Paul: It’s Paul.
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Florin: It’s Florin. What are we grinding today? I know. Let’s grind some health tech startups.
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Paul: While enjoying a V 60 with Burundi from Square Mile from London.
Florin: Oh, Square Mile. This is going to be an awesome episode.
Paul: Yeah, actually, it would be as awesome as the coffee. So a really, really nice coffee with really Creole notes.
Florin: Yeah. And the plus side, Square Mile is from London.
Paul: Anyway, are you planning to go in the health tech?
Florin: I would definitely like to do that. But as I was grinding all of these ideas about health tech startup obstacles in my head, I was like, I actually want to talk to Paul about this because you’ve got some experience in this area, right?
Paul: Yeah, but while getting there, does a health tech startup need to sell?
Florin: No, I don’t care about it. It’s just like, Hey, what company would you start? I’m browsing the web like everybody does. And I’m like, Hmm, health tech seems to be something these days. Let’s try a health tech startup because that’s what all the cool kids on the block are doing and they seem to get more and more popular. What’s your take on the health tech startup obstacles?
Paul: Yeah, actually, what Florin, I think, is trying to say is that all the cool kids are trying to make money in this area, which actually, until you get money, you suffer a lot if you’re doing the proper way.
Florin: Yeah, that’s exactly my point. Everybody’s trying to do health tech startups, but doing a health tech startup can’t be as easy as doing something in software as a service, right?
Paul: Yeah, look at us. We were three programmers thinking that we would do great startups in health tech, and three years later, two of us are employees in product companies, in software companies, and the health tech startup is a zombie, almost dead. It just shows how tough the health tech startup challenges can be.
Florin: I guess that makes sense. I guess it’s not really as easy to do as anything else, right? Starting off the bat, what problems did you guys get yourselves into?
Paul: Starting with the beginning, what we tried to do was to create a WhatsApp for medical advice. If you look at it… That sounds good. Yeah. And our perspective was like, we only need to build a chat app. Exactly, right. With some privacy.
Florin: Some privacy.
Paul: And then everything will come, the doctors, the clients, the money.
Florin: And then you can just go ahead and milk the cow.
Paul: And the reality is nothing like that.
Navigating Health Tech Startup Obstacles
Florin: All right. Well, tell us a bit more about that. So everybody would think like, when listening to this podcast, Hey, this sounds reasonable. It’s quite easy to do. You just have to build another WhatsApp. You just build a chat app and you place Maddox on that chat app. It sounds easy, but is it?
Paul: Actually, it’s not because as funny as it sounds, in health tech, you don’t need to start with the product, you need to start with the research.
Florin: What research?
Paul: Now, definitely research in the medical field, to see that there is something that you can do, and maybe we’ll get to this a little bit later. But also in other fields that some think that is something weird, you need to start with the research in a legal area, like what can you do, what can you not, how do you protect yourself, how do you protect the doctors? Because, hey, a doctor did 10 years of studies and you might ruin his or her career because you made something that is not allowed to.
Florin: I guess the first question to ask is, if we get an actual medic to start using this app, can this backfire on that particular medic?
Paul: Yeah, because in the end it’s a matter of is it more practice? Is it not? Is it allowed to do that medical service in that app or using that device? Because if we go into the hardware devices in health care, it’s even more interesting.
Florin: And actually, is it like a medical service? Are you allowed to say it’s a medical service?
Paul: Well, the interesting part is some lawyers, and I quote here lawyers, will tell you that you should not put it as this. Why? If you kill somebody because, hey, in the health tech, doing a wrong iteration, let’s hope not getting you to jail, and some of them will tell you, Just write in the terms and conditions that you’re not providing the medical services. But how are you looking at this from a marketing perspective, for example?
Florin: From a marketing perspective, what you should do is say that this is the best medical service in the world.
Paul: Without using the words medical service.
Florin: Oh, come on. Then it’s not fun for people. Why would they use it?
Paul: Well, look, for example, in our case, when we did our research, with a proper lawyer, one specialized in the medical field. It was an interesting part. Only using the term patient attracts a lot of legal implications.
Florin: Oh, yeah? Yeah. Really? Yeah.
Paul: Because according to Romanian law, if you call someone a patient, he has some legal rights. The legal landscape is one of the major health tech startup obstacles.
Florin: What are you doing as an app?
Paul: You just call.
Florin: Them users. Regarding those.
Paul: Rights, right? Yeah. That’s the solution. You call them users.
Florin: You don’t call them patients, you call them users.
Paul: Exactly. The question is, are you okay with the fact that you don’t provide the legal rights that they have? Because that is there to protect them. Now you want to innovate and to skip these regulations because all of us look at the regulations like something that…
Florin: Yeah, that you can just skew.
Paul: Your way. Exactly. In this field, basically, it protects you, it protects the doctors, it protects the users or the clients, because it’s even more interesting if you call them clients.
Florin: They are supposed to be clients, basically. But then.
Paul: The question is, do they pay for the same medical advice without getting the same benefits?
Florin: Because they can’t actually pay for medical advice, can they?
Paul: In our fear, they couldn’t.
Florin: All right. Basically, what you’ve given to our audience right now is quite a bit of research that cost quite a lot of money, didn’t it?
Paul: Yeah, but it applies only if you’re in Romania because it’s interesting.
Florin: Part that’s even more interesting, actually.
Paul: Yeah, because even if you’re in the European Union and it’s supposed the law to be the same in all the countries, what is happening in this field from what we saw is that you have certain regulation in a certain market.
Florin: Yeah, and basically they are different from country to country. Exactly.
Paul: It’s interesting to see the challenges that the startups that try to go internationally have. It’s even more interesting to look at this. That idea works in US are just implementing it here.
Florin: Yeah, but it won’t work that way, will it? Because you have different laws, you have different ways in which mathematics view these sorts of things. You have different ways in which hospitals work. You have different consultancy fees. So even your pricing model could be smashed to pieces very easily because the market conditions themselves are quite different from what you’d have in the United States. So then you can’t just copy one from this area to the United States or one from the United States to Romania. You couldn’t really do that.
Paul: Yeah. That’s also the mentality of the people, also the connected services like pharmacies and stuff like that.
Florin: I.
Paul: Probably gave advice that cost me a lot of money, but probably if you’re not from Romania and really into it and to sacrifice all the time to make it work properly, because in health tech, the probability is to stay a little bit and work on that startup. It’s not like I just build an app in one month and then I go with it.
Florin: Yeah, you can really do that. You can do that even in software as a service. You clearly can do that in the medical field.
Paul: Yeah. So probably the most wise would be to have, I don’t know, at least an year in which to research from a medical perspective and from a legal perspective. Do very well your research, medically and legally, before actually building the product.
Florin: I guess that actually in all of these cases, you first need to do your legal research. And then according to the specifics of the app, you also have to do the medical research. Because in your case, there isn’t as much medical research as there is legal research, right?
Paul: Yeah, exactly. So in our case, it was due to how the product was. A lot of research needed to see what the doctors are allowed to do or not and how we phrase the product when I think. And the interesting part is that all these had an implication in the product. So actually we needed to rebuild the product. It was quite funny because actually, we are programmers. The first thing that we did, we were three of us and we started building a native app for Android, one for iOS. We’re like 90 % done with the Android app. Then one of the co-founders wasn’t working a lot. I decided to go with just the two of us. We were like, Okay, we are two of us, none of us know iOS. What do we do? Well, we are programmers. We build the product. We use cross platform technology, basically building the product again like the second mistake.
Florin: That sounds like a lot of work. At this point in time, you hadn’t done your legal research, right?
Paul: No, we were just building products because we were hoping that once we have the product, we just put the doctors in.
Florin: Then the medics will come and clients will come and everybody will start chatting in the app and buying subscriptions. Exactly.
Paul: Then we started to test it with a few doctors and they were asking us, Okay, what will happen if I do this…? It happened to the user. Actually, one of them asked until the end, what’s happen if I give some prescription to that person…
Florin: Well, that’s something that people should consider. And actually, even if the medic wouldn’t think about giving that to your user, the user would request such advice from the medic.
Paul: Exactly. Even more if they pay. And we’re like, Okay, I think you’re supposed to do that due to the fact that I Google it. And then I was like… I was actually staying and thinking, I just told a person that I did my research on Google and I said, Okay, this is not okay. I should do it properly. And I actually looked in the team that I had and actually we were two people, programmers, and I realized the fact that, okay, the legal, but there is more knowledge that I don’t have in the team.
Florin: What knowledge?
Paul: For example, as I said, we only had technical knowledge. I didn’t have… Yeah, that’s right.
Florin: You didn’t even have the Android part, right?
Paul: Yeah, we had only the Android. Basically, not even all the technicalities. But let’s say we could have changed this, going cross platform and things like that on this part. We didn’t have the legal knowledge.
Florin: We.
Paul: Didn’t have proper medical knowledge, like a doctor with experience. Now, with experience, it is very important here. You can just go and take a lawyer from any field because we tried this with one that was generally specialized and actually it didn’t help us at all. No?
Florin: No. Why not?
Paul: Because all that they did was trying and looking just scratching the surface, building the terms and conditions that I was telling you, like replying patiently with the user.
Florin: I see.
Paul: That’s okay from a legal perspective. Now, is it from a moral perspective?
Florin: All right.
Paul: Do you want to be that founder?
Florin: Do you want to found an Uber?
Paul: Well, I think with that I can go to jail.
Florin: Yeah, that’s a happy thought right there.
Paul: Yeah. So on this side. The technical, the legal, the medical. And now an interesting one, the sales guy.
Florin: Why? Why the sales guy?
Paul: Because most probably in health tech, at some point you will go like business to business. Even if you’re business to consumer, you might at some point need to go on a business to business level. So there you need someone to sell.
Florin: Yeah, and you can’t really sell yourself because you’ve most probably got zero connections. I mean, you’re a developer, it’s not like you can have a lot of connections with a lot of clinics which are as big as nationwide clinics.
Paul: In order to do that, you would say you could know a really well known doctor and go and talk with that one. But to get and to talk with that one, you need that sales guy to open the doors and do this connection. Now, don’t get me wrong, we know that in Romania there are some opening the doors. I’m not talking about that part, but actually proper sales in a legal way.
Florin: Yeah. I guess if you are going to speak to medics that have access to a lot of clients and clinics, you actually need to be in the field. And you could even be a medic or something like that and still not have the proper connections to get you through the door to the business side of a clinic, even though you could have a couple of medics that you know, also know a lot of other medics from a certain clinic, they don’t really have the decision, they don’t have the power of decision. They can’t say anything in the name of the clinic, they cannot get you through the door to start your first demo or to implement your first MVP with the clinic so that they can give it in some of their units to all of the patients inside those units.
Paul: Yeah, on this part. And even if you go deeper a little bit and you have a very innovative medical device or medical breakthrough, you still need that sales guy to sell that IP. Because if you do, let’s say, I don’t know, let’s take that startup with the sleep analysis from Clue. Basically what they are doing there, so they start doing clinical research, like medical research. Now, most probably they will get to some point in which they will have very good intellectual property there, from a medical perspective.
Florin: Yeah, and that’s very good, right?
Paul: Yeah. An opportunity there, for example, would be to sell it, to license it, to use it in your own product in some clinics, or I don’t know, business consumer. But still you need sales skills to do that.
Florin: Yeah, I agree.
Paul: You can do them all. So if you’re very good on the medical side, probably you’re not so good on sales. So you need someone in sales. If you’re technical, you will need someone on medical sales and all of that. So I think you need at least some of these roles in the team. But I don’t know, how are you seeing this from outside of the industry?
Florin: Well, not that I actually think about it. Even if you would have a medic, somebody who has done medical studies at university and maybe he’s already practicing medicine in a hospital. I mean, if I were that person, for example, so let’s say that I would be that person, it would still be like, if I had to do a startup in health tech, I would still not have enough experience to decide what’s good from a medical standpoint for my users or patients. So I would still need to get somebody that actually has a lot more experience to look at what we’re doing and what we’re trying to achieve. And I guess as a founder, it would help me to really understand what’s going on, but I would still need extra skills. It’s not as easy as it is in any other startup where basically if you have some development skills, some business development skills, whatever, you can just go ahead and do it because you don’t really need people with more experience than you because you can easily build the experience that you are lacking. In the medical field, I’m not sure that’s quite as true as it is in other fields.
Paul: So actually you would hire a consultant?
Florin: Yeah, or I know give shares to another medical guy who actually has experience and who really understands everything that’s going on with the patient, with ensuring that all of our experiments will go properly, stuff like that.
Paul: You didn’t understand my irony with a consultant because you could have just went to a very well known person that do a lot of medical events with a lot of startups and promoting them.
Florin: Oh, I see. That would be interesting. Yeah, I would like to be that guy. Isn’t that guy popular?
Paul: I.
Florin: Guess all those guys.
Paul: Are popular, right? I don’t know. So I didn’t make the… At least I save money without paying a consultant.
Florin: Yeah. Do people actually fall for that? I mean, do people actually pay those kinds of consultants?
Paul: Well, it’s interesting because unfortunately, a lot of young founders pay them with the equity.
Florin: Oh, and you pay people who don’t really have all the experience, all the necessary experience, and you give them equity because they sound good, they look good, and they’ve got really great presentation skills, right?
Paul: Yeah, because if I see a person everywhere, like at any event, on any panel, on any…
Florin: On every banner, everywhere on the web, in every Facebook event.
Paul: Exactly. So that person probably works 22 hours, so 10 hours per day is at events, and 10 hours per day is working in the real field.
Florin: So basically, would these people fall into the category of the serial PowerPoint presenter? I guess they would, right? Because they just make PowerPoint presentations that they show to everybody. And then everybody’s like, Yeah, let’s trust that guy. That guy’s an expert.
Paul: Yeah. And the first two slides are with badges.
Florin: With badges? Oh, that’s nice.
Paul: Speaker at that event, panelist at that event, speaker at that event.
Florin: Wow. Those are some really good street grads.
Paul: We’re obviously.
Florin: Being sarcastic right now. If you were doubting it, we are sarcastic. We’re just saying it loud.
Paul: And okay. Yeah. So basically, if you need a specialty in a certain field, like in health, go to a proper specialist. In our case, for example, we were a little lucky to be able to work with really good lawyers that were specialized on the medical stuff.
Florin: Otherwise, anybody can give advice and you really need to check their credentials. So let’s see. So basically, what’s brewing right now in the startup industry is health tech. Everybody wants to get into health tech. But from what I understood from today’s episode, I myself could not really get into health tech because I would just have experience in product management, marketing, SEO, obviously SEO, social media and other stuff like that. And even as a product manager, if I do say so myself, we’ve built a couple of products that are remotely successful. Some of them are successful, but we still couldn’t get into health tech because we lack all of the skills that are actually important, like medical skills, legal skills, sales skills.
Paul: Really good technical skills because of a bug here?
Florin: Oh, yeah. We didn’t even get into that, right? You know what we should do, Paul? We should do a whole episode.
Paul: About lean in the health tech, lean fast, iterating.
Florin: And how you can’t really do lean startups in health tech, how you shouldn’t do lean startups in health tech because you’re just going to wind up killing people. In my case, if I do something like that, some people will not be able to use the product for a while until we fix the bugs. But in the case of health.
Paul: Tech, some people won’t be able to use their brain for a while.
Florin: Or their hearts, or their livers.
Paul: Let’s hope only for a while. In an assisted environment.
Florin: Whoa. So basically…
Paul: Not killing them at all, doing like this.
Florin: This is a bit depressing. So you’ve just ruined my dream of going to health tech because I’ve got none of the skills necessary to do that.
Paul: You can make a PowerPoint and go to an investor. That’s it. Or to fund and take some money.
Florin: Oh, boy, I should really do that. I’m really good at PowerPoint stuff, so I should just go ahead, build a couple of slides. I’m not doing anything for real in health tech, and I’m just going to do a couple of slides, and then I’m going to become a serial PowerPoint presenter for the health tech industry.
Paul: Again, I hope you feel the irony. So if Florin is pitching a health tech startup, he’s serious. So please don’t think that he will pitch for some money only. We’re just being sarcastic here with PowerPoint startups that only want to raise some money to buy devices and pay consultants, without addressing real health tech startup challenges.
Florin: And then you never hear from those guys ever again, and they never really launch on the market.
Paul: But hey, after that, you can sell consultancy because actually you had an awesome startup.
Florin: Oh, boy, that’s wrong in so many ways. And that’s why we said you should really choose your consultants wisely. Now, I think that.
Paul: We’ve actually… You’re a specialist, so thank you for interrupting.
Florin: We’ve managed to really grind the topic here. We’ve also done a recap and I guess that for now, the most important part would be to choose what would be the fantasy team draft, what would be the best team that you could build if you were to create a health tech startup today. Considering all the health tech startup challenges we’ve discussed, what would it be, Paul?
Paul: Definitely the medical specialist, a really good one in that field.
Florin: And who has some degree in medicine, right?
Paul: Exactly. A proper doctor, so not somebody who’s talking about the problem from I don’t know what internet sources, or a person who had that medical issue or heat around that medical…
Florin: I know what you mean, but even if and if tell you, let’s say that I would have diabetes, even if I would start a startup that takes care of diabetes, I would still need a.
Paul: Medic, right? Yeah. So basically, if you’re not having the degree in medicine, make sure you take someone in the team who has it. Then take someone who’s a really good legal expert in that medical field, in that medical specialty.
Florin: Take.
Paul: Someone who’s really good on the technical side.
Florin: Yeah, exactly. That was the last point of the recap.
Paul: Sales, if you go business to business, and someone who’s really good at product. Most probably we’ll talk about this in that episode with going lean and iterating in health tech.
Florin: That’s going to be hard to find because most product guys just want to do lean startups. We’ll have to see about that.
Paul: A doctor, a tech guy, a lawyer, a sales guy, a product guy.
Florin: This is already very different from most of the startup ideas that you could ever see in startup weekend competitions or usually all of the startups that get funded on tech range where you don’t necessarily need to have a lot of people who know what’s up in a certain field. They could have some remote experience in that field. Maybe it’s like a web designer creating a startup around web design and boom, he can totally make that happen. But in the medical field, you need this dream team that we’ve talked about in this episode, if you really want to make it happen and you don’t want to end up as a serial PowerPoint presenter.
Paul: Yeah, exactly. And on a short note, we’re not consultants, so not giving advice here.
Florin: We are not.
Paul: Your lawyers. Like selling advice. So probably if you think they are valuable, you should.
Florin: And nothing that you have heard in this episode constitutes any type of legal advice, medical advice, health care advice, therapy advice, or anything for that matter.
Paul: But if you want, you can buy us a coffee.
Florin: Buy Me Coffee. Com, and we are going to have a link there so you can actually do that.
Paul: See you next time.
Florin: See you next time. And maybe we’ll prepare a PowerPoint presentation on avoiding health tech startup obstacles!
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