Abstract
As of today, 90% of the Indian population is not aware they are suffering from chronic diseases.People are becoming sicker, heavier, metabolically unhealthy, depressed & infertile.
Cardiovascular diseases are the number one killer with no preventative solutions while chronic kidney disease, impacting 10% of the Indian adult population, is detected at a late stage, resulting in low prognosis, adverse health outcomes & low survival rates.
The incidence of cancer is increasing so much that 104 Indians die of cancer every hour. The progression free survival rate is dismal,< 50% & in case of some cancers such as lung cancer & brain cancer, it is as low as 20% & this is just the tip of the iceberg.
Even those who survive, have to deal with numerous harmful side effects & often develop metabolic diseases, neurodegenerative disorders or suffer from kidney & liver damage.
The more people spend on healthcare, the more their health deteriorates. The more specialists healthcare system has, the more the health of people deteriorates.
While people may say that the current healthcare system is broken, the fact is the healthcare is not broken & it was designed to address acute care & episodic diseases. It does a great job in curing them using noble inventions such as antibiotics. However, our healthcare system was never conceptualized & developed to address chronic diseases which currently plagues 90% of the Indian adult population. In fact, the very solutions to cure episodic diseases is one of the core reasons for onset & progression of chronic diseases.
While people started developing these lifestyle diseases over time( 1980-Present), our healthcare system lacked access to technology that can study molecular & cellular biology in order to identify changes in biochemistry before disease onset.
What followed next was a series of research & clinical studies conducted by researchers & healthcare practitioners using the primitive & intermediate technologies to study & analyze the blood biomarkers related to post disease symptomatic outcomes( mostly on males with miniscule female representations). The data & inferences from these research studies paved the way for development of plasma level diagnostic tests & investigations that gave postmortem or summary of biochemical processes. These plasma biomarkers, which are just the outcome of certain imbalances in an Individual’s biochemistry( which are the results of years of systemic inflammation) but not the underlying cause, becomes the key reference point for healthcare practitioners including nutritionists to deliver pharmaceutical or generic nutrition intervention strategies to manage those post disease symptoms. However these interventions bring a lot of collateral damage as it disrupts the human microbiome ecosystem & causes dysbiosis which further triggers more disease symptoms leading to more drugs & non-scientific diets. What happened next is a vicious cycle.
The changes in biochemistry, preceding onset of disease, occurred decades ago with chronic inflammation while these signals are invisible & cannot be identified by the plasma level diagnostic tests. In essence, the healthcare system waits an individual to be sick & then treats to manage these symptoms, making patients life time subscribers.
The practice of managing post disease symptoms using external man made chemicals to inhibit a particular or series of biochemical functions has transformed the healthcare system into a financial model.
While the current healthcare system may boost of huge healthcare delivery data (plasma level diagnostic data, wearable data) to the tune of 10^24 collected & analyzed, the interventions derived from these non-actionable data sets just manages & suppresses symptoms, it does not goes to the core of range of chronic diseases & cancer.
The beginning of the disaster
With democratisation of retail diagnostic tests, blind faith in doctors & subscription to generic interventions based on non-actionable healthcare delivery data to manage the post disease symptoms alongside over consumption of ultraprocessed foods, external chemicals, packaged foods,high workplace & relationship stress & environmental toxins, the disease management market propelled to US $ 14 Bn( INR 1.16 trillion).
Low barriers of entry & lost focus on regulatory approvals coupled with advent of technology & “the startup wave” attracted young entrepreneurs to enter the so called “ digital healthcare arena” to grab a pie of this mammoth disease management market.
These young entrepreneurs raised millions of dollars from Indian VCs by selling the “ TAM story”. The business models of these VC funded healthtech startups were copied from the west & had just an app, some wearable stuff & a plain website with a false hope to reverse obesity & type 2 diabetes. For a number of startups “diabetes reversal” became their most prominent punchline while others became distributors of diagnostic tests, human DNA tests, doctors appointments, medicines, health supplements, probiotics, fad diets, fitness solutions, & even listing of surgery services. These startups were classified into varied business models as detailed below:
A) Market place/e-commerce models: The early entrants to digital health were startups who built market place models to list diagnostic tests offered by various labs, medicines( pharmacy), health supplements as well as doctor appointment tools. This was the most ideal choice of building a healthtech business without much investment into the human biology knowledge ecosystem. The most absurd model was listing surgery services. However, such businesses cannot be called “healthtech startups” just because they have a website or an app & listing some healthcare practitioners, supplements or tests. There was not a single element of healthcare which could deliver some value & positive health outcomes for consumers. Most of these companies were nothing but an extended marketing arm of existing healthcare players be it doctors, hospitals, supplement companies or clinics. Even today, these startups are categorised as healthtech startups. Quite funny! These models spent huge marketing & customer acquisition costs while LTV was dismal due to low recurring revenue, lack of data driven trust & miniscule health outcomes.
B) Subscription Models: Startups working on subscription or pay as you go models included those offering generic nutrition advice coupled with nutritionist/health coach consultation. This model was further extended to
- Wearable purchase + subscription & disease reversal programs (99% were type 2 diabetes reversals, we know there are a bunch of them) when startups started offering wearables & continuous glucose monitoring machines to suppress Hba1c, blood sugar levels &/or track HRV levels. Again these startups were just suppressing type 2 diabetes symptoms once an individual develops this metabolic syndrome. It just made patients spend additional 15k to 18k per month without any positive impact on their health. In essence, these companies were new additions to sick care markets that made money by keeping people sick.
- Fitness companies that offered workout + diet plans on monthly subscription models. These companies lacked scientific evidence, delivered generic nutrition interventions based on population studies & were just focussed on suppressing weight. Some of the fitness companies also started offering wearables( smart rings) just to track heart rate & HRV, but were not able to deliver any precision interventions to regulate these markers. The interventions were restricted to calorie deficit, high protein diets & too much weight lifting with the objective of just reducing weight.
The unit economics for these business models are far away from optimal with high customer attrition rate & minimal health outcomes.Since these models do not focus on addressing the disease from the core, the healthcare cost showed an upward trend
C) Plasma level diagnostic testing companies: With increased incidence of lifestyle diseases, the healthcare practitioners driven demand for diagnostic tests has skyrocketed. However the healthcare delivery derived from these tests just tell you the state of your symptoms & cannot identify the underlying cause of a range of diseases. Besides these tests suffer from range of structural & functional issues
- Each of the tests goes through more than 140 steps before the biological sample is transformed into insights. These steps include how the sample is collected, how it is transported, at what temperature it is stored, how it is shaken & the list goes on. If any of the steps is poorly performed, it could directly impact the results so much so that results of two different labs of the same test for an individual would have atleeast 30% variability.
- While diagnostic testing labs may claim that they hold requisite accreditations that establish an element of trust, it is important to note that the accreditation is given for quality control efforts for the processing of samples, but does not guarantee efficacy or authenticity of results.
D)Human DNA Testing companies: Sequencing DNA has picked up since 2019 with certain research articles claiming that DNA can tell risk of certain disease & help prevent diseases. This again is short in the dark as any two individuals share 99.8% of the DNA & genes just tells your potential for a disease. DNA does not translate into function. Until you can sequence what genes are being expressed & what proteins are being coded, it can never prevent diseases. No wonder the human genome project which started in 1990( in the US) has still not been able to deliver any preventative solutions for chronic diseases.
The VC Dilemma
While millions of dollars were poured into each of these category of healthtech startups based on huge market potential, the performance has been far away from optimal on multiple fronts:
- Operating in this huge disease management market dominated by healthcare practitioners, clinics & nutritionists is tricky. These startups with huge money at their disposal started acquiring customers through digital advertisement without any focus on creating value for healthcare practitioners( vendors/partners) & never delivered positive health outcomes. No wonder they are plagued by low LTV & high customer acquisition cost.
- Lacked focus on understanding human biology deep down at molecular level.
- The initiatives never included data driven clinical insights that could establish trust & lacks relevant intellectual property(IP) that can fetch higher valuation at the time of divestment.
The way forward-Disruption in preventive healthcare
India desperately needs a revolution in healthcare. After having burnt millions of dollars & betting on these no science- no tech startups that just treated human body as black box & resorted to primitive calorie counting & fad diets, VC(s) should look at financing innovation & disruptive models that can bring a paradigm shift in how we measure our health using predictive & precision interventions.
There is an urgent need to develop an alternative healthcare system that focuses on studying human biology at molecular & cellular level in order to move from irrelevant healthcare delivery data to actionable molecular data.
With the advent of exponential technologies, it is now possible to collect, process, analyze & interpret molecular data to understand what is happening inside the body at molecular level & changes taking place in the human & microbial biochemistry decades before any disease develops. Transforming human biology into a molecular data platform would enable healthcare practitioners to find answers to the questions which were not possible earlier.
-What genes are being expressed?
-What an individual’s gut & oral microbes are doing?
-How microbes sense, interact & absorb various food substrates & what genes they express?
-What metabolites are secreted & what proteins are coded by that gene?
-How these metabolites stimulate immune response?
-What specific metabolites trigger inflammation & overexpress certain pro-inflammatory cytokines?
-What neurotransmitters & hormones are being produced?
-How efficiently mitochondria is producing energy?
-What stimulates mitochondria biogenesis?
-How to maintain the electric potential of the body?
-What biochemical signals travel from mouth, gut to other parts of the body
& the list goes on
The molecular & gene expression so analyzed for every individual could help the healthcare system predict & early detect various chronic diseases & cancer & deliver interventions that can bring the body back into homeostasis.
These huge molecular data sets could be a great driving force to improve the health of individuals at one hand while generating huge revenue & investment multiples for VC(s).
The future of preventative healthcare is right here!
