How to Improve Your Brain Health and Manage Dementia Risk with an App and Digital Biomarkers: Rene Gilvert, OptiChroniX

Rene Gilvert, OptiChroniX: 0:00

40% of Alzheimer's or dementia cases are preventable. How do we do that? We do that through addressing modifiable risk factors, so we give you an insight about your future risk for dementia.

Alex X-Health.show: 0:16

Hi, I'm Alex and welcome to the X-Health.show where I talk to visionaries behind the latest innovations in healthcare. For the eXtra health of the future. We're in Schönenbuch, on the outskirts of Basel, Switzerland, with a view to France on one side and Germany's Black Forest on the other. My guest is Rene Gilbert, the founder of OptiChroniX. He jumped into the startup world after 25 years in pharma, including GSK, Organon, Novartis and Takeda, with experience in digital medicine in neuropsychiatric disorders. He winds down when mixing trance rhythms. OptiChroniX is a scale-up and has already launched myAVOS app in the US. The app brings your wearables together and encourages lifestyle optimization to minimise late life dementia and cardiovascular risk. You'll hear about healthy brain ageing, digital therapeutics, digital biomarkers, strategic partnerships, and more. You may hear the 19th century village church bells in the background. Rene, why should we measure cognitive well-being and routinely so. And actually who should do it?

Rene Gilvert, OptiChroniX: 1:24

So two questions one. Well, first of all, early detection is good to find out if there is an issue. And we started with patients – get them to care faster. Or when you're already diagnosed, see if you can can delay the disease or let's say slow the disease.

Alex X-Health.show: 1:44

What disease are we speaking about?

Rene Gilvert, OptiChroniX: 1:45

We're talking about Alzheimer's disease or dementia. But then we started speaking with people. So we went to Alzheimer Europe, it's a Pan-European patient organisation. And we got into conversation with caregivers. And when they said, you know, it's good that you measure – so there's a speaking about who, but why are you not measuring us? Our parents already have the disease, we are a group that do not want to get the disease. So if lifestyle interventions, it's part of myAVOS, is going to be helpful, measure us. So that's one. So we do that for multiple things, right? It gives you not only a signal of how is my brain, my cognitive health status, for both cohorts, it allows you to make informed health decisions, do I go to the doctor or not? Can I do something else or not? So you get a good insight about yourself

Alex X-Health.show: 2:34

People at what age are we speaking?

Rene Gilvert, OptiChroniX: 2:36

I think mid-40s onwards.

Alex X-Health.show: 2:38

Mid-40s. You mentioned on your website, but it's like, common belief now, that the 70s are now the past 40s. So we are, somehow, ageing, what? Not that fast? Differently?

Rene Gilvert, OptiChroniX: 2:55

I'm not sure if we're biologically or not ageing differently, but definitely mentally. I think the 70s... If I look at my dad, he's 78, you would probably say he does not compare to our grandparents, right? If I look back at my grandparents when they were 60, they were really old, but also in habit of.

Alex X-Health.show: 3:17

And now, the underlying assumption, as far as I understand behind OptiChroniX, is that dementia is not inevitable, well at least not genetic one, right?

Rene Gilvert, OptiChroniX: 3:32

So there, there are modifiable risk factors and non-modifiable risk factors. I cannot say that it is uninevitable right now, that it is avoidable, that's a claim no one can make. But if you look at The Lancet paper, which was a very well established academic study, what you see is that 40% of Alzheimer's or dementia cases are preventable. How do we do that? We do that through addressing modifiable risk factors.

Alex X-Health.show: 4:01

Okay, 40% is quite quite a lot.

Rene Gilvert, OptiChroniX: 4:03

Exactly. And I think if you look at the healthcare system, and this is where digital solutions are coming into place, the amount of dementia cases is going to triple over the next two decades. So we have 55 million people on the globe today, times three in the next 20 years.

Alex X-Health.show: 4:23

Why is that? Do you know?

Rene Gilvert, OptiChroniX: 4:25

We are ageing. We have an ageing population. And I think that's probably one of the biggest drivers. We're eating... our lifestyle habits are not necessarily as healthy as it was 40 years ago. Look at activity – we sit on our butt the whole day. So that is all that is I think all amounting to an increased prevalence.

Alex X-Health.show: 4:50

You just mentioned the few factors now like what can we address to and what myAVOS is addressing.

Rene Gilvert, OptiChroniX: 4:59

We are addressing the modifiable factors. So you talk about the lifestyle issues like activity, sleep, mental health, mainly stress, nutrition. The modifiable risk factors.

Alex X-Health.show: 5:16

So how does it work? The app?

Rene Gilvert, OptiChroniX: 5:20

You've seen it right?

Alex X-Health.show: 5:21

Yeah, I tried it, I just let you explain the outline.

Rene Gilvert, OptiChroniX: 5:26

In a nutshell, we try to profile you, to profile your lifestyle. So wearables are important, because I need to know, are you moving or you're not moving. So there are the activity trackers, Fitbit or Garmin. But it goes way further. You see on the table here, and your listeners will not see what, we have a wireless device.

Alex X-Health.show: 5:47

What is it that you're holding?

Rene Gilvert, OptiChroniX: 5:50

This is a Withings blood pressure monitor.

Alex X-Health.show: 5:54

With a cuff.

Rene Gilvert, OptiChroniX: 5:55

This is with a cuff, and I'm just hoping that there will be other technology that you'd need to do far less, as passive as possible. So I'm looking forward to an iWatch, or a Samsung watch that basically can say, hey, this is your blood pressure. And we're not there yet. But yeah, so wearables are giving me insights in your lifestyle, into your vitals, on how do you live your daily life. So that's what we profile. And then we calculate. One of the things we calculate is your daily healthy habit number. And we give you suggestions on, hey, this was your day yesterday, you can do this and this, and today make it a better day. That's one of the elements. The other element is all that data allows us to risk profile you. So we give you an insight about your future risk for dementia.

Alex X-Health.show: 6:52

And also cardiovascular disease.

Rene Gilvert, OptiChroniX: 6:55

And also cardiovascular disease.

Alex X-Health.show: 6:59

I mentioned, I tried the app and I did two tests. One was for the cardiovascular disease – clean, all green.

Rene Gilvert, OptiChroniX: 7:07

All Green?

Alex X-Health.show: 7:08

Yeah. And then I did this brain test. And I was actually kind of shocked. I mean, I knew it wasn't the best day, right? Because I had a couple of sleepless nights and I was just after the training, after lunch when I did the test. And the brain function was in red. And I was like, whew, okay! I knew it's bad but I mean... And then the fun part started because the app started sending me tests. It is kind of obvious, when you think about it, the thing that was missing was memory. When you don't sleep well, it affects your memory. So the tests were something like... I have one right now – five words. Five totally random words and you're supposed to memorise

them. So as an example, it was: 8:06

ant, nurse, spider, afternoon, ocean. And then it gives you, like... how much time? I didn't count it, something like 30 seconds?

Rene Gilvert, OptiChroniX: 8:20

Maybe it starts with a minute, but it will go down. So if you're good at it, it will add words to the list. So if you do three good, I think you get a fourth word, a bit more time, okay, until you're done for today. Because the idea is that we use a digital biomarker to measure your cognition. And it gives you an insight into six different domains. And where you have your deficit, you will get a specific game to play for the next 30 days. And we measure it again, hopefully everything stays the same or improves.

Alex X-Health.show: 8:56

What are the areas?

Rene Gilvert, OptiChroniX: 8:57

The six domains measured is memory, comprehension – how do you understand things, reasoning, processing speed, executive functioning, and attention and perception. So if you have a deficit, you get a different game,

Alex X-Health.show: 9:10

You mentioned here digital biomarkers. Could you say a bit more about that? What's that? How does it measure the cognitive well being?

Rene Gilvert, OptiChroniX: 9:20

So digital biomarkers is a very broad term. In essence, the steps that you measure through an app or a watch is a biomarker. It's a digital biomarker, but where we say digital biomarkers, I guess, in digital health is can we get some more meaningfulness out of more unorthodox way. So if you talk about cognition, how do you measure cognition? We are collaborating with a Canadian company called Winterlight Labs. They'll show you a picture, and you'll describe the picture – you get 10 minutes. I think on average people don't need 10 minutes.

Alex X-Health.show: 9:56

I was done actually in a couple of minutes but then I felt, well, it's 10 minutes, should I say more? And then I was trying to make it up to three minutes. Maybe also it was why the memory thing came up, because I started repeating stuff that I already said before.

Rene Gilvert, OptiChroniX: 10:16

No, that should, in essence, not affect your score, or let's say the measurement.

Alex X-Health.show: 10:20

I tried to explain myself here.

Rene Gilvert, OptiChroniX: 10:22

Yeah, no, don't. And I think you're, okay. You need to have one thing in mind, the app is made for the US at the moment. And when we speak about speech analysis and how people have their syntax and grammar, that is all taken into the equation. So there is validated language that might be more appropriate for you. Maybe you're a German speaker, or maybe a French speaker, I'm Dutch, right. And I have always issues on my reading. Because we are not native English speakers. So that's the only caveat, I think we need to be aware of that we need to have the application made for specific language groups.

Alex X-Health.show: 11:05

You mentioned that collaboration. So what is it based on – the speech analysing tool? Or how would you call that?

Rene Gilvert, OptiChroniX: 11:15

I would call this is our digital biomarker to measure cognition. They use speech analysis as their base, there is an AI engine that is proprietary to them. And we have said from the beginning, if we want to make an impact on those preventable disease cases, we probably cannot do this alone. Not a single company can do this alone. And when you look now, at the complexity of myAVOS, measuring is one element of it but then getting into profiling and getting into meaningful coaching. Are you willing to change your lifestyle? Yes or no? How do we do that? So we have a cohort of what I call strategic partners that we need to make the impact of the app become real.

Alex X-Health.show: 11:58

Who are the partners?

Rene Gilvert, OptiChroniX: 11:59

Who are the partners? Winterlight Labs we've just discussed. They provide the cognitive assessment for us. FatSecret is an Australian company, they provide all the answers about nutricion. So when you lock potatoes, we know exactly how many calories, what is in a potato and everything.

Alex X-Health.show: 12:20

I tried that, actually and I learned I can't really go up to my daily calories basis. I never counted calories, right, so here I learned that, actually, I'm not providing myself with the sufficient amount of calories. I'm always below. Which is also information, right?

Rene Gilvert, OptiChroniX: 12:44

And there you can change. You become aware and you take action. And then the third one, even more important one. So these two companies they measure, right, and we use their technology. The third one is the behavioural science aspect of it, how do people coach and there's a company in the UK, it's called Sprout Behavioural Change and that's a team of health psychologists that are working with us to create meaningful conversations when the system detects that your habits are not that healthy and how can we get you back on track.

Alex X-Health.show: 13:18

What kind of habits are we speaking about?

Rene Gilvert, OptiChroniX: 13:21

Are you moving enough? On a daily basis? Is your diet Okay? On a daily basis? If you're on meds, do you take your meds? Medication adherence. If the system detects that you are stressed, how do we distress you? What are the elements that we can guide you to some meaningful interventions or... intervention is probably a very strong word, but meaningful exercises that give you a bit of relief. So when the system detects, it might tell you, hey, mindfulness might be helpful, are you willing to do that now or should we schedule later? So that's what they design.

Alex X-Health.show: 13:59

I can imagine you use that on a daily basis. But there are three options, so you use it as an enthusiast, right, or a quantified-self person, or a caregiver, or a healthcare provider, right?

Rene Gilvert, OptiChroniX: 14:19

Not the provider. So the three

categories are: 14:21

you're a patient, you came from the doctor and now you have a diagnosis of some sort and you might want to alleviate the cause of the disease or help you doing things that are good for your health anyway. Then you have often the associated carer, especially when you talk about progressive diseases, like Alzheimer's, they often have a caregiver, often their spouse, when you look at the larger family, and despite that, I'm a guy, often it's the daughter. So when you talk about their siblings or their kids, what do we see happening in culture is often we are remote caregivers. And my dad, if he would be a patient, he would be living 500 kilometres away, I'm here, I might be incentivized, I want to know more about how he's doing, how he's coping with a disease – he's not. But that's the other group of people. And then the healthy ageing enthusiasts. That couldn't be you, could be me.

Alex X-Health.show: 15:22

Okay, so your father could have an Apple Watch, for example. And then you have an app. Or he could have his app and you could also share what he's getting with him? And you could also have on the same app your own data?

Rene Gilvert, OptiChroniX: 15:38

Yeah.

Alex X-Health.show: 15:39

Oh, lovely.

Rene Gilvert, OptiChroniX: 15:39

That's how it is. iterally, if you go to the dashboard, I can flip a switch and see, hey, how is my dad doing? Is he on track with his therapy medication? Is he moving enough? Or not? Is he sleeping enough or not? So I might be just giving enough input to say and pick up the phone and say, hey, dad, how are you doing? How are you really doing? Because I see some things, right.

Alex X-Health.show: 16:05

So what are the wearables now that are compatible with myAVOS?

Rene Gilvert, OptiChroniX: 16:10

So if you're on an iPhone, a smartwatch is immediately... you don't need to do anything. So the iOS platform is very simple. The other ones – we try to be agnostic – Garmin, big activity brand, Withings, kind of health trackers, blood pressure monitors, weight scales, and Fitbit.

Alex X-Health.show: 16:34

Is that the closed list?

Rene Gilvert, OptiChroniX: 16:36

It's a closed list for now. But we have policy of trying to embed more and more of these trackers into the system. If you're an Android, Samsung would be a native one also.

Alex X-Health.show: 16:47

So now the app is available in the US only right? Do you, or when, because I can imagine the question is rather when do you want to be available in other parts of the

Rene Gilvert, OptiChroniX: 17:13

It's a complex story. We were part of world? an accelerator with Biogen and EIT Health last year. And all our mission is this needs to be a digital therapeutic, which currently is not, because that will be regulated and we will have all the clinical evidence. And so we've laid all that foundation in what we are developing, when we have given a challenge, we were given a challenge, like hey, OptiChroniX, if you want to go faster, then why don't you launch it in the US as a wellness app first. And that's what we do. That's why it's in the US, we give access to a wellness app, so it's not interventional at present time. And it gives us the opportunity to do the clinical studies and then bring it both in the US as well as Europe. Now there might be hope for Switzerland because we've been just selected into Kickstart Innovation 2023.

Alex X-Health.show: 18:14

I've just heard about it, congratulations about that. I mean, that's kind of huge.

Rene Gilvert, OptiChroniX: 18:18

Yeah, that is big. Kickstart Innovation 2023 allows us to work with Swiss corporations. And we hopefully will get into paid pilots where Swiss citizens will get access to the app. So that will be the first European market.

Alex X-Health.show: 18:32

Okay, Switzerland is following FDA regulations. Would that help?

Rene Gilvert, OptiChroniX: 18:36

Yeah, that would help tremendously. It will not help us for Europe, because we still need to follow the MDR, Medical Device Regulation, and software as a medical device as a class to a device. So we need to do all that works, CE marking, getting the clinical data, which is okay, because this is serious.

Alex X-Health.show: 18:56

What plans do you have for clinical

Rene Gilvert, OptiChroniX: 18:58

Kickstarters is probably not a clinical studies? study, it's a pilot. Well, we tried to design that we also have data that will satisfy regulators at some moment in time, but it's probably insufficient. What Kickstart allows us is, hopefully, to get into meaningful pilots with corporations, like health insurance companies, or the other partners that Kickstarter has on their site, to get users on the platform, which allows us to learn and to also refine the application even further and see how that how that works from a European perspective.

Alex X-Health.show: 19:32

Can we just go back and can I ask you, what did you have in mind when you were founding OptiChroniX? And how different it is from what it is now?

Rene Gilvert, OptiChroniX: 19:44

That's an interesting question, because I came out of 25 years of pharma, right? When you have ideas in pharma, and there is a basis of people that says, yeah, this is a good idea, then resources are never an issue. So I was very naive. So this is my pharma part, now, 10 years ago, or in 2011, time flies, it's 12 years ago now. I was responsible for an Alzheimer drug. And we thought, can we marry technology onto that drug? So that the drug becomes smart, and says, hey, your cognition is declining, can I get you to the doctor on time? So we did that.

Alex X-Health.show: 20:22

That was on the adherence part, or was it...

Rene Gilvert, OptiChroniX: 20:24

It was really kind of a digital biomarker embedded in the med. But yeah, pharma, not necessarily always has the right strategic fit, in this case, the drug was exposed to a patent loss. So the generics came in, under this kind of the end of the project. And it's something similar for another company. And in that case, the technology was bound to be married to a medicine that was going to address medical cognitive impairment. So that's in very early stage, potentially, of Alzheimer's disease. But that that drug failed in clinical phase 3, so there was no effectiveness of the drug, so why would you have a technology platform? Now, those two examples to me was like, oh, we need to have a company that can design, develop a solution, but becomes drug independent. So it's agnostic, we don't mind on what drug you are, the application, or in this case myAVOS, should serve all of you.

Alex X-Health.show: 21:24

And it wasn't possible in neither of the pharma companies? Not for now.

Rene Gilvert, OptiChroniX: 21:30

Not for now, maybe they will widen up and say, you know, this is not only a drug platform initiative.

Alex X-Health.show: 21:37

And you took it from there. You were like, hey, okay, let's go.

Rene Gilvert, OptiChroniX: 21:41

And then I went broader, right, because if you look at the company name, OptiChroniX is Optimising Chronic care if you break it down. The reality is tht that was in the eyes of many early investors we've been talking two, three years ago, boiling the ocean. Are you really able with one app to deal with hypertension and cardiovascular disease, diabetes, to do something in neurological disorder? So we let go of that and said, Okay, we'll niche ourselves a bit, we will focus on dementia, as one of those first indications we can address. If you look at the team, we all have a neuroscience background. And then the Lancet paper came out. And they said, you know, modifiable risk factors – hypertension, diabetes, weight, lifestyle – are important. So OptiChroniX came back to life yeah, we need to address multiple diseases or conditions to have an impact on the disease.

Alex X-Health.show: 22:42

[MID-ROLL BREAK] This episode is brought to you by the X-Health.show, and me. So if you like this podcast, be generous hit Follow, leave a review. That'll help me invite more such amazing guests for you. Thank you. [POST-ROLL END] Who's on the team? You've just mentioned the team.

Rene Gilvert, OptiChroniX: 23:01

Roger Bullock is actually a well known old-age psychiatrist, dealing with dementia, cognitive diseases. And he's in Portugal. So we have a completely remote team. He's our Chief Medical Officer.

Alex X-Health.show: 23:14

And you also mentioned, an author of the name of the app.

Rene Gilvert, OptiChroniX: 23:20

He lives in Portugal, right, so we were brainstorming, what do we need? What's the name of the app? And he came up at some point, hey, in Portuguese, AVOS is elders. So that's the grandparents. And that was our focus at the time. So he said, Okay, my AVOS, because everything in the app is about"me" or "my" parents. I'm the founder and the chairman of the group with two companies, one in the US and one here.

Alex X-Health.show: 23:49

What from your corporate background fueled OptiChroniX?

Rene Gilvert, OptiChroniX: 23:53

Good question. It's not what in my corporate background fueled OptiChroniX. I think I've gotten an awful lot of experience in those 23-25 years that they're transferable. I mean, sometimes people say when you're in a big corporation that it doesn't translate into startups. But that's actually not true. If you look at big corporations, if you look at a product team, in my mind, this these are the individual little entities and startups and the dynamics are the same. What shaped me is, is the inability in a very large organisation to move extremely fast. So that's something that is of course, very nice that this small team can just move forward and do things very fast. But all the learnings are basically fueling all the steps we make. I mean, Roger comes out of 30 years NHS, so he's a clinician at heart. We have a regulator, he is in Lausanne – Albrecht is a guy that with, I think, 25 plus years of dealing with the FDA. And Emma, how do we shape the product in such a way that we are approvable at the end? And then we have Anna, she she's doing finance and she's here, based in Basel. And then we have an IP lawyer since day one. So that's the whole team and totally remote.

Alex X-Health.show: 25:44

And was there anything that you had to unlearn from the corporate world? Like you mentioned, when we were talking before that, you were managing 1 billion budget, right, in the corporate world, and then you come down to what, like, no budget at all, like, the minimum budgets,

Rene Gilvert, OptiChroniX: 26:05

The budgets were not a billion, I wish that was. That would be true with drugs turnover of more than a billion. Yeah, no, it's different. I mean, this is also why I said I was naive when I started OptiChroniX. Hey, I got a couple of million to do these projects in pharma. And that's kind of the seed that we talk about when you talk about startups. It's kind of the seed that I had envisioned to get this off the floor. Now in the outside world, it doesn't exist. There is no executive committee where you say, I need 3 million. And so OptiChroniX today is still bootstrapped. The founders are paying the whole development. And we're still looking for that investor to take we take on this journey. And we do this. But we keep straight.

Alex X-Health.show: 26:54

Okay – the things to unlearn?

Rene Gilvert, OptiChroniX: 26:56

Unlearn? I don't know really, it's a difficult question. What do you unlearn? When you go into a startup, the fact that there is no big... it has nothing to do with unlearning, a trait or capability... But unlearning's probably around this sense of collectiveness, people around you, especially now, post-COVID, and the fact that we have decided that this is a remote company where it's about the team and we are not co located. That's kind of... how do you deal with that?

Alex X-Health.show: 27:30

So you're located in different cities in Switzerland, Portugal? US? That's it? Yeah. That's wide enough.

Rene Gilvert, OptiChroniX: 27:40

It's good enough. And then the developers are in India.

Alex X-Health.show: 27:45

Is there anything that you would do differently if you could start all over?

Rene Gilvert, OptiChroniX: 27:52

Nah, not not so much. I still think team is very important. So I think we have a rockstar team.

Alex X-Health.show: 27:58

Was it hard to gather the team? Or, how did you go about that? You had an idea...

Rene Gilvert, OptiChroniX: 28:06

...and I went to the network, to people you know. So Roger was a Key Opinion Leader a decade ago, he still is probably a Key Opinion Leader. I just asked him, hey, you were an advisor for me when I was in the corporate world, would you want to start a company with me doing exactly the same what we did, but now serving all those patients? LinkedIn is a great tool, too. I posted some of the roles on LinkedIn and we got great feedback. And you chat with people. Or you ask the network and say, hey, this is what we need, do you know somebody that is suitable for a startup?

Alex X-Health.show: 28:49

Who is not suitable?

Rene Gilvert, OptiChroniX: 28:50

Who is not suitable? Yeah, I don't know. They need to be suitable to the team. I quite frankly, now think that everyone is suitable for change. And I think if you're in a large corporation, it's not necessarily that that disqualifies you for being part of a startup. But you need to be agile, you need to be flexible. It's not just your turf, your shop, you need to do many, many more roles.

Alex X-Health.show: 29:14

What was the most difficult so far?

Rene Gilvert, OptiChroniX: 29:18

I think the most difficult is dealing with the stress of being constantly bootstrapped. And we are trying to raise funds in an economy that has downturns. Yeah, that's for me, the hardest part is how do we just keep on moving? I think the upside to this company is hey, we have no debt. We do everything by ourselves. There's also no real pressure yet from an investor that says, hey, where's the return?

Alex X-Health.show: 29:46

How do you deal with that? Well, you must have a lot of positive feedback but also, if you're fundraising, there's a lot of either no feedback at all, or negative feedback. So how do you deal with that, on the personal level?

Rene Gilvert, OptiChroniX: 30:04

I've learned to deal with that on a personal level. At the beginning you take everything personal. And now you know it's also numbers game. It might not fit a thesis, we might be too early for some, we might have targeted the wrong people to think, hey, this could be a great opportunity. And of course, it's not personal. So and it's a numbers game. I think that's what we have been told now so many times is don't give up, persist, move on, at some moment in time it will work. Now, of course, I started doing this with a team and an idea. We are now two years further, we have not only a team, an idea, we have a product and the product is launched.

Alex X-Health.show: 30:45

Plus it has been recognised by the Kickstart, right?

Rene Gilvert, OptiChroniX: 30:49

And those are always the boosts, right, it is the recognition of being selected into Basel Day One, one of the accelerators locally here. A year later, the acknowledgement that we were selected into the Creative Destruction Lab, which was a an accelerator in London, affiliated to the Oxford University. And then, last year, we were also part of the accelerator of Biogen with EIT Health in Germany. So it's all those little milestones. People that understand what it is that we built, they give you that acknowledgement, and now Kickstart is I think, maybe, hopefully, the cherry on the top of the cake.

Alex X-Health.show: 31:30

What did the accelerators give you? Or, how, how did you benefit from them?

Rene Gilvert, OptiChroniX: 31:38

You get a lot of expertise for free, in essence, which is great. You get people that will judge you,

coach you, tell you: 31:48

think about this, do you think about that? How do you move on? How do you improve? How do you do your analytics – that doesn't become, hey, there's a product that was designed but no one uses it? So those are the accelerators. There, I mean, if you look at the concept is kind of all the same. It's these silos of expertise that we are being infused with on I would say it's coaching mainly.

Alex X-Health.show: 32:18

Kickstart doesn't take early stage startups. So you already launched the app, so you are at the advanced stage. How would you phrase where are you now? And where do you want to go from here?

Rene Gilvert, OptiChroniX: 32:34

It's an interesting question and probably I don't have the right answer for many people that would understand investors. Because of the fact that we've been bootstrapped for so long, and still are bootstrapping, we're probably still a pre-seed or a seed company. But the fact that it took us so long, and we put the resources in ourselves with our partners, is that we are, in my mind, we're probably a seed company. Because we did launch the app in the US, and now we are making it happen in Switzerland. So I don't know where we sit in the minds of many.

Alex X-Health.show: 33:09

Okay, so it's a bit blurred. It's not like there are these boundaries clear, because you basically invested yourself. So you're covered for the seed.

Rene Gilvert, OptiChroniX: 33:21

At least for the pre-seed.

Alex X-Health.show: 33:23

And where do you want to go? This is also where kickstart plays or can play the role? I mean, they can help you to scale up.

Rene Gilvert, OptiChroniX: 33:35

That's the idea. And in this case, I think the focus is Switzerland, which is great. We want to get here, because we were founded here in Basel-Land. But to get access to users, to expertise – because I think for a solution like this, your payer is going to be your customer. So the end users are, of course, you and me, but the payer will most likely be a health insurance company.

Alex X-Health.show: 34:01

So you're thinking reimbursement at some point?

Rene Gilvert, OptiChroniX: 34:04

Yeah.

Alex X-Health.show: 34:04

And do you see what could be the roadblocks, you know, on the way to the scale up?

Rene Gilvert, OptiChroniX: 34:10

The roadblocks will probably be users. Are they going to really use it? Is there a retention rate that is good enough to make this a commercial, viable company? There will be many people doubting that behavioural changw... can you do that on the phone? Yes or no? Nah, I think there is enough evidence now that we can affect behavioural change through digital coaches on the phone. There are very large companies in the US dealing with diabetes. And optimising that or hypertension, optimising those outcomes. So I think that should be not the biggest issue. But I think for many digital therapeutics, is maybe not necessarily getting the regulatory approval by submitting clinical evidence, but it is creating a value dossier that is convincing enough for a payer to say, yeah, this is value for money, I'm going to cover. So that might be one of the bigger hurdles for many, not just OptiChroniX.

Alex X-Health.show: 35:12

I mentioned that because I also read, just recent studies, the Yale School of Medicine studies, that say two in five US adults with or at risk of cardiovascular disease use their smart devices to track health goals. So the majority of people at risk of cardiovascular disease don't use anything, even though this could improve their well-being, their health, and in the end, well... I covered that in a conversation with a founder of Aktiia, the bracelet measuring blood pressure, and he was putting it straightforwardL there is death actually on the horizon, closer to you if you're not changing your lifestyle. But people won't do that, basically. And hence, you know, the app with the behavioural changes support, right? Any idea, how could you go about that so people start using the app? Because I can imagine when you start, you can be engaged, because you get the messages or there is the whole system that supports using the app.

Rene Gilvert, OptiChroniX: 36:32

So the question is, when do people take ownership of their own health?

Alex X-Health.show: 36:37

Yeah, that's the question. It's a big one.

Rene Gilvert, OptiChroniX: 36:39

I think it needs to be tangible. And I think it's a tough one. If you're in your mid-40s, or early 50s, and you have hypertension, it's a disease you do not feel. So why would I take every day an application? Why do I take everyday a pill?

Alex X-Health.show: 36:55

Or this cognitive health test every month?

Rene Gilvert, OptiChroniX: 36:58

Why would you do that? For us, the eye opener was the conversation we had with the focus groups. And having created an application that was not designed for them. We had an app that was not for the carer yet shared information. But that was it – shared information about

their loved ones: 37:16

their parents or their spouses. And when we started talking about, okay, if this is all true, what we said in the intro, then why are you not measuring me? And why am I not getting all those exercises? Because I don't want to end up where I see my loved ones are. So I think you need to be aware, you need to know what is... what might happen to you. So in the case of Aktiia, yeah, hypertension might lead to death.

Alex X-Health.show: 37:43

Sooner than in other case.

Rene Gilvert, OptiChroniX: 37:46

And in our case, if you don't move, if you eat wrong, if you don't sleep well, if you have hypertension, if you have diabetes – you might be at risk for Alzheimer's disease.

Alex X-Health.show: 37:58

So you mentioned the reimbursement via insurance companies. That's true here in in Switzerland. So this is how can this work. What channels did you think about, like distribution channels for the app? I mean, now you go direct to consumers, right? What else do you have in plants?

Rene Gilvert, OptiChroniX: 38:19

I think the distribution channel

is quite easy: 38:20

it's an App store one way or another. So it might be the Google Play Store or the Apple App Store. So that's where you physically can get your application now, then the question becomes how do you activate the app, when there is a reimbursement in play? And I'm looking at Germany, let's assume we would be a DiGA, and there are more and more, a doctor would need to prescribe. And then the insurance company will reimburse us for paying that the end user is using the application.

Alex X-Health.show: 38:50

Alright, so now it is available in the US for free, right?

Rene Gilvert, OptiChroniX: 38:54

Not totally free, but at an at an extremely reduced rate to compare to what it costs us. But since we are in early stages, we want people to experience the capabilities of the application right now.

Alex X-Health.show: 39:08

There was an interesting article, actually, that pharmacists could be an option to distribute digital therapeutics, and actually, these were pharmacists themselves mentioning that they could learn more about digital therapeutics. How do you see that?

Rene Gilvert, OptiChroniX: 39:32

Well, I think pharmacists are often an underutilised channel. People think: healthcare. I might have symptoms I go to the doctor, the doctor gives me something, drugs in the past, and they might in the future prescribe you a digital application and I go home. But we tend to forget that we see pharmacists for many, many things, or you go to a pharmacy as well when you have a prescription in your hand. You go there, right. But sometimes you go there just to get your non-prescribed medication. So I think pharmacists might also know you quite well and say, hey, there is this that might be suitable for you or your parents, why don't you try this? So I think it is a touch point in the patient journey that is relevant, and they could help us create awareness in the in the user base.

Alex X-Health.show: 40:27

What allies would you ideally have, if you could think about allies to scale the app up? What would they be?

Rene Gilvert, OptiChroniX: 40:37

I think the medical community needs to endorse digital health solutions. So in our case, I think we've been starting to talk to not only neurologists We're not there yet but at least here in Switzerland, we can see that deal with cognitive disease, but also to cardiologists. Hypertension is an element that is of importance in my early 50s but it becomes relevant in my 70s, because of a completely different disease – then, let's start talking to them. So the medical community needs to be behind what the application can do. And I think, we still, in many countries, look up to the doctor, maybe less so in the Western world, as in some of the other parts, but still, when a doctor would say, hey, this is good for you, that is better than when a company advertises in the app store and say, here you have a wellness application. So clinical evidence is important. And your partners will be the academia, and doctors, educating GPs and pharmacists that this is a legitimate tool to help people get into better habits, into better health. And I think, the other one that we need to have as an ally is okay, who is then picking up the bill. So the health insurance companies. Do we need to see value for money. And I think it's good that we may have an opportunity to shape the solution together with them without alienating also the user base. People might also be scared of an insurance company knowing everything. So how do we deal with that in making sure that privacy issues are secured and that the data is not going unauthorised to just anyone, it's something that is very dear to our heart. there is some interest of insurance companies into going into health prevention really, which is not the case now, right? That's not how we do healthcare. No. So I learned whilst we were pitching for Kickstart that, apparently, the Swiss regulator has changed that now. Prevention tools are covered in I think the basic insurance policy. I'm not 100% sure. But this came kind of in the conversation that we had, with the potential partners that there's this mindset shift, that this is not any more post diagnosis – you have a disease, now let's manage healthcare. But it becomes more apparent that it is important to be preventative and that we are also providing the financial support for those people that are going after prevention.

Alex X-Health.show: 43:19

All right, so what's next for OptiChroniX, and myAVOS, just, you know, the next steps.

Rene Gilvert, OptiChroniX: 43:27

Hopefully, we'll have very successful pilots here that also then give more evidence to maybe larger investors to say, we're going to help you scale. And then not only in Switzerland, in the US, but then making sure we can go after the certification that we need for the other European markets where we want to be.

Alex X-Health.show: 43:48

Any dates we could speak about?

Rene Gilvert, OptiChroniX: 43:49

In Switzerland would be relatively fast. In the US we are – if we can financially afford it, we could go after the certification there. That would be within one year both. Europe is a different story. Europe, just doing the clinical work getting through the certification, CE marking, asking for, let's say, a payment...

Alex X-Health.show: 44:14

A couple of years?

Rene Gilvert, OptiChroniX: 44:15

I think that would at least be two years if we would start today, which we do not.

Alex X-Health.show: 44:22

Okay, Rene, so thank you very much for this conversation. And you guys, if you want to read more about OptiChroniX, please go to optichronix.com and myAVOS – you can find it in the App Store if you are in the US. Thanks again.

Rene Gilvert, OptiChroniX: 44:51

Thank you. This was an honour.

Alex X-Health.show: 44:53

I'm totally impressed by the audacity of researchers turned startup founders, doctors turned entrepreneurs or ordinary parents turned healthcare innovators. People battling the battles that no one fought before. For the eXtra health of the future. So if you see a startup posting on LinkedIn, show them some love, hit Like, comment, "That's fabulous". If you have a couple of drops more of that altruism, follow the X-Health.show, leave a review here. I'll be able to bring more of these visionaries to you. So a big thank you, you're awesome, see you next week.

SPEAKER: 45:26

The information in this podcast is for informational purposes only and should not be considered medical advice. If you have any medical questions please consult your healthcare practitioner. The opinions on the show are Alex's or her guests. The podcast does not make any responsibility or warranties about guests statements or credibility. While the podcast makes every effort to ensure that the information shared is accurate, please let us know if you have any comments, suggestions or corrections.