Building a blood-testing startup in 2023 with Vital CEO Vasu Nadella | E1801

0:00I think going back to the beginning of your conversation, it's like, where does this converge with some of the stuff that's coming out now? Yeah. And we get really excited about that, right? If you have the ability to get diagnostics everywhere, what can you build? What do you enable? What can you build on top of that? You know, if you've got the ability to interrogate your body, measure these things all the time, more frequently, you can plug them into knowledge systems. That's a totally new way to think about, you know, care delivery that just could not have existed until both our hardware existed and some of this AI that you're talking about has existed.

0:31So you want to play in that world for sure. This Week in Startups is brought to you by Lemon.io. Need to speed up your product development without draining your budget? Hire vetted engineers from Europe at Lemon.io. Go to Lemon.io slash twist to get 15 % off for the first four weeks. Open Phone brings your team's business calls, texts, and contacts into one delightful app that works anywhere. Get 20 % off your first six months at openphone.com slash twist and LinkedIn jobs. A business is only as strong as its people and every hire matters. Post your first job for free at linkedin.com slash twist.

1:17All right, listen, Theranos was one of the biggest stories in the history of technology and startups. We had John Kerry on this very podcast, right after he broke the story. We I knew it was a scam from day one. I figured that out. And then we had him on after the book came out. Those two episodes, some of the most popular and most watched episodes of This Week in Startups. And there's a reason why this captured everybody's attention. And it was because even though like Elizabeth Holmes was this odd character, fake voice styling herself after Steve Jobs and all the lab secrecy, the fake tests, the lawsuits, the backstabbing all this craziness all the hundreds of millions of dollars invested and them going to jail for 10 years it was an incredibly powerful idea it's one of the best ideas that any of us ever heard what if you get a bunch of tests done with a small amount of blood i literally i'm doing this executive uh you know um health coaching thing right now with a startup and they drew my blood they did no less than 10 vials of my blood to do all these different tests and it's a painful experience and i'm a tough guy and i don't mind it but it is a pain in the neck and then when i my god when i have to take my wife or my kids to get blood drawn some people will skip these blood tests because they don't like having blood drawn so if you could do what elizabeth holmes brilliant idea and horrible criminal execution if you could take that idea and do it without horrible execution, I think it changes healthcare forever.

2:55And that's the big idea that today's founder, who's on the program, is going to try to do. And it's an idea that's been out there for 100 years. But I think there is a chance that he's going to succeed. Vasu Nadella is the CEO and co-founder of Vital Biosciences. Welcome to the program, Vasu. Thanks for having me on, Jason. I got it correct, right? V-A-S-U is Vasu. Yeah, perfect. Perfect. Okay, there you have it. Okay, so you heard my introduction there. And you seem like you're pretty young. You graduated from college when 2014 2012. I actually didn't finish. So I started in 2012. And I left in 2014.

3:37Okay, great. So you and Elizabeth Holmes have something in common with dropouts. I think that's the hopefully the last. We're both working in blood testing. Yeah. Yeah. Yeah. But how did you get drawn to blood testing? Yeah, you know, I think it's a space that I've spent a lot of time thinking about. And, you know, my friends will tell you this. Other investors I spend time with will tell you this, like, I've been fascinated with a bunch of companies in this space, whether they're tests for doing things like sepsis detection, at home testing for cancer patients. I've just been enamored with the idea and I think it comes from having a lot of chronic disease in the family like seeing my mom I have to spend a lot of weekends in the lab waiting for results that's sort of dread that everyone feels when they're waiting for an important lab result that takes days feeling disempowered right because you're waiting for the physician to call you and you don't hear anything just kind of assume you're okay or do you assume you got forgotten and then a lot of doctors in the family too and you kind of hear it on both sides where you know they're frustrated that patients don't get their lab tests like you said um it is just a very broken system but kind of you know we get to build in this amazing world all this new technology and i think one of the big things you wonder is everyone kind of agrees that health care sucks everyone agrees that we spend too much on administration that we burn doctors out that we treat sickness instead of avoiding sickness and that there's a ton of people that fundamentally just don't have access.

5:05And so like, why hasn't there been this sort of like software moment in healthcare, right? Why do costs keep going up? Why do you not get really kind of more efficient systems? And so my view on this has always been that you're fundamentally delimited by physical connection there, right? You have to go to the physician, you have to go somewhere, get your blood drawn, things have to get shipped across the country. And in that world, it's really hard to drive software efficiencies. So we like to think about this, you know, and we think of vital, not as a blood testing startup. We think about ourselves as a care delivery startup, and we're building devices to make care more accessible, ubiquitous, available, empowering.

5:40But if you think about all of these things that people are working on, right, they're trying to solve all those problems, whether it's going to your local CVS, going to a minute clinic, and having a really high quality primary care visit, whether it's like telehealth that can do more than just tell you if you have the flu and send a simple prescription over, or like crazy big ideas, like we're going to build AI doctors that totally replace the need to ever talk to a real doctor. All of that stuff is going to be rate limited with the current infrastructure on diagnostics. It just likely won't happen, right?

6:09If you have to go take your blood somewhere, ship it across the country, wait days, you're fundamentally not going to enable all this software and all these really great innovations to really have the impact they could have. So that's what we're tackling. We're addressing that. And I think the first instantiation of that is what you're seeing it's a vital one it's a system that lets you get all of your blood tests in 20 minutes at the doctor's office with a small volume of blood um yeah that's the quick so let's talk about the and we'll show the machine here for those of you who are watching at home will sports if you're listening will sportscast it if not just go search for this week in startups on youtube and you can find the video real quick but uh how much blood are we talking about here because obviously elizabeth holmes you know held that tiny vial and was on the cover of a magazine and it was going to be like literally a drop of blood which to me seemed laughable that you could actually use that for that many tests so how much blood are we talking about here and then how many tests she was talking about 200 tests or something crazy you just said i think 40 or 50 tests is you know what you think you can do off of uh what a vial of blood yeah so we're using two different types of blood right the total sample volume we're using about is about 600 microliters so for context one of those tubes jason that was probably drawn from you is 10 milliliters so we're using less than one tenth of that sample oh wow and we can run the full gambit and so that 600 microliters is split between two different anticoagulants for two different types of tests drops are not you know scientific uh units of measure they're not standard units right so So to contextualize, she was trying to do stuff on roughly 100 to 150 microliters.

7:46That's what she was calling a drop. So if you take that, and again, it's not a real unit of measure, but 600 microliters is about six to 10 drops, depending on what we're talking about. Imagine this. You got an idea for a tech startup. You're going to change the world. I know it. But you got a problem. You don't have any engineers. Engineers, hard to come by. They're very busy. They got jobs backed up. Well, you need to find great engineers, you need to find them quickly, and you need to reduce your burn rate, right? Because you can't be spending like a drunken sailor. You have a limited amount of resources as a startup.

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8:53They've had great experiences. So here's the call to action. Super easy. To learn more, go to Lemon.io slash twist to find your perfect developer or tech team in 48 hours or less. And twist listeners get 15 % off the first four weeks. what a deal so stop burning money hire developers smarter and visit lemon.io slash twist easy peasy lemon squeezy at lemon.io slash twist so let's take a look at this demo here you have a machine and hilariously you know they wouldn't show the edison machine to people you have a slick looking machine as well uh which makes this an incredible parallel when people come to your office is specifically investors yeah and they see that you're building blood testing and that you have a machine yeah what's the general general reaction we we love doing demos and we like love to put on a full show where we like we did demos in a hotel room a couple weeks ago we put a camera inside the machine so people have like full custody of their blood as it was going in and they knew they could watch the blood get tested uh yeah i think it's one of these things that the bar has just gotten so much higher.

10:02And so we get to put ourselves into their shoes and say, like, how do we make sure they feel really comfortable with the technology here? So we spend a lot of time before the demo walking them through how the tech works. And then we spend a bunch of time running the demo, we get their results. And often we tell them what tests we're going to run so they can go, you know, get their tests at LabCorp request before they fly over to see us. And we compare and often we're really, really close, right? Because that's the point of a system that can meet the gold standard of lab testing. all right so here's a beautiful machine with an uh led on the front uh or lcd whatever some kind of display and so um the person just picks i guess what they're ordering or picks who sample this is and drops it in and the rest is history yeah exactly so here what you're seeing i have two videos so what you're going to see here is a user walk up they're going to select the patient so bidirectional connectivity emrs is how we're designing the whole system they'll they open the drawer they drop electronic medical records uh emr right yeah yep and these tubes can be microtainers or vacutainers so microtainers are small ones if you've ever done a mail-in test those are those tubes that's how we do the smaller samples they put in what's called a disc pack and a support pack so i'll just kind of walk through what's going on in the disc pack are three microfluidic discs and in the support pack are reagents mostly about water in this case or buffer, and eight disposable tips.

11:24So each disc does a different type of test. One of the really big challenges in this space is how do you combine three very different modalities of testing, immunoassays versus hematology, for example, into a single platform. And so we've got this relatively breakthrough, you know, microfluidics platform that lets us use a disc to do these tests, and each disc is designed around that type of test. And on each disc are these freeze-dried reagents these little lio beads we like to call them like like the same technology behind dip and dots if you will and uh and that support back and i got told you there's tips and reagents so just to orient you this is inside the system the left hand side is going to be the drawer coming in and then you're going to see the disc get moved and the samples on the on the bottom left here right so what's happening inside the system to run these three very different modalities of tests in parallel is we actually have three subsystems inside and kind of like three mini dvd players each disc gets loaded while we're mixing and decapping that blood so the user never gets exposed to blood everything gets done inside the system there's no pre-elemental error from a poorly mixed sample for example we want this to be super easy to use and yeah we load up blood we load up buffer into each disc depending on the type of test it's going to be edta blood depending on other types of tests with lithium heparin blood and as we load up these discs they start spinning so you can see the bottom one spinning there at the one on the left hand side spinning as they spin right it looks like it's a uh cd player that's been opened up or if you had a glass cd player like if you're in jail they have plastic ones where you can see on the inside it looks like that yeah we want to do like a limited edition version of the system with with clear covers in case people want to watch it do stuff but i was going to show you what's going on so on these discs are these channels i know it's white on white so let me know if it's hard to see um and these channels you load up blood and buffer in the center and then you just modulate the acceleration deceleration of this disk and that's what lets you you know run with really high precision and accuracy all the fluidic kind of processes that you might expect metering diluting uh aliquoting and by the time it gets to the end it mixes with these reagents these reagent bees you can see at the end there wow and that's how we run these tests in parallel and then i assume the machine cleans itself it has some sort of way to make sure that my blood sample and the next person's do not cross contaminate each other yeah yeah so these are all disposable right and we all recycle plastic so this all comes back out in in the tray and then the user just disposes of this tray got it but you also had those i guess um you know uh eye droppers essentially yeah the tips so those are also replaced each time those are also replaced got it so and it can do that in 20 minutes the machine's going to cost 50 100 250 000 dollars what do you think it will wind up costing or do you just give them the machine and charge per test we're going to do yeah like this is a pretty standard model lab testing where people have a minimum volume that they go for and then based on that minimum volume we'll either totally discount the price of the instrument or they'll have a price based on that um this is going to be you know there's an opportunity here to be faster better cheaper right today a lot of lab testing all the demand gets originated by the physician but it's folks like lab corp request who you know tend to absorb those economics there's they're the ones running those tests are the ones that insurance companies pay once they run those tests so by bringing this to the doctor's office we actually enable physicians to run these procedures and bill for them and that's a huge unlock for them because they can now bill for this stuff or absorb those costs if they're in some sort of value-based care arrangement where they're covering the cost of a lab test so it's designed to be in a doctor's office, not in a phlebotomist, I guess is the term, or a lab corp office or something like that.

15:09Yeah, we're designing this to sit in every doctor's office, but also what we call all these alternative sites of care. So today, skilled nursing facilities are another good example where there's a lot of blood draws, but they don't have a lab on site to send it out. It's a really painful process in an environment that could really use some of these diagnostics, would enable kind of new applications, telehealth and stuff like that. Pharmacies are another good example. 20 minutes though to get your results or as opposed to what's typically multiple days. And so when we look at this, what have you figured out here in terms of testing blood quickly that LabCorp, which is an investor in your company, I understand?

15:48Yeah, LabCorp's an investor. And maybe Elizabeth Holmes and Sonny Balwani didn't figure out. But what have you figured out here? There's a bunch of things. I think there's very specific things that we've figured out from a technology perspective. And then there's some meta lessons that I think have led to success so far. The specific set of bets that we made are really based around our deep intentionality, but where we place complexity in the system. So a lot of people who attempted stuff, Theranos included, but as you study Theranos, you realize there's actually a half dozen other dead bodies in the space or zombie companies that have raised$100,$200 million as well.

16:26and what a lot of these guys got wrong was they really counted they placed complexity in the wrong part of the stack so a good example of this is if you rely on an electromechanical component like a pipetting head or a gantry to do everything to drive all the accuracy and precision that you need to run these tests over time they'll fail and actually over time it's really hard to integrate new tests because you're relying on this system that's actually relatively brittle and so what we did differently was place all that complexity to drive accuracy and precision into a microfluidic platform. This is disposed of every single time.

17:00So as long as we know how to make this stuff, which, you know, thanks to the many, many DVDs that have been made, you have a whole supply chain here, a lot of know-how on how to mold thin plastic discs. We can leverage that learning and make something that's easily disposed and is going to perform the same way every single time, as opposed to something that will drift over the years that you're using it, for example. So that's just one example. I think the meta lessons that we took away from this was just being hyper paranoid at the outset of where the complexity that you're, you know, the decisions you're making about the architecture of the system lead to from a durability perspective, reliability perspective, and accuracy perspective.

17:40There's like a set of lessons there. And then the other is really thinking about building in platforms. I think people in software do this all the time, like this notion of microservices and really thinking about how to platformize your technology. We did that with our tech as well, where we thought about how do you make the incremental test much easier than the first test that you built? And you don't get a lot of credit from investors for this, right? But I actually think it's the right way to build some of these harder companies. You need the N plus one to challenge to be easier. and so we spent a lot of time building platform approaches where for example we have a lot of ip around our immunoassay that lets us take off-the-shelf antibodies get them to perform a lot better than their advertised kinetics because we have a way to take them and get them to fit into our paradigm of a microfluidic a bull assay that sits on a disc that can run in 20 minutes a small sample and so when we need to build another test we can go a lot faster than a traditional company does because we've got this approach this sort of uh computational methods around it design of experiments around it that let us put that onto our system a lot faster so going slower making sure you got a strong foundation that the accuracy is there and that you know scaling will happen if you have the the right platform built which is the reason probably you raised a war chest of 48 million bucks um was that one round out of the gate you raised that or Or is that in total for the company?

19:05No, that's in total. So that's over several rounds. You know, I think the simplest way to put this is like, you have to sharpen your axe before you start chopping down trees. And you will never converge on a timescale that makes sense for venture cost of capital. If every new asset in our case or any new thing in any kind of deep tech company is a totally new challenge. Like you just never really scale fast enough. well and that is i guess you started um in 2019 2020 sometimes so you've been at it for three or four years yeah just over four years old but the product's not in market yet so you had to have very patient investors and then hit some sort of milestones that you explained to them made you worthy of future investment correct yeah i think you have to like any company like this you have to break this down into like you know here are the incremental steps that de-risk the company over time.

19:55In the beginning, a lot of them are technical, right? Like, can we do this many tests at once? So the first demo of the system that you saw was actually like using another company's pipetting robot and our subsystems inside it. And then it turned, or actually even before that, it was my co-founder pretending to be the robot, right? And just showing that you could run these things in parallel. And so you have to kind of set these markers yourself, convince investors that they're meaningful, convince investors that you paid down a lot of risk as a result of being able to do those things. And then, yeah, go raise to hit that next milestone.

20:27So we're finally at the stage now where I think we're going to raise another round of capital soon. And that's really going to orient us to fund all the way through to commercial through the FDA. So we'll pay down the regulatory risk and get into some of that early commercial risk. And you want to have this in market or in testing in 2024, correct? Yeah, we'll be in clinical studies towards like the back half of 2024 and then in market in 2025 amazing uh and then uh how long does the fda take to clear this and does the history of what happened with theranos impact you in other words in your discussions with them are they like yeah that was like a very unique one-off and we understand like you're not that and they're kind of rooting for you or is it just like they're like Like we can't, in fairness, I guess they did do their job.

21:18They're the heroes of the Theranos story. So I guess they're just telling you like, hey, we got a process, follow the process and everything's good. What's the interaction like there post Theranos? All of our interactions at the FDA have actually been super positive. They've brought kind of more people than they needed to. They've spent a lot more time helping us understand what they'd want to see. What's awesome is when you want to follow the rules, the rules are actually really, really kind of obvious and they're available for you to look at. So you can look at guidelines, you can look at, in our case, predicate instruments and see how they proved to the FDA they were meeting this performance bar and basically tell the FDA, hey, I'm going to do the same thing that this other company did.

21:55Are you good with that? Are there any new risks that you're seeing as a result of our use case or our instrument? Here's what we're seeing. Here's what we'll test. So we're doing all that work now. We're talking to the FDA, getting a ton of clarity there. but 80 to 90 percent of it you can do before you talk to the fda just by looking at you know how they approved or sorry cleared other devices yeah i mean it it's interesting in our industry where people want to ask for you know uh beg for forgiveness instead of asking for permission this is fine if you're doing sass software it's totally fine if you'd like to make you know an electric go-kart that you're the only person driving but at a certain point when the public touches things the playbooks are there so if you're making nfts or some cryptocurrency for you and your friends that's fine if you want to sell 100 million of it you probably want to look at the sec's rules security yeah yeah just maybe if they expected it to go up in value yada yada how we test here and it's i think for certain people who are entrepreneurs i think they have taken the approach of well airbnb broke the rules or this company broke the rules or uber broke the rules whoever doordash put in and out burger on the thing putting in and out burger on a doordash or you know a postmates app without their permission going there and picking up and delivering it that's i could send my assistant to go pick up in and out burgers for everybody it is no harm no foul yeah blood test cryptocurrency people's savings, you know what you're doing is wrong, you know, in those cases, if you're bending the rules, huh?

23:32I totally agree. I think, you know, there's never a perfect system. Like in our space, you could argue that there could have been a lot more innovation if this was an easier process or the bar was lower. But you're totally right. You're talking about people's health, people's, you know, well-being, and that bar should be, you know, at the right level to make sure everyone's safe. I think we've always invited that bar. And, you know, what's awesome is the FDA at positive reaction, they want to help us through this. And we've been having more conversations with them as we make more progress and want to show them more stuff.

24:04So yeah, it's been good so far. I mean, the thing that I took from our first part of our conversation here is that you said you told people to get their blood test done before going to yours and then comparing the results. yeah and you know there's a famous individual jean-louis gassier um and he worked for um steve jobs he ran apple in france i believe yeah i read his blog yeah it's cool he read his blog post right and there was this famous uh there are no trouble a first person account um where he and his monday note essentially um said you know i he started emailing elizabeth and other people who he knew with our notes and their investors like hey i got a test at stanford i'm an old dude who you know like my blood tests matter and um yeah what did he test again it was hematocrit and platelets i think yeah i can't remember and yeah and it was just completely off yeah so platelets is one that's notorious for the difference between capillary uh which is from a finger stick or you know from a shoulder versus venus platelets is notorious for for dropping because your blood you know tends to not want to leave your body and so you you clod and you coagulate and your platelets drop as a result of that um so yeah it makes sense that the the method that they had didn't work uh platelets at all um hematocrit you know that one typically isn't as off but and it doesn't look like it was that bad there wasn't really platelets was a really bad one yeah and so how How do you look at your benchmarking now?

25:36And is it true that all lab tests have significant variability or non, you know, or significant or maybe even more than significant variability? And should we all be getting our blood tested from two different labs and comparing them? No, that's that's probably overkill. That's overkill. Okay. The thing is that every single test has a different kind of bar, right? So some tests have very, very tight ranges and being outside of that range can mean life or death. Other tests have very wide ranges. And so between all this, like the clinical chemistry community and a whole bunch of other groups have come out with what are guidelines.

26:15And so CLIA is one of the big groups that governs this stuff, governs labs, and they have their own guidelines for the total allowable error that you should be getting on an instrument. We can use those guidelines and be like, cool, we're going to hit that bar. It's the highest bar that's out there. and so all of our tests are designed to fall within our the total allowable error based on a lot of these guidelines where those guidelines don't exist for a handful of tests they haven't developed them yet you go and look at predicate instruments and typically those predicate instruments are developed around some philosophy like you're going to use this test to diagnose x or prevent y and therefore they'll come up with that and defend that to the fda and that sort of becomes the gold standard and you fit into that paradigm so you have two paths right and these things converge really quickly.

26:58Like, you know, what, what isn't a guideline eventually becomes a guideline and it's pretty standard. What we've, what we've done, I think that no one else has really done in this space is just put our data up on our website. So you can go look at it, vitalbio.com slash data. We asked for emails, we can bug you later if you're a potential customer that we can get feedback from. But other than that, it's all we asked for. And we want you to see our data. We want you to see where we're not performing yet. And so on some tests that we're going to tighten up over the next couple weeks and we'll update our data set as a result of that.

27:27And all that data is coming off of real samples comparing to gold standard lab instruments that are out there, typically a Roche instrument or a Sysmex instrument. Are you still using your personal phone number for your startup? It's 2023. It's time to stop. It is a huge mistake that founders make. Why? You're just getting started with your company and you don't think about phone numbers as being an important part of the IP collection of your startup. With OpenPhone, you can totally solve this problem. They've rethought everything about a modern business phone and how it should work. It's super easy.

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28:32So we get one phone number, but it can go to multiple people like a round robin thing, we have a shared phone number, do that for customer support. And open phone is rated number one on G2 for customer satisfaction. And I trust G2's ratings, open phone, it's ready, it's affordable starts at just 13 bucks a month but twist listeners can get 20 off any plan for the first six months at openphone.com twist and if you have existing numbers with another service no problem easy peasy lemon squeezy open phone will port them over at no cost head to openphone.com twist to start your free trial and get 20 off let me ask a somewhat stupid question that you would know the answer to which is wrote we see robotics in the world you know people building cars and factories or we have an investment in cafe x you know moving coffee cups around to make perfect you know boba and coffees and you know foam and ice and it's just incredible to watch um but it's been advancing lab robot laboratory robots is a distinct subset of robotics and you were saying hey you did an interesting thing where you had your co-founder doing it manually with the understanding hey robots are going to do this what is the state of robotics in these laboratories is it it seems like that's such a constrained narrow use of robotics has it essentially been perfected and reliable and you can very quickly and easily program a robot to do what is necessary or is there still a lot of iteration that still needs to occur in laboratory robotics i think it's massively sophisticated like if you go to some of these trade shows a lot of the vendors that are our robotics or automation companies like really big companies you may have heard of like festo or tecan or hamilton they sell a lot right and there's startups too like opentrons that did really well through covid scaling their robotic lines um i think it's i think like almost every major lab right in north america has probably some of the most sophisticated robotics you've seen and they've vertically integrated a lot of ways too like the company that sells you the machine also you know typically now offers an automation solution it's a good it's a good uh marker for what's different than you know 10 years ago or 20 years ago that makes a lot of this stuff possible like you can go on amazon today and for a hundred dollars buy a relatively sophisticated 3d printer that's got pretty good precision right and yeah because of things like that you can now have instruments that you know sit on your counter and also do blood tests using the same similar type of supply chain so it's a lot of a lot of So those little gears that move the, what I call the eyedropper around, that is a descendant of all of those 3D printer hackers, you know, making little ornaments or trinkets in their 3D printers over the holidays.

31:15If you look at our platform, we are taking advantage of supply chain and know-how from the billions of DVDs and Blu-rays that were made, from advancements in gantries, from advancements in cell phone technology. The image sensor that we use is a cell phone image sensor, cell phone lens. You bring the cost down, you can bring the size down. You get a lot of this stuff more off the shelf. and then on the other side like maybe less you know obvious to consumers but like nanoparticle technology quantum dot technology a lot of that stuff is cheaper too and that's how you can make these assays more sensitive and more sophisticated uh in a format that fits under microphoetic than you could have before so we have i think a lot of this stuff is now just just now possible it is really interesting what happened because of the video game you know uh gpus and cell phone technology i mean cell phone technology is now impacting desktop computer technology it's the the convergence is incredible but the cameras on your phone are more sophisticated than your desktop camera so now like laptops and desktops are kind of borrowing from those uh advances yeah it hasn't come up yet in our discussion because what you're doing is trying to be incredibly precise you're not asking some ai to figure things out for you is there some ai angle here that will eventually emerge or is what you're doing just incredibly finite and precise that you don't want ai getting in there and guessing and making its best guess as it were as impressive as the guesses can be in ai Yeah, look, a lot of the DNA of the team comes from AI and optics and machine learning.

32:58So we are not afraid of that stuff. We use a lot of those techniques on the kind of the design side of things to speed up progress. But as far as the instrument goes, there's a ton of computer vision. We aren't using, you know, what you may see in like a Tesla for self-driving where it's learning all the time. Those things tend to be tougher with the FDA, right? You want to understand how those algorithms work. Most of the time, we can't explain how like a really large LLM works yet. like it's like cutting edge stuff to be able to explain that stuff so we want i mean that's i mean say more about that like you you have these you know tensors set up and it's meeting its best guess and then you ask sam or you know greg or whoever like hey how does this actually work and it's like yeah well we trained it and then stuff comes out and okay but how does it work and he's like yeah yeah it's a borderline philosophy at this point like it is it is a very very hard problem yeah explainability i think is a massive problem in ai the fda actually has like a ton of guidance around systems that are built around this type of thing in particular on the ai side we have enough with the fda to deal with and we have a pretty clear path with the standard of vitro diagnostic pathway so we're staying out of that lane we don't need it you know we can do the old school computer vision stuff and get really far with it and we can explain it and understand it and tune it in ways that um we fully get that being said i think going back to the beginning of our conversation it's like where does this you know converge with some of the stuff that's coming out now.

34:20Yeah. And we get really excited about that, right? If you have the ability to get diagnostics everywhere, what can you build? What do you enable? What can you build on top of that? You know, if you've got the ability to interrogate your body, measure these things all the time, more frequently, and you can plug them into knowledge systems, that's a totally new way to think about, you know, care delivery that just could not have existed until both our hardware existed and some of this AI that you're talking about has existed. So we want to play in that world for sure. i was just reading um somebody had taken one of these you know mri type scans pre-novo whatever and they had like a nodule or something on their thyroid something like you know not super concerning but then this person was going back every year and then they had like three years and the nodule had grown a little bit and the person went to stanford or harvard or whatever and said hey how many people do you know who are in like the first two years of a nodule growing and cancer on a thyroid and they're like well we don't have any patients like that we have no data and he's like um i'll be your first yeah and now like it's you think about how uh reactive medicine is and health care as opposed to you know maybe thinking about these things in real time we're we're recording our sleep and our heart rate but man we could be actually knowing what's happening in the body in real time or close to real time and listen yearly scans is real time as far as the answer goes forget about if this became a daily thing where your body was on the daily basis giving blood and or weekly i mean it seems like science fiction but a weekly blood draw and understanding the changes in it could revolutionize medicine it's a space we're excited to work in i think you know the current state of lab testing is like living in a world where you take like a picture with your phone and then you have to wait a week to see what the picture was like that's kind of the world that you live in today right and today we can order a pizza and it's like here in 15 to 20 minutes like why is lab testing not like that so we're totally excited about that i think a lot of what we have built and designed with the vital one is to enable a platform that can one day go in the home so a lot of the ip that we have is how do you use cell phone technologies and really cheap technologies that have kind of scaled with the economies of uh you know those types of supply chains um they're like at the limit i think of vital as this company that is really trying to build something like a systems biologist for everyone like can we give you the ability to measure and understand yourself and then plug that into these systems that keep you healthy right rather than treat sickness to your point of like oh you know you kind of wait until this is either a tumor or it's not that we're worried about it or not how do you get to a place where there's a system kind of monitoring you keep you healthy and like less so even for us like that's what we want for our loved ones like that's the anxiety that we have incredible parents or grandparents well and imagine when these systems start converging and that's the thing i you know i i am in a very very privileged position to have incredible founders like yourself on this program and you know you look at prenovo and they're over here you know making the skins and then what you're doing and there are people who are making models of the heart and people who are doing stuff with the brain and then there's the quantified self you know there's whoop and apple watches and sleep and eight sleep and then there's nutrition and there's gut biome and nobody's taking all of this into a manhattan project like project where if we had but a thousand you know people commit to doing whatever quarterly monthly blood tests pre-novo scans and we said hey let's hire and this would be something that a university could do they said hey you know what let's put a team on this to take the pre-novo scan to take your blood test to to take all these other quantified self things uh put it together right and then let's see where the the path with these uh what do they call the long studies that people do longitudinal yeah longitudinal studies and say let's do one of these but with these new tools and the new the tools are sitting there.

38:25They're waiting for somebody to, you know, know everybody's glucose level combined with, you know, other, you know, real time glucose and everything. And we might figure some things out and that's where AI could come in and start looking at the results and saying, Hey, you know, a heart rate variability, you know, there's just so many different concepts here. And yeah, this is one of the things I was excited about. Like I thought Verily was working on something like this. I think maybe they shut it down or they were, they were doing something in this vein, you know, combine that with, you know, full genome sequencing, all the other stuff happening in that world.

38:57Yeah, no, totally. I hope someone works on that. I think we're going to try to do our best from our angle on the diagnostic side. But the end state vision we want to build is what you're describing, like this systems biologist that's keeping you healthy, right? And to do that, you have to learn from a bunch of data that today does not exist. Creating a job and finding qualified candidates, it's so time consuming. Don't I know it? I'm trying to add five positions right now because things are going so well at the launch fund. But you know what, I have a secret weapon. And I'm going to share it with you Lincoln jobs.

39:30They're about to hit a billion users over at LinkedIn. So just think about all the insanely qualified people that are there looking for work. You just go post your role on LinkedIn, and you will be 100 % certain that you got access to the most qualified candidates. And guess what? First one's on us. That's right. First drinks on us. go to linkedin.com slash twist and post your first job for free. You got nothing to lose. And that will give you that purple ring on your profile. You see that everybody's got the purple ring now. That means everybody in your network knows you're hiring, they click on it, and you'll get those friends of friends, right?

40:05Those are the really high quality leads that you want applying to your job because there's someone in your network who can vet them. So I did that for launch. And I do it for inside. And we found so many amazing people at our company. When you think LinkedIn jobs, I want you to think better candidates faster. Let me say that one more time, better candidates faster. LinkedIn jobs will help you find the qualified candidates you want to talk to faster, post your job for free at linkedin.com slash twist. That's linkedin.com slash twist to post your job for free terms and conditions to apply. Notice like is like you have all these mutants with this like superpowers around the world.

40:40And there's no Professor X saying like, hey, let's get all the mutants together and put them on the same team yeah and let's see what these crazy mutants you know yeah can they save the world right and where's the avengers or x-men of the space they're all fighting different battles alone and what the justice league taught us or the x-men taught us is when you work together as a team you might be able to go further and that's really like somebody out there who's listening to this has got you know an extra couple of billion dollars laying around and um you know there's a few people going after that one No, I think it's going to happen.

41:13But look, I don't think the hardware is there yet. Like, you know, to your point, Renuvo is still like a$2 ,000 thing. We're working on a lab testing side. This stuff has to come down the cost curve in order to enable that future. It's another one of those ideas. I think you said this at the beginning of our call, right? It's another kind of extremely obvious thing that's just super hard, but hopefully it gets easier with stuff like this. Yeah, I feel like we're at a certain tipping point here with what happened with the cell phone revolution, what happened with accumulating the world's data online and the sensors robotics ai all of this is in like a crescendo and you know there's somebody who needs to be the conductor of this you know and there's no conductor but it is a crescendo and all of this music is coming together and you know what happens in the next decade i think is going to be truly truly uh mind-blowing because i don't think people understand the how quickly stuff is compounding right and you get to see it yeah and when you see it up close and personal i think it's something that um tim urban talks about a lot is you know exponential is just super hard for humans to comprehend exponential change yeah i think the only people who really know what this is like are the super wealthy that have really really like high-end concierge doctors who do get this type of care right they're being constantly monitored they get every single test under the sun and you know they tend to be healthier and they tend to live longer as a result of that um it's interesting i literally am now moving into this myself and i am working with a company called found uh dot bio if you know them and uh this is like a world-class theme of performance and longevity folks and i literally just did my onboarding today i did my blood tests last week and i am in the process of just saying you know what i i like to drive a model y you know some people like to drive the model x is a fifty thousand dollar car versus a hundred fifty thousand dollar car right if you get it loaded yeah i i don't mind flying coach uh you know for certain flights i'd rather put my money into like maybe making myself optimally perform and i this like found out bio is not cheap but it's also not absurdly expensive a cold plunge infrared sauna nutritionist you know it sounds crazy to invest 25 000 a year i understand if you were a firefighter or a teacher to spend 25 000 on your health sounds crazy but like we're talking about this stuff the people who do spend the 25k or 50k on their healthy year and i know people spending 250 you know peter atia is not cheap my understanding is that's like a quarter million dollars a year or a half million dollars a year to be his patient that's what i heard um that's coming down the price curve and with services like found up io pro novo all this stuff i think it's eventually going to be 2500 a year yeah and that's really accessible super accessible is going to be the key and then hopefully the lessons um you know are open sourced right like you you're a founder you listen to this week in startups when you're in high school you told me before this made me feel old but yeah that was 10 years ago i guess uh a little bit more than 10 but yeah yeah 12 because i've been doing it for 13 or 14 so you must have been listening in the first year or two of the pod yeah yeah um but founder advice used to be this like hidden resource and then this week in startups y combinator you know fred wilson bill girley blogging now it's become like oh yeah the playbooks are out there there's a lot of knowledge i think that's going to happen in healthcare you know like the knowledge is going to be released into the wild and people will be able to optimize even and take control of your healthcare right like there's a there's a massive like category to your point about how this wasn't even a thing right like startup podcast startup advice like there's a whole category i think in consumer electronics and broadly like even healthcare that has not been built yet like per nuvo vital where i think we're all like the kind of first first movers in this but there i think this stuff will look very very different the way you know 2008 didn't you know felt very different uh it does today and everything it looks looks and feels so much more different than it did even you know 15 years ago yeah i think it's gonna be the same thing 15 years from from today right in healthcare consumer healthcare and then broadly consumer-driven healthcare consumers need to take control of this huh that's you think that's a key piece to it if consumers are in control of their spend and if they have options to buy stuff and maybe route around their doctor make some decisions for themselves because the doctor patient relationship seems like so broken to me like i go when something's hurting as opposed to i'm doing research online and i i would love to just have a service where i could pay by the minute to just talk to three doctors simultaneously ask three of them the same question specialist and yeah yes but like i could just say hey i'm thinking about doing this tart cherry juice i've been looking at tart jerry juice and you know it's supposed to be great for there's all these studies on tart cherry juice i'll just leave it at that you can do your own research i mean and then there's people who make it who make it like cold pressed and then it's like incredibly good for inflammation antioxidants all this stuff so i'm down the rabbit hole on this i'd like to talk to three people about that how do we talk to them how do i pay somebody 100 bucks to have a conversation for 20 minutes about tart cherry juice i don't It doesn't exist except for podcasts, Tim Ferriss or Huberman or whoever, Joe Rogan.