Monitor vital biomarkers from home

[00:00:00] Michael Dubrovsky: You put several drops on these windows and it, separates blood from serum. And then this is dried, and it has a two week lifetime, and you just put it on your mailbox, the USPS picks it up, and then it gets tested for 17 biomarkers.

[00:00:19] Peter Bowes: Michael Dubrovsky is a materials chemist, chief product officer and co-founder of SiPhox Health, the company behind this system of home blood testing, a service that claims to be as clinically accurate as traditional methods without the need to go to your doctor’s office to provide a sample. Is this the future for keeping track of our vital biomarkers? Indeed, what are our vital biomarkers? Why do they matter? Hello again. Welcome to the Live Long and Master Aging podcast. I’m Peter Bowes. This is where we explore the science and stories behind human longevity. Michael, it’s good to meet you.

[00:01:00] Michael Dubrovsky: Great meeting you, Peter. Thank you for having me.

[00:01:02] Peter Bowes: So I posed the question, is this the future? I guess you believe it is.

[00:01:07] Michael Dubrovsky: Yeah. I mean, I think it’s it’s already here, right? It’s just not evenly distributed. That’s like the classic trope. But, you know, I think people that are spending a lot of money on concierge medicine live longer, and they also get blood tests more frequently. So you’ll typically get a quarterly pretty broad blood test if you’re, you know, top couple percent in wealth and are are paying a lot for concierge medicine. So what we’re doing is really just trying to make that accessible and convenient for people who don’t have the time or money to, to do, you know, extensive venous blood draws every quarter.

[00:01:42] Peter Bowes: And the company’s called SiPhox Health. How did you come up with that name?

[00:01:46] Michael Dubrovsky: We’re a SiPhox is a short for silicon photonics. So we are originally you know, we started the company. We ended up doing blood testing very quickly. But at the beginning it was not a blood testing company. It was just a pure silicon photonics company, which is a semiconductor technology for controlling light on a chip. And so that’s where the name comes from. We tacked on health once we decided to to go for blood testing.

[00:02:13] Peter Bowes: Got it. And I described you as a materials chemist. Can you just elaborate on that in terms of what your academic background is and what your experience is that essentially brought you to this point of founding a company like this?

[00:02:27] Michael Dubrovsky: Yeah. So I’ve spent my whole career in kind of a combination of startups and academia. I originally studied chemistry and biochemistry, and then worked more in, you know, hardware like electronics manufacturing and then eventually back to academia in Technion and MIT, working on, photonics like, and materials. So, you know, kind of nanotechnology related to controlling light. About seven years ago or so, I kind of discovered, you know, for me, it was discovery. Obviously, that’s been going on for a long time. Is this thing called silicon photonics, which is taking the existing equipment that produces transistors. So, like in your computer or phone, you have all these electronic chips that are doing logic, and also you have your camera chip. There are many different chips in the computer, in a computer or phone, but there’s taking that technology and using it to miniaturize optics is relatively new. So the real use case where it’s been commercialized is the internet. So like this phone call we’re having or this recording, it’s going through fiber optic cables between data centers. And at the end of each cable is a silicon chip that’s actually controlling that data flow. And it processes the light that’s coming in and out of of these fiber optic cables. So when I discovered silicon photonics, it had already it was like kind of becoming very successful in the, in internet. So it was helping scale the internet, you know, in the, kind of like 2017 or circa 2017, 2018. And there was a question of like, what’s the next use case of this technology? So I’ve kind of came at a point where it was clearly winning in the internet.And the question is what’s next? and so that’s some of what I’ve been trying to answer myself. And also with my co-founder at SiPhox, who has spent his whole career in silicon photonics. So he actually built, you know, a lot well known products in the internet space based on silicon photonics. And we kind of decided together to start SiPhox and very quickly realized that we could apply this optics technology to miniaturizing blood testing tools. And the reason is that if you open up, if you go into a central lab like a LabCorp or Quest in America, they’re using tools to do blood tests that are primarily full of optics. So if you open the tool, it’s lasers, lenses, mirrors, and so on and so there’s like a clear opportunity to evolve the technology to, you know, to be used in this, these kind of like biotech use cases. And so about four and a half years ago, when we started the company, we saw this this is a pretty, pretty good opportunity because a lot of trends are kind of, coming together in the sense that, you know, like health care is very broken. but a lot of the solutions are very data driven, right? Like solutions that kind of make sense, like trying to fix, you know, okay, let’s take health care and just make it the way it is in Europe or something. It’s very difficult. Right? But if you take a data driven approach, maybe you can get around some of the issues that the health care system has. And, you know, everybody has a personal story of like problems they’ve had with with the American health care system. So it’s easy to think of, kind of problems and sometimes even solutions. But basically that that caused us to focus like, okay, if we can make this happen, it could be something that affects, you know, hundreds of millions, billions of people. and that’s historically just … I think is really important point. If you look at what products have scaled to, you know, to like billions of people to affect billions of people, it’s really not that many things. So like there are manufacturing methods like injection molding, right? Like if you want a piece of plastic or an aluminum can, you know, like stamping. There’s only a couple of things. If you want something very complicated and you want to give it to billions of people, it’s really a chip, you know, like like a camera chip in your phone is $1, right? So like the Kodak camera with film, that would have never happened. It’s just impossible. So the chip industry, the semiconductor industry is amazing at scaling something very complicated. And that’s why there’s, you know, some hope of actually taking that enormous blood test tool that takes up a whole table and miniaturizing it to something you could have on your, you know, countertop in your house.

[00:06:22] Peter Bowes: So I can see what the initial, let’s say, academic challenge was for you. And you mentioned the health care system as you see it being broken. This is something I hear from a lot of people and also the personal stories, the personal reasons for people wanting to do something like blood testing at home, to have a much deeper dive in a much easier way in terms of their own personal, the current status of their health. Was there a personal incentive for you? Because, as I say, I kind of get the academic challenge, but I’m just wondering if there was a personal, almost a light bulb moment for you to want to apply to your knowledge, to this medical sphere and this whole new era of people being able to monitor their own health at home. 

[00:07:09] Michael Dubrovsky: Yeah, I think it’s you know, originally we both my co-founder and I both kind of came into it with slightly different motivation. So because he’s when he did his PhD, my co-founders name was Diedrik. So he did his PhD in Belgium, at like the center. It’s like the big Silicon photonics research center, one of one of the two in the world. And it’s, he he was there like when he did his PhD. There were no commercial products at all. And but when I when I met him, he had already designed like one of the chips that actually traffics, like 50% of all internet traffic. So it was this, you know, his career is kind of like him in silicon photonics have grown together. And so his thinking was like, how do I apply this to the next thing? Right? Like, how do we scale this, do more with it? For me, I because I had a chemistry and biology background and then I had gotten into silicon photonics and photonic materials. I was excited about, like, merging my just my, like, the things that I knew about. Right. So for me, just from a personal level, it was interesting to combine biology, chemistry and these photonic chips. Right? So that was the original thing. It was like some intellectual curiosity. Also, we knew that it was a big market. I mean, these are just the practical things. Like if you’re honest, it’s if you want VC funding, you need something that’s a very big market. Right? So if you make a tool that’s used by some researchers or something that’s typically not really fundable, you have to get government grants or whatever. But if you do something that really affects society, then you can also raise a lot of money for it and actually make it happen. So you kind of it starts to narrow, you know, your scope. And that’s how it started out. But then as we started working on it, you know, more and more got sucked into this whole space. And I had known about it a little bit tangentially. I mean, I have a lot of doctors in my family and, you know, myself kind of have never really had any good experiences with health care. So as we started doing this, we started trying every single health care product, like direct to consumer health care product on the market, right? And having lots of conversations with doctors in all walks of life and so on. And so just got more and more into this, as it was all happening like probably by year two of the company. So a couple of years now, it’s like two and a half years ago, my father got pancreatic cancer. And so I got to go through the entire process of him, like going through the machine. you know, even though, like here in Boston, we have, like, some of the best hospitals in America was still like a really, it’s like, very disappointing experience, I would say. And you could see in all of that how if you’re going to build a solution to this, it’s going to be centered around something more personalized, more convenient and so on. And that only encouraged us to really like focus on like you can actually focus on many different things. if you’re building a blood testing tool. So, for example, the classic story is like Theranos, right? So they wanted to replace the yearly blood draw with a draw that you do at your at your doctor’s office. But in reality, and now there are like three different companies, like legitimate ones that are pretty close to launching something like this. So like kind of like your yearly blood draw, but you get it in half an hour at the doctor’s office. And but you still need, let’s say, a phlebotomist to get the tube of blood and so on. And so that that seems like, oh, that’s sci fi. It’s amazing. But in reality, you still it’s still something that’s happening once a year, probably. It’s still you still get two minutes of your doctor’s time. So there are a lot of things that like, you know, if you plug into a broken system, it doesn’t necessarily you fix one component. You’re not necessarily improving that much. I mean, certainly there’s a lot of benefit to getting the results right away, but it doesn’t solve a lot of the fundamental issues. So I think, you know, when we looked at it, we were much more excited about, okay, what’s really working. And if you look like the companies that were out there, you know, a couple of years ago, it’s like what’s oh, interesting. Like levels health was an interesting one where they’re taking the continuous glucose monitor but using it to help people that are not diabetic. Right. But actually, you know, maybe pre-diabetic or they’re having sleep issues or, you know, they need it for weight loss or whatever. So looking and seeing like what what are the solutions that are actually working like surprisingly well versus oh, like people are pretty dissatisfied. Maybe we can make this a little better or like catch this many more cases a little bit earlier or whatever, versus how do you completely change it. And from our perspective, you know, at home asynchronous, more data driven, potentially AI driven over time that that felt to us like a better direction.

[00:11:28] Peter Bowes: So for people watching and listening to this, who whose interest you have piqued through this detailed background as to how you came to this point, let’s talk about what you have developed. And I have tried it myself, and we’ll talk about my experience in in a moment. But just in pure practical terms, what is it that you have produced? How do people use it and what can they expect from it?

[00:11:50] Michael Dubrovsky: Yeah. so basically so what we’ve been working on, there’s a two, two kind of product thrusts at the company or the major ones. So we have a hardware program where we’re building a at home cartridge. So you can actually see in here there’s a small chip, this black square. and so that that comes out of a silicon wafer like this, and it’s got a lot of optics on it to do blood testing, and it goes in a kind of like a microfluidic system where, where the fluidic steps happen to perform the blood test, the blood test chemistry. So this is not available yet. This has to go through FDA clearance to be used in the home, and in the interim while we’re working on that. So that’s a multi year program that’s been going on. And it takes quite a while to get to market. but you know we’re having some very good results with it. We demoed a conferences and so on. We launched like a more intermediate product, but it still turned out that we could build something that was much better than anything else on the market. So it’s similar to other like home test kits where you get a kit and you, you collect your blood and mail it to a central lab so you’re not getting the result right away. It has to go through the mail. But the the way we set it up is we use a card that actually you put several drops on these windows and it, separates blood from serum. And then this is dried and it has a two week lifetime so it can travel through, like, convenient. you just put it on your mailbox, the USPS picks it up, and then it gets tested for 17 biomarkers. So one of the things we discovered was that a lot of companies like what they do is they look at people are searching like cholesterol tests. Right. And so then they make a kit like this for cholesterol. But you have to go through the whole process of pricking your finger, collecting the blood, mailing it, buying it, like everything. And you just get, you know, two results, you know, HDL, LDL, total cholesterol, whatever. Right. And what we said is, okay, we want to do is we want to see what’s what. Can you really get out of blood testing if you if you try to do like high performance. Right. So we packed as many biomarkers as we could into this one test.  and what that what we found is that people really preferred that because you get all of these results, you don’t have to necessarily even know, like let’s say you might not realize you have a thyroid issue, but if we screen you for TSH, which is like the thyroid stimulating hormone, and we find that that’s high, that then goes down a path of, okay, we found like a root cause issue that would not have been discovered. Like you wouldn’t have known, you wouldn’t be searching thyroid, you know, thyroid tests necessarily. Right. So it’s the idea was let’s just do a comprehensive test because the person’s going through all the trouble of taking, you know, of collecting their sample and mailing it and so on. And that’s been very successful. You know, we have thousands of thousands of people taking tests every month. and it’s growing. And what we found is that actually different people use it for different things. But but it’s, it’s it’s really validated. The thesis that we had that more data is better, more markers is better. And it’s it can also be done at a like a cost that’s affordable relative to other, you know, relative to like the overall cost of, you know, staying healthy.

[00:14:50] Peter Bowes: And just in terms of the practicalities of doing this, this I think for some people would be even though I’ve done it and it is actually quite simple, it would still be quite daunting for some to have to go through the fingerprick the making sure you’re doing it properly. You offer a a real time video guidance for this, which is something that I took advantage of as well. Could you just talk me through how that works? I mean, essentially you’re talking to a real person who’s step by step will talk you through it. 

[00:15:18] Michael Dubrovsky: Yeah. So we found, you know, when we started doing this, actually, I think we launched let’s see, we launched it internally to 30 people about two years ago, and we were taking tests every week. And we found that there’s a big difference between different people, like how easily are they able to collect the blood from their finger and so on. And we really optimize that experience like we’re always optimizing it. That’s something that we’re constantly trying to improve. And so now we have several things. One of them, maybe you didn’t get to try this, but we actually have a tool that you put on your finger that that vacuums your finger a little bit to get more blood to the surface of the skin, and that allows you to more easily collect after, like when you actually prick yourself, you get more blood easily. You don’t have to squeeze as much. But what we did that’s really a game changer is we have as you’re registering your test, you can hit live help and you can immediately talk to somebody and they’ll walk you through the basics of doing it. And once you’ve done it once, that’s the thing we realized because we do repeat testing, it’s worth it for us to do that for free. Because once the person has done it right once, it’s very easy for them to do it again. and that’s something that, like a lot of other companies can’t do because they sell one off tests. It’s not really designed as a repeat testing, service.

[00:16:27] Peter Bowes: So you take your own sample, you send it off in the mail. The result comes in a week or so it took for me to get my results. And I suppose the key question that everyone’s going to be wondering is how accurate are these results when you compare them with traditional laboratory testing, where you go to your doctor’s office and you provide the blood sample, obviously much more blood into a vial. You provide the sample there and then you wait for your results. In terms of and what kind of clinical trials have been done to to validate this, how accurate are these tests compared with those that people will be more used to?

[00:17:02] Michael Dubrovsky: So I think one thing to realize is that when you when you have blood collected for, like standard lab draw, not the entire sample is used. So they’re not actually using the whole sample. There’s a whole business of selling left over samples for studies and so on. So they always collect a very conservative conservative in the sense that more than they need these samples like that, you you sent yours in and so on, they’re all processed on actually FDA cleared analyzers, so they’re not being processed yet on our technology. That’s something we’re working towards. But again, that requires clearance. So we’re just maxing out what’s possible with the FDA cleared tool. There is a, something I mean, this is like technical, but there’s another, agency called CLIA. It’s a federal agency that regulates these tests where you’re mailing it to a central lab. And so that agency has a ton of requirements for validating because we are rehydrating the blood, right? It’s being dried and then rehydrated. And so the the lab that we work with that does this for us. They have to go through a very big validation of every single biomarker, showing that if you take it from the finger versus taking it from a venous draw, you’re going to get the same results if you go through this process versus the venous draw. So there’s a really actually a pretty robust regulatory framework around it. And we’re like all the other companies that sell at home tests. You know, we’re subject to that.

[00:18:16] Peter Bowes: Just to give you an example. And I will stress that obviously I’m just one person. And when I took my test and then a few weeks later had similar tests in the regular way, going to the doctor’s office and providing blood, clearly you’re not doing this at exactly the same time, so you wouldn’t expect exactly the same results. But just broadly speaking, I’m just looking at HDL, LDL, triglycerides, total cholesterol, HDL was within one milligram per deciliter 48 versus 49. So almost the identical results the LDL, triglycerides, total cholesterol, your test was tended to be lower than the laboratory test, about 18mg per deciliter lower for LDL triglycerides, 14 lower 18 for total cholesterol. Again, totally acknowledge that these were done on different days at different times. My behavior in the previous 24 hours will have been slightly different as well. But what it does show me, and taking into account some of the other results as well, it showed me the trends in terms of generally what was high and what was in a in a normal range and what was maybe on a low side of a range. And I’ve only done your test once, and perhaps to make a really sound judgment, you would want to do it repeatedly over, over a period of of time. Is there a just bearing in mind those numbers that I’ve just given to you? Is that kind of typical?

[00:19:42] Michael Dubrovsky: Yeah, I think so. So we have, you know, the types of people that like to use, you know, home testing are often very curious And and they’ll do like these side by side tests. So that happens all the time. the closer they are temporally like we always recommend like try to actually prick your finger at the wherever you’re getting your venous draw done. And then and then the comparison is more direct, especially for something that depends a little bit on how long have you fasted and all these things. but in, in general, if you go to two different companies that do blood testing, this is important. Just like public service announcement, the the industry doesn’t like to talk about this that much. But if they’re using different tools. So there are, you know, big players like Siemens, Roche, like the people who make the machines. Each tool will give a slightly different result for the same sample, and it’s because of the way that they’re validated. It’s a longer discussion. but but basically because of that, there’s a little bit of a blur around, let’s say the ideal cholesterol is 70 or whatever the number is. Well, there’s a blur around that because we’re the studies done with a Siemens tool or a Roche tool. And so it’s not quite as precise as we would like. You know, as an engineer, you want it to be, I put a volt meter on a battery. It says three volts, right. This is the voltage of the battery. But in reality, you know, in the blood testing industry, every tool will give you a slightly different result. And so that variation is kind of built into all of the clinical decision making that goes on normally. And it’s also how you have to view your own results. like that’s something that doctors take into account. And so the ideal thing is using the same test repeatedly over time, because that test will agree with itself a lot better than with like LabCorp will agree with LabCorp better than it will with Quest. And so that because they’re using the same tools every time and And so that in general trends work very well. and there’s enough agreement between labs that, you know, if you have a high ApoB, you’re not going to have a low ApoB at another lab. But, you know, if the if it changed 10% from lab to lab, I wouldn’t view that as, oh, I’ve lowered my ApoB. That’s just kind of the noise that’s that’s inherent in this.

[00:21:48] Peter Bowes: And what is your recommendation for what people should do with the results? So you’re doing this away from your doctor, away from your regular professional health care person. And you are. And you provide a lot of information in terms of the standard ranges, the normal ranges. And people are essentially analyzing these results at home and then interpreting the data and perhaps wondering what to do next if they see something that concerns them. Presumably the next step is to go to their regular healthcare practitioner, show them these results, and have a discussion about what to do.

[00:22:26] Michael Dubrovsky: So it depends a little bit. So, if something is really out of range, like in a, you know, there’s a serious kind of imminent risk we’ll actually call. So we’ll call the person and notify them. We will offer them to do a free venous draw to confirm. So because often if you take the number to your doctor and it’s very out of range, they’re going to say, oh I don’t know this at home test. Let’s just send you to get like a venous draw. So we preempt that and say just go, we’ll pay for it. Just go get the venous draw. So when you go see your doctor you’ll have the number with you. Like they, you know, incontrovertibly this is a LabCorp number. And you know. So that’s – we found that to be helpful, historically. We’ve actually generally that’s always yielded the same thing. But you know the doctor just wants to see it. So it skips you. It skips like a week of back and forth. so, so I think for very out of range values, you want to get that handled like directly in the medical system. What happens is for for values that are not out of range enough, where your doctor will say, well, you know, let’s wait and see basically or this isn’t out of region enough if you want optimal health, if you do your research, you’ll see that, okay, optimal health is actually not this. It’s a little bit lower or it’s a little bit higher, whatever it is. And so we try to provide that context and it’s all evidence based. Just what what’s the best best known research out there. We encourage people to do their own research consult with their doctor. But we provide a lot of data and information that you can you can go as far kind of down the rabbit hole as you want. And then also, we do have coaching where you can, pay for pay $69 to have somebody actually walk through the results with you. and we recently launched another program which is like much more full stack, which is a we call it the Heart Health Blueprint, where you can actually get a full assessment of your heart disease risk. And that includes more like you have to answer a lot of lifestyle questions and family history questions and so on. Blood pressure, waist to height, circumference, waist circumference to high, all these things. So we take all that data and we actually put it through the American Heart Association risk calculator. And we give you like your ten year chance of of having a heart, you know, like a heart attack or stroke versus your 30 year chance. And then you know, you get a full assessment and next steps, which includes if you, if, if you need it, you can actually talk to a doctor via telemedicine service that we work with and get prescribed a low dose statin, for example, or some of the other options. So we’ve gone as far as like for that use case, because it’s so common where somebody wants to lower their heart disease risk. We’ve built like a more full stack offering where you can go straight through the telemedicine. For a lot of the other things. We provide a lot of lifestyle feedback, so we have a whole insight system that provides personalized feedback, like here are the, you know, couple of things that are really well understood that modify this marker and that we’ve had a lot of great results with that, where people can just apply these things. We try to find like kind of like the 80, 20, like things that seem to work, you know, in the studies show that they seem to work for a lot of people. And it’s something that in the end, you have to try on yourself and look at the data like test again. That’s one of the flaws in kind of like these articles that’s like chocolate is good for this or whatever, right? So if you look at the studies, typically what you’ll see is like, well, only 50% of the people in the study benefited from it or whatever. And so are you in that 50%? Well, there’s no way. I mean, there’s no way to know without like at least as of today, it’s very difficult to know without just trying it and testing. And I think that’s the basic version of that is you try something and see how you feel, right? Like as my sleep better or whatever. But I think a data driven approach is even better in some cases. And you can see, you know, like, does this lower my inflammation is my, you know, hormonal health better if I take the supplement or whatever. And that’s something we enable people to do.

[00:26:08] Peter Bowes: It’s about taking control of your own health, isn’t it? That’s essentially what you’re saying. That you’re providing. You’re helping individuals access their own data, and then it’s up to all of us really to decide how to use that data, who to share that data with and to get the best possible advice. And that is the real challenge, isn’t it? And that’s why so many people are confused and you talk about, you know, mainstream news articles about chocolate or coffee or alcohol or this is good for you, this is bad for you. It’s this information overload that we’re getting that is is confusing people. And I think what the challenge for people like you and to some extent for me to try to explain these issues in simple terms, is, is to do that is to break everything down, to make it relevant to ordinary people, because otherwise I think people just get lost and almost drown in the amount of data that’s available to them and become more and more confused.

[00:27:05] Michael Dubrovsky: Yeah. I mean, I think the good news is actually that, like if you look at the discourse, let’s say 10 or 20 years ago versus today, I think there’s quite a bit of progress in the sense that things that are more evidence based, that work that show up in bloodwork, that show up and stuff like that. It’s not only is the medical community getting more comfortable with, oh, this lifestyle thing actually works, right, or whatever it is. But actually, I think the internet is just helping people, you know, the things that have high signal to noise, like like they actually something meaningful is happening. They tend to rise to the top in the podcast world, in Reddit, in all these places where there’s a bit of a competition, like an evolutionary competition, where like, I think a good example of this, you know, the classic example is like, you know, there’s a lot of people giving health advice, but like, why is Huberman so successful? I think maybe some percentage of what he’s saying doesn’t even work. Right. But I think some of the things like I’ll give you a simple example, like the thing with the light in your eyes that’s that just works like, for me at least so if I do the thing he says, you know, this is like what he says on every episode, right? You get up right away, go look at sunlight for five minutes, and it’s going to set your circadian rhythm like I really do. You know, I can objectively, this is this improves my sleep and sleep and wake cycle if I do this. and I think that’s part of the reason that he’s become very successful is, is like at least at one hack is true. Right? And he keeps repeating it. And so I think there is like a meritocracy that exists on the internet. And that’s actually a good thing. Right. And eventually a lot of these things will make it into like more mainstream medicine as well. which is worse at dealing with like lifestyle stuff. Right? Like how do you prescribe lifestyle, right, or whatever. But they’re starting to think about that.

[00:28:49] Peter Bowes: Yeah, exactly. One of the things we hear a lot about in the the podcast world is ApoB, which you’ve already mentioned, a tremendous amount of conversation about that. Could you just, in simple terms as possible, explain why you think ApoB testing is important? Of course, it is one of the tests that’s included in your particular test. .

[00:29:08] Michael Dubrovsky: So so there are two factors as far as I understand it. So I think the person who can really speak on this is our head of clinical product who’s, who’s like a lipids, you know, lipids enthusiast. but I think who might be a great guest also for, for this podcast. But basically, the, the fundamental thing is that LDL like in a big population, you’re, low density cholesterol is is predictive, like it does predict heart disease and so on. But if you start breaking it down, it’s not it’s not predictive in all populations. And the reason is that what you’re measuring, it’s a little bit technical, but what you’re measuring when you measure cholesterol, like the normal LDL, HDL is you’re measuring the quantity of this fat in your blood. So your blood carries, fats, which are used for energy storage and so on. And so it’s measuring the quantity. Let’s say if I take a milliliter of your blood, how much fat is in there? so this, this many milligrams of fat per per milliliter. What it doesn’t tell you is the way the fat is carried in blood is it’s carried on proteins. So these proteins are apolipoproteins. And so the protein that carries the fat, it doesn’t tell you how many of those proteins you have, because you can have one protein carrying a lot of fat or many, many of these proteins carrying a little bit. And it turns out that the stronger correlation to heart disease and other other chronic disease is the number of these proteins that carry the low density fat, the LDL fats. That’s why it’s called ApoB apolipoprotein B. The number of these particles in your in your bloodstream seems to be much better correlated to heart disease. And there’s also some connection to metabolic dysfunction. So if you’re not good at processing sugar, dealing with the sugar control, that’s going to show up more in your ApoB than it does in LDL. So because there’s a lot of interconnection between your heart health, like a chances of heart disease and your metabolic health, and ApoB kind of integrates both of those to some extent. So those two factors kind of in the end, there’s extremely good data showing that ApoB the risk is much better correlated to ApoB than LDL. And that’s been known, I think, for 20 years. But the problem is just there’s a lot of inertia in the medical system. And and LDL has all the really big studies have been done with LDL. all the, you know, kind of like, should I take statins or not? All of that is based on LDL, and there’s good reasons for that. But more and more, the medical community is moving towards ApoB. And certainly if you’re getting concierge medicine, they’re looking at your ApoB. So it’s just a matter of when, not if with that marker. And we’re just trying to bring that day closer. Right. So like let’s get everybody tested. I think the same is true for LP(a) little A which which is a little bit less popular. But that’s another one that’s like a big risk factor for heart disease.

[00:31:51] Peter Bowes: What do you say to doctors in traditional medical systems who say that we’re moving towards a time of overtesting, that we’re doing too much. We’re looking at too much. I did an episode recently about full body scans, which are a very, very controversial. Concierge medicine people swear by them. These days, your traditional doctors say there’s not enough evidence to support them, and the insurance companies don’t support them either. But in terms of your field and the criticism that this could be verging on overtesting. So what do you say to that?

[00:32:25] Michael Dubrovsky: Yeah. So I mean, I think it really depends on your incentives. so, you know, there’s the population level where you’re trying to manage your 300 million person population and spend X dollars to get Y benefit, health care benefit. also the incentives of, okay, we have this much time. The doctor has n number of hours in the day, right? So he’s going to work for eight hours a day. How are we going to spread this time between people. Right. That’s the second thing. And the third thing is how many years is the insurance company responsible for your health? So if you’re staying on the same insurance for three years, year four, I mean, they just they cannot care, right? Like they’re just not they’re financially disincentivized to care about what happens to you in year four. So for them finding an issue, unfortunately this is just how it is finding an issue in America at least finding an issue. Let’s say today that’s only going to affect you in five years. If the average customer for an insurance stays for three years, they have to deal with the problem now, but they don’t get any of the benefit of making you healthier in five years. So all of these factors, you know, are in play. And certainly if you collect a ton of data about somebody, you’re you’re going to get false positives. You know, things that don’t like, especially with scans. You know, I have a friend that did this. He did a scan and they thought they saw something in his prostate. So you had to go to like seven prostate exams. It was very invasive. It’s kind of funny. And in the end and he’s kind of a hyper hypochondriac. So I’m sure, you know it’s made him nervous. He’s like, oh my God, you know whatever. Right. So so there’s all this, there’s actually a there’s a great paper. I don’t remember the name, but it’s like the crossover point where actually you’re hurting somebody by testing them more because there’s your there’s some cost to testing. Right. Like for x rays it’s very clear. Right. You’re getting irradiated. Right. So if you get an x ray every day, you know, at some point you’re actually giving yourself cancer, right. Rather than finding cancer. But I think over time as we get better at processing the data. Right. So so you want to have more and more software, less and less human time to understand the data and the better we are at acting on it, I think then you can handle more data. So I think, you know, is there a purpose to scanning people if you can’t really interpret the data properly? Probably not. Right. But but on the other hand, if you’re doing multiple scans over time, not my expertise, but I think if you’re doing if you have a scan, let’s say from your age, 30, and then you do a scan at 35, you might be much better at interpreting that 35 year old scan because you have the previous one. So you can look at the differences, right? But now if the person’s already sick and you’re scanning them, it might be much more difficult to, interpret. So so I’m I’m in the more data camp. I do think there’s a risk, especially if you have the kind of personality where you get very worried. I think there is a risk of, like, over, over measuring SiPhox, I would say, is all the way on the side of you should measure these things. So if you look at like what’s out there in the market, there are tests that will measure like 100 or 500 biomarkers. And I think a lot of them, it’s really low chance that you’re going to get something out of it. It’s just like a ton of information. And that marker, you know, is very rarely insightful, but it’s just a way of like it’s a vanity number, like we measure 500 biomarkers. Right. But I think the nice thing about what we’ve done is we were limited. Like like we collect very little blood so we can only measure, you know, 10, 20 markers. And so we really went for the ones where if you look at a thousand people and you measure these markers, you’re going to have a big health benefit from knowing these numbers because they’re the ones that correlate over time to all the major, you know, chronic diseases that end up, you know, basically debilitating people and eventually killing them. And so so I think from that perspective, you know, six out of ten Americans have a chronic disease, three out of ten, three out of ten of two. So it’s not like a rare thing or something. And and it’s to me it feels like we’re under-testing like I think every American should, should be getting at least once a year a test with the markers that, that we test like it should just be something that goes along with your yearly blood panel. So that’s my bias take, I would say.

[00:36:18] Peter Bowes: And Michael, what kind of anecdotal feedback have you had from the users of your product? You must have heard stories from people about how they’ve responded, what sort of data they’ve gathered, and how they’ve used that to their benefit.

[00:36:33] Michael Dubrovsky: Yeah, I think a great example. So I can give you two, two interesting examples. one is we used this was early on, so we hadn’t done a lot of tests. And this was kind of the first big one. So it sticks in my memory is we called them Ferritin guy. So we had a guy who came up with a Ferritin, which is the protein that stores iron. It’s ten times higher than normal. And we thought, oh my God, like, there must be a lab error. Like, this is so embarrassing, you know, whatever. And we had him go and test and LabCorp and he comes back, same number. And he went and got diagnosed. He’s a young guy around my age, you know, 35 or something. And he hadn’t been feeling that great for several years. And it turned out he had hemochromatosis, which is a condition where you have very high iron levels. And he had done a bunch of like he wrote us this whole long review so people can go find it and read it. But basically he had been through a lot of like medical stuff and they never tested iron. they never tested ferritin. And basically there’s a simple fix. So now he goes and gives blood. And so he’s basically able to reduce his iron levels by giving blood. And he feels much better. And the important thing is that over time, this is a really dangerous condition that can shorten your life by decades. and a fair amount. I forget what the percentage is, but it’s not a small percentage of people actually have this. It’s partially genetic. and so that that was like a very interesting example where super low cost, I mean, you know, in the scheme of things, very low cost test added, you know, potentially decades of life to this to this guy’s life. And he’s, you know, he has kids. He’s like in the, in the, you know, peak of his life. Right. And this was like a huge unlock for him. I think another very interesting one was, we had somebody who tested for a high ApoB. They ended up going and getting it. But the interesting thing is they had a low LDL, so doing their normal cholesterol test, they wouldn’t have seen anything They tested high in ApoB. They were suspicious, very healthy. So they were running half marathons like fit everything. And so he went and got tested a Cat scan. So the follow up thing to do might be to get a Cat scan, which is a calcium scan that actually looks at what’s in your arteries. And they were so blocked that he basically was immediately told, like, you have to get two stents. You’re like very close to getting a heart attack. So he ended up getting two stents. you know, he’s back to running marathons. Another guy who wrote us, like, a long, you know, saved my life review. but that those kinds of stories, once you start testing lots of people, these things just start happening because it’s, at the population level, there are a lot of people walking around with these kinds of, like, ticking time bombs. I think a very typical one is like early thyroid issues. You know, you really only find out that your thyroid is functional, like pretty far down the line with symptoms. Right? So you’ll see the symptoms. They’re hard to tell apart from general malaise, right. So you’ll only see the symptoms pretty far down the line. So we’ve seen a lot of that. And you know I can keep going. But that’s the kind of category of things that that that we like to see. And we’re excited that okay we’re actually making a difference. 

[00:39:27] Peter Bowes: Yeah. I think it’s really interesting. Michael, this has been a really fascinating conversation in the show notes for this episode. I’ll obviously put a link to the product. There’s a transcript of this conversation. Just in closing, I’m just curious, based on your knowledge and your background and what you’ve managed to do with this product and your aspirations for the future, how do you think about your own personal longevity and the years and decades ahead? And do you live your life in a way that is perhaps influenced by the the knowledge of of this product and the education that you’ve had that’s made it possible.

[00:40:03] Michael Dubrovsky: It’s actually a very interesting question. There’s a joke that we would we had, like a meme that we would pass around internally when we were building the first version, which is like, it’s this meme. I can send it to you later if you want to put it on the screen, but it’s basically how our customers look versus how we look. And the customers. It’s like, you know, these like well-dressed, very healthy people. And we have like, you know, enormous bags under our eyes and, you know, our hair is frizzled and we’re drinking a monster or whatever, you know, so building a startup is like the opposite, you know, if you want longevity, it’s not necessarily the best idea. I also have had two kids, you know, during the time of the startup. So it’s been difficult to manage. But but I actually think that this is my second startup. And if I look at how I’ve been living my life while I do these blood tests frequently, you know, I probably on a monthly basis at this point versus how I would be living if I wasn’t doing them. I will say that it’s definitely modified my behavior and made me get a lot more serious about, you know, what is this? You know, what am I going to look like? I think at my age, right. It’s a little bit different. So it’s really a bifurcation, like some people at this age start to decline and other people actually get into the best shape of their life, you know. So you’ll see guys that like by 40 are like in the best shape of their life doing whatever. So I’m trying. I’m like, okay, how do I go in that direction versus that direction? So I haven’t I’m still I would say fighting that battle. but but my hope so I’ve…  I can talk about this, but I, you know, implemented a bunch of things to try to improve my markers. And also just because I’m so exposed to the whole longevity scene, try to take the kind of like easiest things, like, I look for silver bullets because I just don’t have the time to implement everything, right? But like take the easiest things and try to implement them in my life.

[00:41:38] Peter Bowes: Yeah, all interesting points. And I’m certainly in the in the more data is better camp. And I think what you’re doing is is really fascinating. I’m going to follow it with a huge amount of interest. Michael, thank you so much.

[00:41:50] Michael Dubrovsky: Thank you Peter.