Healthcare: The Next Big Thing

Each year, around €7 trillion is spent in global healthcare which accounts for approximately 10% of worldwide gross domestic product (GDP). While being a major economical challenge, it’s also an opportunity to renew, transform and innovate in the healthcare domain. The pressure to fundamentally enhance productivity in healthcare is unprecedented.

This need calls for disruptive innovations. Innovations that transform the core elements of healthcare. Innovations enabling a major impact in the areas where global health challenges occur. In addition, a new way to build and manage start-ups is required.

This article is the first in a series to be published in Horizon 2020 Projects: Portal where a Finnish blood biomarker analysis start-up, Brainshake Ltd., is followed for a year. Brainshake Ltd. has developed a unique blood analysis technology that analyses around 230 biomarkers from a single blood sample. The series will provide opinions, experiences and the progress of our ambitious journey towards the next big thing in healthcare.

Blood biomarkers at the core of healthcare

Blood sample analyses are the basis for 70% of healthcare diagnoses. The biomarkers provided by the analyses help doctors understand the status of health and disease. The status of many chronic diseases such as heart disease and diabetes in particular can be monitored through blood biomarkers. However, the amount of routinely available blood biomarkers is limited due to technological and cost limitations.

If routinely performed blood analyses would provide more biomarkers i.e. biological data, the ability to understand health and disease would improve. In general, it’s like any decision making process; the more appropriate data there is, the better the resources to understand and decide. This is particularly applicable when aiming to achieve predictive and personalised medicine – the two key elements defining the new era of healthcare.

The new era of predictive and personalised health

The more data there is on an event, the stronger the prediction can be. This is clearly shown in multidimensional systems like biology, but also in man-made systems such as healthcare. Therefore, given the amount of digital data in the world, it’s no wonder that many advanced analytics companies have been raised to provide data driven insights to various global challenges, including healthcare.

Predicting disease and health without biological data is very difficult or impossible. If the available data is not relevant, the prediction is vague at best. In other words, having a lot of relevant data, rather than just any data, creates the foundation to understand and analyse complexity.

Metabolic blood biomarkers are highly relevant for understanding key chronic diseases like heart disease and diabetes. For these two diseases, the current clinical practice routinely captures five biomarkers: HDL and LDL cholesterol; total cholesterol; triglycerides; and glucose values to diagnose and treat patients. Even though these biomarkers provide a baseline for diagnostics, it’s also scientifically shown that more extensive biomarker data would take the understanding to a new level. Especially when aiming to predict future disease events, having 230 biomarkers instead of five makes a great difference.

The same applies to personalised health. The trends in population studies shown by the five biomarkers are relevant in population, but provide very little information on individual health. This can be explained by a lack of data. When people are categorised according to these five biomarkers, only a few categories are created as the data would not allow a more distinct separation. In each category, average treatment for individuals is provided based on the category.

However, if there were data for 230 metabolic biomarkers, the number of categories would be very large. Each category would be a distinct combination of values of the 230 metabolic biomarkers. Individuals would belong to one of these categories based on his/her biomarker profile and personalised treatment could be provided.

Without the appropriate tools to predict and personalise health, the current clinical practice has been forced many times into a reactive and general approach. Bringing these new tools to global healthcare is one of the key steps to reach the new era of medicine.

From potential to impact

Potential is a key concept in any technology development. However, maintaining the right balance between potential and actual impact is important. In healthcare, large scale global impact fundamentally requires addressing the biggest health problems with technologies that are compatible with the current clinical practice, the expertise of medical doctors, and can be made available and affordable on a worldwide scale.

Heart diseases are the main cause of death in Europe and worldwide (four million and 15.5 million deaths respectively). Diabetes reduces quality of life and causes premature death among 415 million diabetic patients worldwide. The financial costs of these metabolic diseases amount to €352bn annually in the EU and USD 1.3tr (~€1.1tr) worldwide. Metabolic diseases are not only a global health issue, but a major challenge in the global economy.

Brainshake Ltd. has developed a unique blood analysis technology that analyses around 230 biomarkers from a single blood sample. The biomarkers are compatible with the current healthcare system and the technology can be scaled globally. The price for an analysis panel of 230 biomarkers is similar to the current and routinely used lipid panel, which provides four biomarkers. This is over 50 times more biomarkers with a price around 20 times more affordable than the solutions available in clinical practice today to provide the same biomarker profile.

There are no silver bullets in healthcare. No drug, genomics method, lab-on-a-chip technology or analytics tool will provide a single explanation to health and disease. It is rather a combination of different technologies that will contribute to the biological understanding of the immense complexity of human biology.

A disruptive impact to healthcare is created when leading technologies mature to a level where they can be affordably integrated into the existing global healthcare system. From the very beginning, this has been our vision at Brainshake Ltd., and we believe we are on the right track.

Science, technology and innovation

Brainshake is born from science. There are more than 100 scientific articles applying our method published in the top biomedical journals. We have chosen this transparent strategy intentionally. Instead of internal stealth research and development, we rely on international scientific peer review to validate and scrutinise our technology.

We believe this is the most creditable and ethical way to introduce new technologies for the medical community. It has also been an immensely important and continuous development process for our technology. It’s hard to imagine a more demanding evaluation than one from top scientific peer reviews – perfecting a technology to pass these evaluations creates a win-win situation for everyone.

The key enabler to start the technological development process at Brainshake Ltd. was the Finnish innovation system, which provided a highly supportive and fast start for the commercialisation of our Finnish university-born technology. It is a very capable concept; a successful scientific development phase typically creates a very high potential. However, turning that potential into commercial value is an entirely different challenge, requiring an entirely different expertise. Acknowledging and supporting this transformation is an elemental part of an innovation strategy.

Successful transformations during the early stages in commercialising an innovation are crucial – the success or failure of a start-up is typically defined in those early stages. Original innovators, business experts, funders and customers all set their specific requirements, which undergo continuous change according to business stage and success. In technology start-ups the major challenge is in the transformation of the technological dominance of the early stages into scalable business strategies and decision making. Conflicts are all but impossible to avoid.

However, having a balanced ownership structure, a shareholders’ agreement and funding instruments that enable forward-looking decision making from the beginning helps a start-up to quickly transform. Crucially, having business professionals who build an ambitious business-driven roadmap will help achieve the full potential of the innovation.

Managing the intangibles

Many start-ups are created by generations born in the late 70s or after. Often they are not raised by corporation management or academic meritocracy. The start-up community is nurturing the next generation of thinkers and leaders. For them it’s not about ‘what’s in it for me?’ but rather ‘how do I make a difference around me?’.

When people expect more than money or fame, the management principles need to change. There are two important concepts that we have been focusing on whilst scaling up Brainshake: risk and power.

While traditional risk management aims to recognise, diminish and avoid future risks, it also mitigates the opportunity of the unknown and the unreasonable. World-changing innovations are rarely foreseen by experts, and history tells numerous stories of failed predictions by philosophers and visionaries. Predicting the future, rather than trying to create the future, often leads to larger risks.

Emphasising risk management compromises one of the key drivers in start-ups – fearless acumen into the unknown and the unreasonable. Without this characteristic, even the best start-up transforms into another company.

Managing employees to do their tasks is a straightforward job. There are also multiple means to build better working environments and compensation packages. However, when aiming to achieve something extraordinary, this is just the baseline. What is needed is commitment, which is often considered as an individual characteristic, but this is only true in part as commitment can be managed by creating intangible value. The process consists of many parts, including engaging with people about the future, strategy and results, but, and most importantly, it is created by people.

To achieve this, management needs to change the rules of power and this cannot be done from the top down. Empowering people to contribute to company operations beyond their job descriptions, and asking management to take a step back, gives employees the opportunity to make a personal mark.

Funding opportunities and challenges

The European funding environment is very challenging for ambitious start-ups. Many European investors have risk-driven thinking, differing from the opportunity-driven American and Chinese venture capital. Generally, the first priority for them is focusing on whether the product is worth making, whilst in Europe the discussion is easily steered to operative financials.

Intuition says month-to-month financial performance and a solid bottom line are the foundation of a good business, but when aiming to build the next big thing or grow rapidly, this strategy becomes a burden. Investments that are too small drive already under-resourced start-ups to utilise money in supporting current operative business, leading only to organic growth – meaning short-term revenue and profits. While the best start-ups may excel in this, it is mostly a missed opportunity.

In contrast, the opportunity-driven strategy aims to invest a larger part of each euro in growth. In this scenario, large net profit is a sign of not utilising all the available resources necessary to growth. The venture capital investments are used to build the fastest possible revenue growth strategy in the long term, rather than optimising the short-term bottom line.

Venture capital aims for the opportunity-driven strategy. However, what really defines the strategy is the actual amount of money and willingness to take risks. The investment needs to cover the operative requirements, but determining the scale and use of the investment should be based on building new growth. The risk in this is obviously larger, but so is the opportunity. This should be the primary point of venture capital.

Brainshake has selected a growth strategy utilising both approaches. The seed phase of the company has been funded by operative cash flow, non-equity investments and development funding from the Finnish Funding Agency for Innovation (Tekes). The organic growth over three years has been strong, but scaling the business to its full potential with this approach is not possible.

Therefore, after demonstrating the potential of our technology, we have moved to an opportunity-driven growth strategy and are currently raising ‘Round A’ equity investment.

What’s next?

Many perspectives need to be considered when aiming to scale a start-up to global success. Great products, the ability to make an impact, technology, management and funding all need to be in great shape.

This is defined in relation to the prevailing status of our company, which changes on a more-or-less monthly basis. Almost every month brings opportunities that can be true game-changers, re-arranging the perspectives once again.

Acknowledging and appreciating the dynamic and complex nature of a fast growing start-up is vital. Brainshake has been balancing its operations in this environment while continuously learning from the feedback. Learning and transforming quickly keeps our company alert, keeps us focused on our goal to build the next big thing in healthcare.

The article has first been published on Horizon2020.

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