#451: A new biomarker for depression? Ben Finlay

Speaker A: We've normalized the guesswork in mental health in ways that wouldn't be acceptable in other therapy areas. Chronic depression manifests and remains untreated in adult life. You double the mortality risk and you double the chance of developing Alzheimer's or Parkinson's. The only thing that separates these conditions is time.

Speaker B: Hey, everybody. This week I have got Ben Finley. And I've known Ben for a long time actually from when you were at Publicis. Uh, but you've been at Medtronic. Uh, you are now a partner at Strat. You are an advisor to Romva. AI. Don't get that, uh, confused with Ranvia. It's not Ranvia, it's Romva. Uh, and we're going to hear about the origins of that. Um, but yeah, looking forward to having you on, man. It's been a while. Um, and yeah, it should have got you on a long time ago, but it's taken us, it's taken us this long to find a time.

Speaker A: You're a busy man indeed. No, it's great to see you, James. Thank you. And um, yeah, we began chatting, I think in 2019, pre Covid. And I think it's one of these relationships we've had which is never come face to face episode, the next episode we could do, you know, on the couch.

Speaker B: Let's do it. Let's do it. Um, yeah, looking forward to getting into this one. So, I mean, give us, give us the whole story because I think there's a lot here. Obviously there's, um, drug development stuff in your history. There's Medtronic in your history and yeah, obviously then publicists and getting more into my world of things there, um, on the communication side, the consulting side, more that you were part of, I guess, and moving into what you're in now. So why don't you, yeah, why don't you start at the beginning and just give us the whole, Give us the whole journey.

Speaker A: Absolutely, yeah. So I think, um, it's fair to say I wasn't really academic as a kid. Right. So I kind of left school, um, you know, pre university. So I went straight into employment and I was lucky enough to find, um, a role in clinical research right. In the lab. And I think I owe a huge debt of gratitude to a person called Bob Johnson, who was head ah, of the lab. And he spotted me and said, you know, you really could go a bit further with your sort of, um, you know, inquiry into biology and your interest in science. So he actually encouraged me to go to uni as part of an Undergrad sponsorship scheme. So um, I do owe ah, a lot to Bob for that phase of my life. And um, yeah, and I think you know, learning the ropes of lab research gave me a good grounding in evidence based approaches. And then I spread my wings and developed a interest for a field based role. So I joined Medtronic, um, to look at market access for complex um, and novel devices at the time. So this was the early 2000s, um, and learning how to raise awareness, learning how to enable access and get novel therapies into market was again just a huge learning experience for me. And it was during that period, um, around 20 years ago when I met um, Nick Patel, who was just about to be a certified consultant in neurosurgery and come full circle 20 years later. And it's Nick who I'm now supporting with um, the Ranvier AI business. Yeah. And in between then and now, I've set up my first Digital Agency in 2008. And this was the era of just about when the iPad was being released. Um, so you think about pharma life sciences, you think about commercial laws, excellence, you think about medical scientific education. A lot of what we were doing then was preparing large pharma companies to go to market with the right information, the right evidence points, the right talking points to really look at increasing share of market. Right. Or increasing the scientific knowledge of a given therapy. So you uh, know the red thread throughout all of this has been, you know, my, my passion for evidence and my um, desire to create meaningful work that helps to improve health outcomes. Yeah. And then, yeah, I did a very nice stint at uh, Publicis for around eight years. I was the chief innovation officer looking at Martech and Marcoms, but more broadly looking at service design, service innovation and how you can connect novel data sources with unmet um, patient needs. And then actually, you know, kind of I call myself the Robin Hood of Farmer at the time where we were taking funding from big pharma companies. Right. And helping to use that funding in ways that helped communities. Um, so we were building preventative care services for the aging population, we were building supportive care services for complex medicine or building tools that help to identify rare disease patients in a microscopic proportion of the population. So yeah, I've had a long and varied career but really I think all roads do lead to this point where now I advise companies on how to get to market with responsible investment in technology and data and people and help get products and services and therapies into the hands of patients that need it the most.

Speaker B: Great story Man, Um, loads that we can talk about. The first thing that jumps out actually, from what you've said, it feels like you've been a little bit ahead of your time in some, in, in some areas you mentioned there, like preventative care services, um, and you mentioned connecting data to patient needs and all of this stuff which, you know, you mentioned those two things literally today and you're like, oh, yeah, was thinking about doing these things, you know, years and years and years ago, like that, that, that it feels, it feels very, I guess ahead of the time. And I mean, it wasn't to some extent in that, of course there were companies doing this in a certain way. But you being in this sector and your technological areas and your areas in healthcare, the world's changed a lot. Right? Like what you can do today in a single prompt is very much what companies that I imagine you are part of were taking weeks, months, years to do. How does it feel to have kind of lived a career through that? And how do you keep pace with everything that's going on?

Speaker A: Well, I think keeping pace, that's a challenge that will never leave us now that we have any number of LLMs at our disposal. Um, it's a really interesting observation, James. Ultimately, we were building novel approaches and concepts of trying to do things differently. Yeah. 10, 15 years ago. Um, and I think, when, I think back to 2014, 2015, we began building fairly complex language models within healthcare back in those days. Really?

Speaker B: 2014.

Speaker A: Yeah, yeah, yeah, yeah. So, I mean this, this goes back to the, to some great people I work with back at Publicis and specifically within, Within Sapient. Um, these guys, those guys were ahead of their time. Right. Uh, you know, and, and ultimately, you know, it wasn't as finessed as it is now. Right. We were literally sellotape, Blue Tape, Blue Tack, sticking together different modules, which when IBM, Watson for Health was a thing. Right. Uh, I've been working on very large data sets then, and this was before Nuance was acquired by Microsoft. So we were stitching together, uh, inference engines and ontology mapping from Microsoft, Google, AI servers, um, and putting together these systems just to see how it could work. Wow. Right. And one of the biggest questions we had in those times was around, um, the device that you interact with.

Speaker B: Right.

Speaker A: Whether or not we should be building or partnering or borrowing, um, a device to then distill and, um, communicate this novel AI experience through. Unfortunately, back in those days, we actually did decide not to invest in hard tech and go down the sort of the platform and the OS routes. So through people's phones. A really funny story was when we were doing some remote co design with physicians, um, you know, to understand what they might need from an AI assistant. Um, we shipped I think like 30 individual mobile phones with ah, an innovation manual that was guiding people through. And um, you know, we gave them this phone for a few days and said whenever you have a request just press the button, just ask this thing and we'll log it and we'll respond to you. But we're just looking at data, just looking at data. And we received like 516 data requests over three days from 30 physicians. And it was like, you know, what's the dosing instructions for this therapy? Or where can I get an X ray booked in automatically? Or how might I integrate with pharmacy for a request. But one of the funniest requests was um, from a really, really entertaining doctor in Chicago. His only request of information on this app was is chicken a fish? And it was, and obviously it was a dietary related question I think also related to a certain faith group. And actually it was one of those examples where tech and the availability of a new service isn't always about prescribing information or a dosing instruction or a uh, limitation of what's on the label. It's actually sometimes about lifestyle or in the moment. How can you help me solve a question I have for a real patient need and how can I guide someone on for example fasting. Right. Or other dietary requirements that might be super important to someone but actually it could affect when that person takes the treatment or if they take it, uh, whatsoever. So I think the idea of experimenting with novel um, technology and different approaches, it's just been in my blood. Right. It's just been probably part of my restless nature. Um, I've looked at things and thought that doesn't interest me, let's do it differently. And, and that was one of those projects back in, back in those days. So I think that you know, it's, it's having the ability to, or having the freedom to operate differently is one of the best aspects about um, I think my role, the roles I've had and being able to give um, honest thought to solving the same challenges but in different ways.

Speaker B: Yeah, this is great context for the world we live in now. And actually you being part of that development of this stuff, I find this stuff fascinating. Before I just ask you a question on that though, it does remind me of a story actually. And we talk about technology taking over our lives and in medicine this reminder that we are Human. And we have these very human type questions that we want to ask of AI or, or perhaps to ignore it completely. I remember my GP supervisor, I was, I was a medical student and I was sat in their GP practice and they, someone came in with uh, uh, and I think it was an ear infection, but I can't quite remember it was, it was, I think it was an ear infection. But anyway, they didn't prescribe the inverted common, usual or best medication. They prescribed a different medication. And I, you know, as a medical student, the one thing that you do know is you've got book knowledge, you don't have real life knowledge. And so I then pipe up at the end of the consultation and they were super, lovely, super lovely man, Martin, his name was, um, and he said he was waiting for me to ask the question, you know, why, why have you given this when the gold standard is this or nice guideline says this and I'm, you know, reciting all of this nonsense, uh, to try and impress him. And he said to me, uh, because she prays five times a day and actually the medication mapped to her prayers. And I was like, oh. It was like one of those moments that's, that's just so fundamental to your learning as a person of this is how the world works. Like, this is how. This is my, this is me having a very expansive moment of ah, you can't learn everything that you need to learn in a book. That is not how the world works. It does remind me of that, of how this constant reminder of however much technology there is, there is so much to be said about experience and being a person and actually that trumping a lot of this stuff. But actually, you know, in the modern world, plot twist, can you actually write that stuff into AI so that it prompts you to ask those sorts of questions. And I think that's even more of the world we're in now. But the question I have for you, of what you talked about there in those development days of stitching that stuff together, I see this a lot of technology actually of the way that we seem to move forwards in technology. I can remember trying to build A website maybe 15 years ago, 20 years ago, was all about what you kind of just described. It was piecing together all of these different things and you had to learn about DNS and C name and A records and you had to learn about all these things and you had to piece them from different places and you had to do a bit of coding yourself and there was no drag and drop WIX or Squarespace, these things didn't exist, but they came in right then WIX and Squarespace come in and they go, right, we're now the one platform. You don't have to do any of that now. You just do it in this one step. And it's. And it's funny that that seems to be how the world seems to work. I co say coded. I did not code anything, but I with Claude, I built the other day a uh, for this podcast you can go on the health podcast.com and you can now click on AI search and the AI is going to search all of our. You ask it a question, it's going to search all the histor or transcripts of the podcast and it's gonna tell you which episodes that your question relates to. It's going to give you the quotes and the comments of exactly where you can find that info and you can just click the links and it'll go straight to that point in the episode. It was a full day of working with Claude and GitHub and Deep Something and like it was five or six different platforms, like all this stuff. And I was like, why can't Claude just do it? Like, surely Claude will just be able to just do it at some point. Um, but it's funny, like that's how I think now that I can see patterns. I've been in this game long enough of like, ah, uh, what, what a good thing. If I productize that and just did it all in one platform, then that becomes quite interesting because it's better for people to do. My question for you though, in those development days is that when you were stitching all that stuff together in the same way that I was just with that AI search thing, were you, were you doing it commercially? Like, what was your driver to do? Who are you doing that with in your career? And what was the driver behind it? Because I can remember IBM, Watson, I can remember these different things and it all, it never really clicked with the health care space, I don't think. And we saw that in kind of the outcomes of it and what ended up happening to it. But yeah, what was, what was your, what was your place in the history of it? If that makes sense as a question.

Speaker A: Yeah, I mean the majority of innovations that I've been lucky enough to, to be involved in or lead have been a result of or. Sorry, have been the result of an intention of a company. Right, Right. So typically a small to medium or medium to large size pharma, they want to do something novel, they want to do something different. Um, and this is where we're sort of juxtaposed with improving health outcomes, you know, versus the self interest of a corporation. Right. That there is a fine balance here.

Speaker B: Interesting.

Speaker A: Between those two things. Um, you know, ultimately what companies try and do in the health and life sciences space, whether you're a drug maker or a service provider or pharmacy or similar, what most companies are trying to do is to gain or protect market share. So it's competitive by its nature. So we would normally take professional service fees and use that to then go look somewhere different, go and find a novel or differentiated approach in a service or a particular digital experience. So the commercial side of it has historically been sponsored by companies and you know, long way that continue. It's great. Yeah. Um, but as you mentioned earlier, we are now, uh, we're almost normalizing the execution layer of digital. Right. We're making accessible so that interns or undergrads or younger. Right. Can uh, with very little experience, create what looks like seemingly intelligent experience layers. Right. Of connecting things together. That was unimaginable 15 years ago, probably even five years ago. It's unimaginable. Right. But so we're now democratizing what it takes to get to a credible looking experience. The real finesse comes in the plumbing and the piping. Right. And understanding how, you know, why you might have made an experience a certain way. It must always be tied back to unmet human needs, otherwise it won't get adopted. But crucially also has to have the right kind of interface with data layers, the right interface with security, the right interoperability, so you become able to operate across physical borders or across jurisdictions. So the one observation I've had over these years is commercial sponsorship of projects is great. Um, but it's a bit like global conflict. What if everyone just fought for the same thing, like to get to the moon quicker, everyone pooled resources. That would be fantastic. It's not going to happen, unfortunately. But in healthcare it could. Right? What if we got partnerships with major pharma and rather than Novartis doing a deal with Anthropic and Novo doing a deal with OpenAI, maybe there's a shared data platform where we still maintain competitive factors, but perhaps for rare disease you're pooling data because it's so hard to find patients in those sectors. So uh, I would like to see a shift in the way that health and life sciences operates to be a little bit less self centered. That would be great. It's a little bit ambitious, but actually if you think about it. More and more of our decisions are being made on data and data quality. If you implement data standards and then increase the volume of data by partnership, by law, you typically will have better results. So I think there's a move coming in the future which will see more and more collaborations, a bit like Flatiron and Roche and whatnot. And we'll see hopefully that impact the end user or the patient or the family caregiver or the people close to those taking therapy. So yeah, um, it's traditionally been commercially sponsored but actually I do wonder if there's ah, an intermediary layer that's going to emerge which sort of specialize in maybe LLM data, you know, across platform and that could then be used to sense, you know, sense the require the inquiry from patients and consumers using LLMs. Right. Because more and more people, I think over half of inbound inquiries to large pharma now come from language models, not search engines.

Speaker B: Interesting.

Speaker A: Over half, um, over half. Over half of inbound inquiries from both consumers and um, healthcare professionals.

Speaker B: Wow.

Speaker A: They originate in a language model of their choice. Uh, so now pharma is having to look at language model optimization, look at uh, ways to integrate a more seamless or frictionless flow within language models. Right. So if they inquire about a replacement inhaler within Claude, they get served the nearest opportunity to resolve that requirement within claw. They're not being, you know, directed elsewhere. So yeah, I do see certainly enterprise, the opportunity for enterprise grade partnerships that could help, um, you know, pool data, uh, and improve the availability of choice and improve the decision systems that sit behind better health, health choices.

Speaker B: Couple of questions on that. Um, um, I want to move on to actually talking about the companies you're involved with. The two, yeah, uh, the two things you're evolved with a bit more specifically in a second. But what needs to happen to enable that? You've got big companies that are trying to maximize shareholder value. What is it that unites them in this single goal that we all then pull towards? Is that a vision thing? Is that more of a practical what is the deal type thing? Is it segmenting like their territory a bit more so that, okay, we've got this new collaborative. But you play here commercially, I play here commercially. I mean is that even legal? Is that a competition's authority thing? I don't even know. Like what, what. Yeah, what, what actually helps with that? Uh, that's like saying how do you get well placed?

Speaker A: But. Well, yeah, it's going to be difficult, right? It is difficult, but I Think it's more of an aspiration and a guiding concept than anything else. Um, you know, you're never going to have Novo and Lilly playing nicely in the glp, right?

Speaker B: That is very true.

Speaker A: But, but, but, but you might have, you know, for some novel treatments, for some super, super rare disease that require precision therapy, um, pooling of that data, um, between competitors might help identify those that need the therapy the most. The thing that comes to mind is, and this is not a solution, by no means do I deserve a seat on the who, but if you think about the FHIR regulations, the FHIR regulations across, um, health systems across Europe and parts of the developed worlds, um, we have templates, we have standards for interoperability between health record systems.

Speaker B: Yeah.

Speaker A: And, you know, prior to Brexit, you know, if you went off to do some, you know, um, winter skiing in France, you know, your medical records are pretty, pretty good. If you, like me, fell over and did your shoulder, you could fairly quickly get treatment. And in that moment, doctors can access your health records from overseas. So we've demonstrated as a, uh, set of individual countries, we've already demonstrated how we can bring together health record data and the ability to map and mine that data in responsible ways, in private ways. So I see that as the nearest analogy, if I'm honest. Um, you know, there's the most likely going to be some specialist cases that would benefit first the most, and then, you know, you would spread out towards general medicine. But obviously, you know, the abundance of data now, the availability of data processing and the server farms that are popping up, um, all over the place, that obviously lends itself to companies, um, being able to process more data and get more out of that data. I think ultimately we have to probably shift from companies measuring prescription uplift to companies measuring an uplift in health outcome measures. And that's a really tricky one to

Speaker B: try and to incentivize.

Speaker A: To incentivize on health, oddly enough, not profit. But, um, you know, been in this game long enough to realize that won't change overnight.

Speaker B: No. Because that becomes a policy thing, doesn't it? In a lot of ways. Because if you can then move the policy, you then just move the goalposts of what people are aiming at. Especially if that policy is linked to financial stuff, tax breaks, this, that and the other, if they actually achieve things. And that's broadly how we can do it. So one of the things I learned the most actually about policy when I, when I went into policy, I was at Health Education England, and a little bit with uh, Tony Young at NHS England, I did learn that actually policy isn't just this boring place where things happen really slowly, which was kind of cool to say at the time, when you're in your early 20s and you just want to, like, move fast and break things in inverted commas. But I ended up learning that, you know what it was, it was, um, overnight they, uh, they implemented a new policy in health care, which was that all GP practices had to have, um, 24, 7 triage. And, um, in one policy, in one policy move, an entire market of AI companies was like, it's game time, here we go. Right, finally the phones are going to start ringing. And they certainly did. So it was so interesting to me that, like, uh, I've actually seen this in real time. I've genuinely, genuinely seen this in real time, that as soon as you activate policy in a certain way, you can enable an entire market of things to, uh, end up happening, which is super interesting.

Speaker A: I can imagine now that you could run scenario models on policy shifts and then marry that with scenario models on response to a molecule or a therapy or a service intervention, which doesn't have to be necessarily a therapy or a drug. It could be, you know, something else a bit more human. And so, so with the rise and this advent of huge availability of computational power.

Speaker B: So true.

Speaker A: I think policy could be a really interesting area for disruption. So probably is happening.

Speaker B: That's so true. Like a Cambridge Analytica for good modeling, all of this stuff.

Speaker A: Yeah, yeah, for good, please.

Speaker B: Um, yeah, the results of that we're still seeing with recent voting, et cetera. But, um, the other question I had for you before we move on to the third stuff you're doing, uh, with your companies is, uh, what do you think then of the chat? GPT for health, Claude for health. Like Perplexity for health. Probably like all of, yeah, all of these four healths that basically these, these massive data companies are now encouraging you. Not only, not only have they got all of your search data. Ah, I said this a few times, but just like that. I remember seeing a talk from the head of Google Health once, um, who ended up saying, like, not only, uh, my caveat, it might not have been Google Health, I can't remember which one, but it's one of them. Um, not only do we know what drugs people are on because of what they search for, we know the side effects. Not. Not only do we know the side effects, we know the rare side effects. Not only do we know the rare side effects, we know the rare side effects and the rare contraindications, we have data from search history on absolutely everything. So now extrapolate that to what the AIs are capable of. So not only people are putting that search data in, they're then just being encouraged to just, oh, just whack in all your blood tests and then we'll give you even better data. Oh just whack in all of your wearable data. Like I will give you even better insights. Oh, just whack in all your hospital letters, whack in all of this. Like literally anything that you get from over there. Like we don't, we're not going to interrupt, we're not going to be interoperable with all that stuff but, but we are encouraging you to whack it all into here.

Speaker A: Um,

Speaker B: that data set. And now by the way, loads of value being given to those at the individual level who doesn't care about any of the stuff that you need to worry about. Like the cool. Yeah on the individual level I will get amazing insights from all of that stuff. And even on the again like bringing the consumer stuff like for Google Health, you know they're bringing out their new band no subscription like you, you again can just get even more data through that and like by the way, whack in all of your medical stuff as well and we'll just give you even more insights. It's a strange time that we're able to do that and, and I'll come back to it. At the individual level creates so much value because there are people and I've seen you know the chat GPT for health, the video is, is uh, amazing. People in remote communities that do not know much about their health, that have a chronic condition or an autoimmune condition or something like that, they have a flare up, they don't know what to do. They don't have very good, good access to health care very quickly in terms of interventional stuff. But they get immediate information, they've got all of the recent stuff. They can be informed about potential flare ups about to happen. Like all of this stuff uh, at the individual level is incredible and amazing but from what you've built over your career and knowing the back end of these systems and how you architect them, there are concerns that people have over uh, security and power quite frankly of what people can be capable of. The disproportionate kind of power dynamic between well my data is worth something to you but I'm only getting that, that kind of recompensed if there is an issue and all that sorts of stuff. Then I, then I get information back. But am I not entitled to that stuff? Anyway, so it's, it's a, it's a strange time. But how do you feel with all of this stuff happening? And, uh, it's more of a feel question than anything else because you're, you're so connected to it all. I imagine you've got a very long technical answer to that. But, like, how does it feel for you broadly?

Speaker A: I mean, I'm less of a skeptic than I think the majority of people.

Speaker B: Well, that's interesting because you're very informed.

Speaker A: Yeah, I'm less of a skeptic because maybe I'm just a little bit, you know, I just believe in the best. But I feel that, first of all, you know, directors of any company in most developed worlds have fiduciary duties, and if they don't observe them, they'll get put in prison. Right. We've seen that with Bitcoin. Um, and secondly, you know, I do believe that m. From what I've read of individual testimony and also, uh, just seeing how governments across the world are adapting to this new, uh, normal. I do believe that we are putting the right checks and balances in place. Um, thirdly, I believe that, you know, when large companies, large pharma, engage with these enterprise providers, um, you know, they are. It takes far too long to get new therapies into market. Let me start with that. Right. And that's because pharma and healthcare are very, very hold themselves to very high standards of regulation and accountability. So when you see moves from Novartis and Novo and other companies going big with enterprise AI like, that will not have come without serious consideration and legal protection. Right? So we're already operating within a conservative, regulated environment. Um, so I believe, I truly believe that we can hope for the best. And it is a hope and a feeling, like you asked for. Um, but I'll give you a personal account. Right. So, 2013, I was finally diagnosed with an autoimmune condition, uh, um, called ankylosing spondylitis. It's an inflammatory bone disease. So just for whatever reason, my T cells and my blood markers, whenever I get a common cold or a sore throat, it just sends my joints haywire. So I suffer really chronic severe pain most mornings. Um, but particularly when I've got an illness, it's just like, don't talk to me, please. And when that happened back in 2013, I was taking food diaries. I was doing all these things to try and have A better health pattern or better health knowledge. Fast forward 13 years, all I got to do is upload my bloods, upload my wearables, tell my GPT coach project how I'm feeling today. Right. Send a photo of the food I've had throughout the day and every single evening it gives me a readout and says you might feel in your right hand a bit more inflammation because you had a bit too much pasta yesterday.

Speaker B: Uh, wow.

Speaker A: Like I, I don't have any issue with, with Sam Altman owning that data.

Speaker B: Yeah.

Speaker A: Like they can have it for free because the benefits I get are uh, personalized advice and prompts for me to ask my physician and my specialist care team at UCL for me to be more informed of me to ask better questions at the point of health.

Speaker B: Wow.

Speaker A: And that's where I feel we've got an incredibly strong potential in health care to bring, to bring everyday health choices to the consumers rather than a patient. Quite often, as we'll discuss in mental health, when you're talking to a patient, it can be too late. What we should be talking to, who we should be talking to is the human looking to make better choices. So I think the idea of personal coaching, the idea of personal data and sharing all your secrets, uh, with a machine, you know, so what, like I'm just not bothered about that. Uh, I'm more bothered about being happy each day and I'm more bothered about learning uh, about my health choices and then feeding that into whatever I do in my career. Um, you know, so I think the old attitude, nothing to hide, nothing to worry about, you know, so, um, and so I do feel, you know, regulation as a starting point is already there and companies um, that don't adhere will, will then fail and you know, there'll be that we will just survive and roll on regardless. So yeah, I think, yeah, I just have a, I have a very personal anecdote there. But ultimately I, I think something like 2/3 of mental health inquiries begin in GPT. Now I, I'll get a citation. More and more people are using, in fact there's now a PhD. Um, it's PhD content available and you can do courses certainly over in the states where you can become certified coach through GPT. Right. For, for mindfulness and well being. So this is not going away. This is not a fad or a niche challenge or you know, there will be more and more people, more and more projects being used at um, a personal level. And I just feel it's going to drive um, more people towards making Better choices because it's truly personalized around their lifestyle.

Speaker B: Yeah, no, thanks for sharing that, but I didn't, I didn't know that, um, that you've been diagnosed with that, but I, Yeah, I, I appreciate it from, from the patient side. It's funny. It's funny, isn't it? It's very easy, I think, for people in healthcare to talk in generalizations when they don't go through it. I mean, they say, you know, when you're healthy, you've got a thousand problems. When you're unhealthy, you've just got one, and it's your health. Like you, you know, we've all, we've all been there with health scares and, you know, even just a sore throat can do that, to be perfectly honest. Like, you just want to get rid of it and feel better and let alone a condition like you've described and that kind of thing. And I think it does become about the deal, doesn't it? Like the, it's you. You said there, like it feels like a fair deal. And I think that's really important to remember, and I'm sort of coaching myself here that that is important to remember. And we can get on our high horse about specifics of security and all these different things, but at the end of the day, there is a patient at the other end asking a question and probably getting an answer. And we just need to make sure and we need to be absolutely certain that it's the right answer and that there's an element of determinism and all these different things that is thrown at the LLMs. But the other, the other thing is that there is also media accountability as well, which we've seen play out with everyone moving from OpenAI to Claude, for example, for reasons of deals being done with weapons and all the rest of it, and, you know, the media reporting on that and then the public voting with their feet and going, no, thank you. We want to go to the one that has a seemingly better moral compass. Um, not that we truly know what goes on behind the scenes of all of this stuff, but at the same time, you're right. The checks and balances do exist in the world that make these things possible and a bit more palatable, I guess. And thank goodness there's not just one of these companies. At least we can vote with our feet towards the ones that do have a better morality. And therefore at least that then is on the table of, okay, we need to fix our brand and do the right things and have these values and all These of rest of it at least it uh, at least it forces that side of things as well.

Speaker A: Yeah. Fortunately there's not a monopoly. And you know, as you mentioned this morning, you know, you fired up granola. I thought you were talking about breakfast, but you weren't. Yeah, right. There's, there's so many more providers out there. But again that comes with risk because you're not sure the level of regulation they're undergoing. But certainly, um, you know, I feel optimistic, perhaps blindly, but um, that's because I've waited 20 years for healthcare to take some risks, frankly.

Speaker B: Yeah, but you've also built some, you've built this stuff as well. Like you have actually done the deals with the pharma companies and you've been on the side of the build and you know the technical architecture more than most people will do and you'll know the limitations. And I, yeah, I mean I, I, I take delight in hearing that you're optimistic rather than pessimistic because that could have frankly gone either way. Um, but no, I, no, I definitely appreciate that and as I say, thank you again for sharing it. I appreciate the, the, the patient insight as well. Um, it does move us nicely onto, you know, your career is obviously taking you to a place where you can I guess choose to put your time and energy into what matters to you and tell me what you're up to now then as a result, the best

Speaker A: way to describe what I do is, is global health care advisory. So I advise companies on how to get to market, um, you know, by accelerating insights by orchestrating commercial launch excellence, by having the right medical scientific content in one place and by helping um, people understand um, the benefits um, of new therapies. And that can also be a service, um, you know, equally so. Um, and one of the things I've been supporting with over the past three years, um, is a novel company that is focused in neurological wellness. Um, it's a company that's evolving very quickly. Um, as I mentioned earlier in my career, um, I met um, with Nick Patel who was then an up and coming neurological, uh, sorry, an up and coming neurosurgeon. And um, Nick is now one of the world leaders in movement disorders, um, helping to um, you know, help people with um, Parkinson's, Alzheimer's, um, as well as um, severe treatment resistant chronic depression. Um, so Nick is a world leader in uh, essentially neurosurgery that helps to relieve the symptoms of untreated neurological disorders. Um, and the company is called Ranvier Ranvier AI. So we've developed a very simple to use taste test that enables people to objectively measure, um, their mood. So we were able to give, ah, an attributable score to how people feel. And that has its origins rooted right back in the science of, um, of levels of serotonin. Um, so we're able to detect, um, yeah. Essentially codify how people feel, um, through a simple swab test.

Speaker B: Amazing. So question then, what you're saying is that the objective truth here then scientifically, what sounds like evidence based is that people's perception of sweetness and taste is altered in a, uh, correlation fashion with their mood. So low mood, don't know whether it increases or decreases, I assume decreases their perception of sweetness and how they taste. Is that correct? Why was I not taught this at medical school, Ben? Like what? That what?

Speaker A: Yeah. So the company's called Ranvier. It was named after a professor, a French professor, Professor Ranvier. And he discovered, um, the gaps in essentially the insulation of our neurons, okay. That run throughout our body. And those gaps in the myelin sheath are called. In the myelin sheath. Yeah. So we have the nodes of rhombia.

Speaker B: Oh, that's where I've heard it. Nodes of Ranvier. Yes. Interesting.

Speaker A: There you go. So, so everyone's body, um, has a natural level of neurotransmitters. And those neurotransmitters essentially help the neurological signal jump the gap over the node of rhombus. Right. So throughout our body, and when those neurotransmitters are low or when those neurotransmitters are depressed, um, we are considered in a clinical state of depression. And this was the biggest aha moment for me three years ago. Um, oh, it's not about feeling depressed and potentially feeling exposed to stigma of having a low mood. I am clinically depressed because the levels of neurotransmitters in my body are, ah, Depressed.

Speaker B: Right.

Speaker A: That's the origin of the whole term.

Speaker B: In the first place, decreased appetite, hence poor sleep, hence. So those are secondary to the primary of reduced neurotransmitter. Interesting.

Speaker A: Right, Right. So we've created, um, a taste test that is able to, um, essentially, as you mentioned, it's translate taste sensitivity or taste, the perception of taste, translate that into a score. So we now have an objective measure of the levels of serotonin in, in your body as an individual.

Speaker B: Wow, that is. Yeah, amazing. So, uh, of other people done this, do you have competitors to this? Is this a common thing that's used in clinics? Is this. I'm, uh, sort of taken Aback like.

Speaker A: Yeah.

Speaker B: Do you know what it is, Ben, is like, sometimes you come across ideas where you're like, why hasn't someone done this already? This is in that category and they are often the best businesses. Right. So it is a very much kind of what. That's my question. Why hasn't this been done already?

Speaker A: Well, I mean, this, this was, um, you know, I can't take credit for the idea. Um, you know, I'm very much continuing the legacy of, uh, Professor Yann Melicar. And, and Jan sadly passed away last August. Um, and there was a very sudden event and, um, you know, I'm really here to continue his legacy. Um, he, he was a, he was a world leader in, um, addiction science and addiction research. And had. The last time I spoke with Jan was on a zoom call and he was smiling ear to ear because he'd just released and established new science that was a cure to opioid addiction. Wow.

Speaker B: It's bold.

Speaker A: And Dave Nutt wrote an amazing obituary which I'll make available.

Speaker B: Yeah.

Speaker A: Please share that for your listeners. Um, uh, so Yan established this science actually based off some original research in 2008. And this is where, you know, the chemistry and the science really link in together because there was a paper done by Heath et al, um, a spin off of Dave Nutt's lab in Bristol. People may have heard of SSRIs, uh, selective serotonin reuptake inhibitors. They're the most common form of antidepressants on the market. Those, uh, drugs have a certain mechanism of action where they help the body absorb less serotonin to therefore raise the levels of natural serotonin in your body, therefore restore the levels that you're normally used to. So, um, back in 2008, um, a bunch of people out of Dave Nutt's lab in Bristol wanted to test and actually put under the microscope what happens when you take your first tablet. Um, so what they did was they measured taste sensitivity before, taste sensitivity during, and taste sensitivity after a course of antidepressants. And what they found was this spike in the regeneration of sensitivity. So you were able to taste better when you were at the CMAX value of your first tablet. So within six or seven hours of taking your first tablet, um, which demonstrated that scientifically the reuptake inhibitors were working and we had better neurotransmission of our signals across those gaps of the myelin sheath across the nodes around VA. So therefore we demonstrated that SSRIs do increase taste sensitivity. So that was the baseline science that we Then worked with Jan, um, and Lucy Donaldson. Um, they worked on a new research method and fast forward, um, several years and we now have a data set that compares, um, what we call drug naive healthy people. So people that don't identify as living with depression, they don't have high dependency in alcohol, they don't have high stress levels, they are generally healthy and happy. We compared their taste sensitivity with people who had just been diagnosed through the traditional pathways in the uk and what we did was say, please take the test as normal. And it's a guided test with a research associate. And we see uh, two orders of magnitude delta between the taste responses between the healthy volunteers and those um, who have been diagnosed by a gp. So people who are living with depression have a lower taste sensitivity. Um, people who are happy have a higher taste sensitivity because the levels of neurotransmitters are, you know, uh, where they would normally be for that individual.

Speaker B: It's so interesting, isn't it, that m. Where my mind goes to is almost like ancient wisdom. I'm finding this a lot at the moment. Like we talked about before we started recording about the barbell of like, there's all this AI, but then there's like businesses of people just like, come for a walk with me and pay ten quid. Like this, this barbell of stuff. Um, it's, it's, it's so interesting to me that with all the world of AI, there's like, I'm finding so much ancient wisdom. Like just, just coming back, we talking like our language almost uh, relates to this, doesn't it? That, you know, if you see a vibrant person whose life is colorful, all that. It's almost like we're describing enhanced senses and that being, you know, the antithesis to like dullness and gray and the dark clouds and all these things. And it's, and it's like, it's almost. We sort of know, we sort of know this intuitively. Like I said, like, I assume that taste gets less, you know, gets less sensitive when you get depression. It's almost, it's almost intuitive to us, isn't it?

Speaker A: Um, and it's intuitive, but it's also, you know, there are lots of people who put masks on, you know.

Speaker B: Yes.

Speaker A: To survive and cope in the world. There are lots of people who don't care how they look and that's fine. Um, and what you're describing is essentially the nexus of the challenge of the last 30 or 40 years of health care within, within mental wellbeing is that we've been We've been measuring the wrong thing. Right. We've been measuring how someone responds subjectively in a questionnaire, typically in the waiting room of a GP when they're probably the most stressed because they're about to, or have recently disclosed to their GP they're not feeling great. First of all, well done to them for going to a gp. But like, secondly, like, those questionnaires are open to interpretation, they're open to the bias of emotion at that point in time.

Speaker B: Huge.

Speaker A: Hugely, um, subjective and, and so. Right. Hugely subjective. So we are, we are intensely motivated by delivering the notion of delivering objectivity into mood measurement, um, to reduce or dispel completely stigma, um, associated with how you feel. And, and that's what we're on a mission to, to develop. Um, interesting. We've got, um, a second taste test in development which is measuring noradrenaline.

Speaker B: Wow.

Speaker A: Same mechanism. Right. So we've got anxiety and depression. Wow. And having that differential diagnosis is like a game changer because I think roughly half of the people on antidepressants should actually be on anti anxiety.

Speaker B: Interesting. Interesting. Unbelievable. Unbelievable invention. Um, and to be honest, very rarely do I get to speak to people that are kind of creating a stepwise change of something in healthcare. I think it's so common, it's so common to get incremental change. And, you know, you can argue here, there's incremental change here, but feel this, this for me, like you're, you're, you're creating objectivity around something that is historically subjective and subject to so many different reasons why that test would be incorrect, from personal motivations or recent experience or current status or like, there's, there's loads that would go into, uh, as you quite rightly say, you're in the business of creating objectivity around depression and anxiety, which, when you think about. Well, I mean, you tell me, but the ramifications for pharma, for example, for testing medications, is enormous. The ramifications, of course, for patients making sure they're on the right treatments at the right time and the right dosages of the right treatments at the right time, that they don't come off too quickly if they're trying to come down or, you know, all these different things. Like for me, it's, it's. Do you know what? I interviewed Claire from. Claire Palmer from AESO on here recently, who's Director of Evidence at ISO. And, um. Why have I brought that up? I have brought that up because, um. Yes, we just mark that for edit. And when I spoke to Claire One of the things I mentioned was that when I was in my GP placement, uh, as an F2 doctor and I would see people with depression and would need to prescribe, uh, SSRIs or lifestyle, like wherever they were in that spectrum. You know, you try and go in accordingly at the right thing. I didn't, I'm being completely honest now. I didn't have belief in the treatment that I was recommending as much as I would for amoxicillin for bacterial tonsillitis. I know that amoxicillin for bacterial tonsillitis or co Amoxiclav, if they work in a hospital or whatever, is going to do something to the beta lactam ring and it's going to make sure that that bacteria can't propagate, uh, and, and you know, multiply, uh, and all the rest of it and then, and then the body's going to kick in and kill it and eventually get over the infection. And this is going to help you. Like I know, like I know that it's just so difficult to have that same belief when so many people bounce back and the dosage is incorrect and all these different things. And it's a, it's a strange thing to reflect on actually because. Oh God, like I have so much more empathy now that I've left medicine. Like, uh, uh, you have to, in order to survive, just be so like put the wall up and just things are factual and is what it is. Like someone I was at a national trust walking around with, you know, my dog and my wife and my baby and this lady with Parkinson's disease fell over and she clearly broken her hip like, and she was just crying and holding my hand and like I was just in tear. I couldn't cope with it. I was like, God, this wouldn't have even touched the sides when I was a medic. Like it's crazy. But thinking about all this now, like this is just, it just could be so great for people even. I'm. Like you said at the beginning, I finally got my diagnosis with my autoimmune disease of ankalizing spondylitis. The odd. The odyssey of, of the seven years or whatever it was of that's what that's average for a rare disease, of not knowing what that was is the worst bit. Right? Uh, even just being able question to have an objective measurement that allows people to sit in the. What little comfort they have of just knowing that there is a physiological thing going wrong and that is why they feel this way or I imagine help them plot a path out of it at least, or know that there is a solution coming, whatever it is. I don't know, like, I've got my soapbox there a little bit. Like, I just, I just feel like that's my reflection on what you've just talked about, man. I think, I think it's really super interesting.

Speaker A: Well, look around. I think around one third of people, um, in the world may, um, not respond to antidepressants, um, just biologically. Right. So we have an appropriate prescribing issue. Step one, as you mentioned earlier, we then have the ability to put this test into drug development, clinical trials for antidepressants and anti anxiety drugs. So we can look at suitability screening for trials. We can then look at, you know, um, within trials, measurement of mood. Right. But then you mentioned earlier, we can also look at, um, how we titrate people away or wean people off therapy who have been on them. Um, there's a crazy stat saying, like, I think antidepressants were only ever designed for like a 6 to 12 month period. Well, I know people have been on them 20 years. Yeah. Right. So this is where it gets really interesting, James, because, because we've, we've segued within our company from, from a taste test for, for anxiety and depression and we've expanded into the detection or the early detection of Alzheimer's, um, and to some extent Parkinson's, um, using a blood biomarker. Right. So we're beginning to finally treat neurological and mental wellness as a continuum. Because it really is. Right. I think there's a, there's a, where depression remains untreated. If chronic depression manifests and remains untreated in adult life, you double the mortality risk of that person. Right. And you double the chance of developing Alzheimer's or Parkinson's. Right. Because neurological health is on this, on this continuum. The only thing that separates these conditions is time. Right. So early intervention in depression is absolutely key in trying to stave off and prevent the development of neurological decline. And if you think about other therapy areas, right. For cardiovascular, we have devices that continually monitor that function. Right. For glucose monitoring, we can get the remote monitoring and instant readouts. We can monitor arrhythmias remotely, which we were doing in Medtronic 20 years ago. But when someone says they're depressed or they're anxious or they feel they're cognitively declining or beginning to lose any sense of neurological resilience, we still predominantly rely on subjective tooling for that and, or it's gone too far. Right. We're Treating the patient before, um, you know, before, after it's too late. We're beginning to treat the patient when it's too late. So for us, um, we're continuing to develop a, ah, number of diagnoses that really does consider neurological wellness across this spectrum. Um, and very interestingly, the Alzheimer's, uh, biomarker, it's uh, looking at protein folded oligomers. Right. We're looking at these factors that give us between 10 and 12 years pre symptomatic probability of developing Alzheimer's. Wow. So we can tell from the protein markers if you have the propensity, right, the genetic predisposition to be in that pool of people who are likely to develop it. Um, so of course you can make lifestyle measures, um, intervention, dietary intervention activity, um, even down to social interaction. All of these factors that affect our mood actually are super important to maintain healthy levels of neurotransmission so that we maintain healthy and active lives, so that we try and um, you know, stave off the development of neurological decline. Um, and look, to put the icing on the cake, we've got a phase three molecule which uh, is a compound therapy of two existing drugs that are already pre approved in the market. And that compound molecule in the lab so far has proven to slow or in some cases completely halt the progression of Alzheimer's, uh, currently in mice. Right. So we've got a theory here which is you look after yourself through early intervention, uh, of uh, depression or anxiety, you prevent the long term degeneration of your neurological system, um, and you get ahead of any genetic predisposition that you might have with regards to neurological decline through Alzheimer's or Parkinson's, through therapy and through treatment. Um, um, of course we're putting all that together with an agentic and artificial intelligence system that plugs in lifestyle data, that plugs in coaching outcomes, that plugs in hopefully one day through partner deals, um, headspace or calm or the things that are really important to people outside of the molecule of medicine. Right. So we see ourselves as an inference platform that's, that's looking to develop neurological prediction to help people make better steps and better choices that actually um, prevent neurological decline.

Speaker B: Well, I mean what a fantastic innovation is all I can say. And just quickly, before I let you go, where are you at in terms of um, like clinical research or bringing this to market or people getting involved in trials or like whereabouts is this? Or can you get this at your gp? Like whereabouts is this?

Speaker A: Yeah, I mean I really wish we could get this to market sooner but we are following due process and in partnership with NHIR and nice, we are continuing to develop the body of research that's required to, to take this from a scientific discovery to, um, a verified diagnostic signal. So, um, the depression taste test is currently going through expanded research in the uk, um, also in Europe, um, and also in the us. So we are, um, hoping to publish, um, the breakthrough science and the robust data sets towards the end of the year, um, in Nature or Journal Neuroscience, um, for the biomarkers for Alzheimer's and Parkinson's. We have a little bit of a longer roadmap on that, have a bit of more work to do, um, in the lab and also with patients, of course. Um, we require patients who are able to give blood samples, a small pinprick blood sample. Um, so there's a screening issue as well as a sensitive topic to talk with people about. So as they're going through the triage systems of Alzheimer's or Parkinson's care, we have to be very careful of how we ask for access to their blood samples. And then the compound therapy is currently in phase three and we hope to release, um, more data on that early next year. Q1. 27. Um, and then, yeah, we're building the tech around it as we go, so very much taking an agile approach to this and, um, you know, very excited about what the future holds.

Speaker B: Amazing. Ben, it's been absolute pleasure. Let's definitely not leave it so long next time. And um, RONVA AI R A N V I E R AI um, if you want to hear more about that. And Ben, what's the best way for people to get in touch with you if they want to have a chat about any of the above we have spoken about?

Speaker A: I'd love for people to follow the Ron VA channel on LinkedIn, um, and also reach out to me directly and I'm happy to, you know, to get in touch with people through dm.

Speaker B: Amazing. It's been a pleasure, mate. Thank you.

Speaker A: Thank you, James.