay what are we missing why aren't we offering that some will be in the um head of yama he'll sort of think like an engineer and kind of go well hold on if we can do that and that why can't we do that and i think uh you guys talked about this in the podcast he'd i think his brother had said something about how one assesses a patient and talks very much about data points and then yaoma was saying well hold on looking at a patient as a data point his brother was like yeah oh okay so that sort of thinking when you bring together clinicians and engineers and innovators you're constantly thinking about what can you do next and differently um there's a a proper process in there as well what you know what do our members say what are what and not just what do our members say in terms of evidence-based changes what else are our members asking for because actually the reality is the noise out there is huge not doing things just because there's no evidence isn't the full story now we are evidence-based in terms of um bringing in interventions that are that will give us modifiable information things that we can do something different and we are an organization that is building a data set day after day week after week month after month and now year on year and we're the only people who are publishing this data openly and saying okay this is what we're seeing this is what we're founding because we don't have all the answers nobody does but unless we collect that data and go on that journey we we can't so what our data will now tell us is okay now let's focus our r &d in this area and in this area um let's build out in this way and because each of our um clinics is like a live r &d lab properly consented properly thought through but actually how how incredible is that we can keep building on that offer it does mean that we then have to refit our clinics so what you experienced this morning you were one of the very first in the uk to have a new scan i mean we've been doing the training internally but first members of the public to have the new scan with the new blood test so our team have been trained on a whole new flow a whole new scan a whole new experience so that that innovation doesn't just sit in somebody's brain or on a you know in some sort of cool software or even in our production company in in stockholm it is here it is live and rolled out to you year on year actually that's the ambition nice so just because i had the scan this morning i'm still gonna give you a bit of a hard time on the data yeah please one thing i spoke to uh yalmar about last time was worried well and that being an obvious you know are you perpetuating this that and the other and yalmar's answer at the time was that we only test what's actionable there's also an element that you do detect potential life-threatening disease as well and that's shown up in the data so what can you say about worried well and all of that stuff as a criticism when you look at this year three data so luckily my personal position on worried well um it kind of makes sense in the context of neco i've always found it a really frustrating term if in surgery in gp surgery somebody comes in and they're worried about something yeah they're worried about something they might be well today but if they're worried that if you believe in that kind of mind body connection then that worry is for a reason and will have an impact so people who are worried do need a way to navigate that and a safe way to navigate what they're worried about why they might be worried and how to make sure they are on the most healthy track possible that's thing one thing two uh unsurprisingly jamar's right we do look at only things that we can modify and that now shows up in the data so just for listeners or we i was going to say readers but the brain listeners or viewers maybe readers this data report that james is looking at looked at about 80 000 scans in 2025 so that's across uk and sweden that's a mix of first time second time third time recipients about 9 000 having their third scan um which tends to be obviously mainly Sweden quite a few in the UK now as well some of us are well into well I don't know how many scans I've had now but you know people are hitting their third scan what we're learning is is that no matter the volume as in every year we see more and more people the number of people we're picking up with life-threatening illness and let's come back to what that means is about one percent one percent in 2023 1.2 percent in 2024 and then last year one percent so that lifetime condition pickup is staying steady no matter the volume of scans so we're not finding additional incidental omas the more we do we're not finding more false positives that is actually really critical from a kind of clinical robustness point every year we still find about one percent that life threatening we're not just finding what would traditionally be called worried well interesting i noticed when i read it there's an there's a really interesting quirk on the third scan and i only zoned in on it because it's the thing that i'm focused on which is the hdl cholesterol yeah um and there's just an interesting quirk that it doesn't improve as much on the third yeah what's what's interesting to me though is that what you said previously that this information then directs your r &d and it will change your practice this is a dynamic way that you're now looking at this stuff and so this just becomes information that you then act on and by the way like you know i'm looking at everything else and everything else goes in the right direction broadly it's just that there's obviously these quirks but is that the sort of thing that you look at it and go hmm is there some information intervention that needs to then be done around this specific thing not for people that are with us because we don't know what people like outside of neca we don't know how people behave year on year we don't have anything to prepare this to so the fact that we're not quite sure so maybe year four does uh does hl improve again does it does it drop off okay so it's been one of the the livest conversations we've been having internally do we have to ask different questions now that we integrate wearables where will we focus what is the sort of conversation we have in the debrief how is it different do we do something and what does the evidence say and what does our kind of anecdote say where people have improved their hdl what do we do differently was uh you know we can drill now in an anonymized and really data conscious way we can drill right down and go actually this pattern of practitioner had this impact on hdl over these many years ah ha ha those are the things and then i was sort of joking with some of our clinic leadership team yesterday so in in the nhs general practice kind of consultation model we we talk about the neighbor uh roger neighbor model don't we um of the consultation style you know we are developing our own unique consultation style now because we will think to ask and pick up and prod on different things as we go year on year so that is exciting that is really exciting by practitioner is a very interesting way of like scoping that and seeing like you know some exceptional people that are what and asking them what are they doing differently how do you coach this is how curious we are you know i have flown out to sweden for one of our you know we've got somebody well we've got many exceptional practitioners but i was like okay and you do that and then you have oh right okay then you can take that back to the training and education team right can we modify the debrief in this way can we build this in then it's can we scale that to all of our teams because you know our teams are growing quickly can we make sure that as people on board with us they learn this new technique and can we make sure the cpd the continuous professional development is there as well absolutely couple of questions before i let you go um raising 700 million that i mean it didn't come out of nowhere but that was a whopping sum and some some incredibly interesting people that that were part of that round what's changed internally what what what you guys do i mean that must change the pace of things quite quickly yes and no um we're still one of the things i love is that we're still very values driven we know what kind of drives our value and our behaviors so some of the sort of sort of relational behavioral things just haven't changed we're like we were already striving for 10x for doing the best we possibly can we don't have time to lose we have people that have to have access to our scan all around the world yesterday so that hasn't really changed in many senses what it has allowed us to do is think very carefully about kind of what comes next year and the year after we already had a plan we already want to grow we already want to deliver an exceptional and high quality experience but can we go faster you push more can we do more how do we do that in a way that doesn't undermine that member trust in us and takes our clinical teams with us as much as our innovators and and and engineers um and so so yeah we're doing thinking about how we grow faster and safely hand in hand um and that diversity of investors well look this is something that we want to be for everyone and different voices back to where we started different voices appeal to different people it can take a footballer or a 10 star or somebody on the street or a faith leader we need all of those people advocating for proper prevention so that we can offer it to as many people as possible and i think this is the thing that's exciting for me and i hope that we can you know do more events like we did previously you guys because i i do think particularly around the faith leaders thing and you and i you know both have you know certain genetics that means that we're susceptible to certain things and i and i know that those communities are also happen to be the ones that don't often trust the healthcare system and actually finding ways to get in to actually spread that message and build that trust with the system is is genuinely so exciting and just for a little bit you go um I do just want to like show I was gonna say readers then listeners and watchers uh you also you're on the board of NHS online and um you are helping young girls in STEM as well in whatever on earth is your spare time um the nhs online thing that's super interesting given everything that's in your orbit at the minute i know that must just does it just slot in and is this all synergistic it is all synergistic and oh i mean what a what a fantastic thing to be part of the first proper foray into kind of a not just digitized nhs but an nhs that is truly accessible in a way that we just haven't kind of thought about when it was constructed because most of these modalities well all of them were pretty much not around yeah and so yeah building out nhs online as a non-exec is is incredible and one of the great things is there's a real appetite for that public-private partnership and we haven't worked out how yet but we know it's going to need to take a lot of people to get this right for the for the population as it changes and grows so that feels genuinely innovative and nhs facing well yeah the people on that board the group of people on that board i mean i don't know if you want to imagine those conversations it's it's so i mean you you can explain probably better than i can like but the backgrounds are not the traditional oh it's them no no it's like well you can explain yeah i mean just i mean people have just done some pretty amazing thing in all of their fields i won't i won't name all of them and but each each one comes with this incredible background experience something very different so all of us coming together is some it's like um i don't know gold dust fireworks i'm terrible at analogies because of the gujarati background um but it does there's a spark and you think oh can we do that can we do this and now we've got caroline clark as our chief exec that's going to be really good fun as well as super like another super smart brilliant woman so yeah i'm very people that people that really understand consumers is what i picked up from yes that being the real difference obviously your your work on both sides of that world in health care and and the nhs side and and with neco as well and looking at from that side but so many people that have exited and sold businesses that have done that exceptionally well and bringing that element to the nhs that's i think the bit that i'm most excited about i always get excited when worlds collide therefore ideas and an acceptance of it whereas before the very traditionally kept all these things apart you would intentionally keep that yeah and when i was asked if i would apply i i was doing this job and i was like oh i'm not sure i mean i can you know i can declare and everything they were like no no bring your whole authentic self i was like well that i can do wow that's awesome um and final question then your spare time inverted commas is it with your sister it's my baby sister so she's the real superstar here she's an astrophysicist writes loads of children's books does lots of stuff about um diversity inclusion and representation in um stem and so it was more than 10 years ago now when they added the well not they an m was added to stem so instead of stem with one it was two medicine was added and kind of went oh we can do something together um so it's about creating opportunities my sister and i we didn't realize it but we grew up with nothing mum and dad dad worked all the hours mum did every like many of our families um but we had opportunities just to see that there was something possible mum always said we could do anything so we kind of went forth and we wanted to create that opportunity for others um and then we also get to have a podcast nothing like yours but we get to have a podcast together where we also do kind of smashing traditional kind of memes and tropes and stuff or whatever the word is and just talking about real life stuff so just trying to kind of to your point bring worlds together because none of us are just our work self or our home self or whatever we're all a mishmash of how we're brought up and what we bring and um i think that's what makes us the best agents for the people we're here to to look after amazing um i'm gonna steal one more question from you what is one thing that you're excited about at the moment given everything you do everything you're part of everything you're seeing what's exciting um you will probably want me or you probably think that I'm going to come up with something cool in the tech space but the problem with that is given my job um there are too many things as you say I look at our product roadmap I genuinely feel tearful because I didn't even know some of this stuff was doable or feasible let alone bringable to many to a population so that for me whenever I get anywhere near to what's coming um you think this was a you know a markup the next year the year after what that brings for people is incredible um I'm I'm look I'm also I wouldn't be I wouldn't be me if I didn't say I'm also hitting a new phase of life my first kid goes to uni in a couple of weeks so I'm I'm trying very hard not to be consumed with grief and instead be excited about what that brings next in like our family dynamic and stuff so yeah it's all change and there's plenty of time in New York the next few weeks and months as it has been I'm really looking forward to what our US teams are able to do because again that's a whole different dynamic what people want and need how clinicians are trained so it's been really fun thinking about how to bring that to life but yeah we are you know I can confidently say I'm part of a company that is doing something really meaningful and I can't wait to see what we do next.

47:26Dr James Somauroo:Amazing. If people want to learn more and they want to get in touch with you, what's the best way for them to do so? Through you? Yep, perfect. And that's what happened last time. Usually LinkedIn. LinkedIn is the best way to go. It's been a pleasure. It's been a long time coming, but glad to have you on. Loved it. Thanks, James.