The future of wearable technology

Chris:

Hello digital health community. Today I'm thrilled to have our guest João Bocas, one of if not the premier experts on wearables in digital health. João is CEO and Co-founder of Digital Salutem, a digital transformation and marketing firm for healthcare organizations. João is also one of the biggest personalities and influencers around digital health, and in particular wearables, where he has 1000s of subscribers on his YouTube channel, gives keynotes and publishes articles around the future of digital health and emerging technology. He is also an advisor with several startup incubator programs. And we'll be talking about wearables influencing, and of course, startups. João , welcome to the podcast. Did I miss anything with that intro?

João:

No, I think you're covered more or less everything, Chris, thank you for having me. I'm delighted to be here with you.

Chris:

Well, thank you very much. So you are a wearables expert, and one of the world's top digital health influencers. But I'm curious what interested you in what interests you so much about digital health and wearables specifically?

João:

Brilliant, actually, uh, Chris, I always say, I have two passions, one, sport and health, they go hand in hand, because I mean, sporting behaviors and activity behaviors lead to health. But I actually entered the technology industry, by accident, not an accident. But I explained to you, I've been in health care for over 25 years. And I have worked the last 15 years in corporate health. And then I started doing this startup with another person who was more of a technology guy. And we had this big vision of creating a big data acquisition platform, and  wearables to bring the data in and then do predictive analytics and everything. And back then, it was quite a while ago, back in 2015. But prior to that, I was already collaborating with some health tech startups from the Nordics from Finland . And they had the limiters in their platforms to employ well being and employing programs. This agenda has been very topical for several years. And then I discovered wearables and started using wearables from the beginning, from the first Fitbit brands, they're not around anymore, like misfit and everything and then polar from Finland, and really have a pedigree in wearable brands. And so I've been following this revolution for quite some time, and they must start using them and testing them. My desk at Tom and that work is full of wearables, I've been doing a number of things with wearables. So yeah, and I am very interested in performance. I was in professional sports for a number of years. I like the insights around human ball, the performance improvement, and of course, the overall health picture.

Chris:

Right, which sport did you play?

João:

Primarily, primarily football. I mean, soccer, as they say on US. I was also a runner, and I started doing triathlons in my 40s. So, since I was a child, I was always very active. I play basketball and volleyball. I was into athletics and football and soccer.

Chris:

Right. Okay, yeah. But it's very cool to learn. So where are we at today, in terms of the state of wearables, and this confluence of technology that seems to be about ready for primetime? And then all of these other emerging technologies like AI and medical devices? Where are we at in healthcare delivery using those in 2022? We'd love for you just to give us a overview of the landscape.

João:

Sure. I believe in terms of the digital health industry. I called the industry because my vision is that the digital health absorb naturally will absorb the traditional health care industry, and bring all these elements together medtech, wearables, virtual care, so I call it digital health of the overall arch of the industry. But regards to your question. In terms of wearables, I think we are at the very, very beginning of the journey in terms of implementation in the industry. And the industry was maturing for quite some time and is still maturing. Actually, we talk about wearables for many, many years, but I only feel that things are starting to happen right now. I believe the pandemic played a big role there. But also, companies are trying to find an advantage to use data to create new business models to remote patient monitoring patients for homecare, hospitals and home, so all these things go natural into the direction of wearables, because wearables are a perfect vehicle to make this happen in terms of acquiring data from the human being, and also have this capability of doing things on the remote, in continuous level. So I see a big improvement, especially in the last 12 months. Companies are very keen to try things out. But also they see the needs to really innovate, and try things out. No one wants to be left behind in that belief wearables will play a crucial role in the healthcare delivery of the future.

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Chris:

Right. What are some of those barriers to adoption of wearables that you've observed?  So I mean, the wearables have been around for a while, like you mentioned since the Fitbit days, but they haven't yet taken over the world yet. Right? You, you're saying we're still at the beginning of this hyper adoption cycle? What is anything to standing in the way of becoming more mature becoming more used in care delivery programs or monitoring programs?

João:

Well, Chris, that's a fantastic question. I actually just shared it on my LinkedIn. As you know, I'm very active on social media, LinkedIn, and Twitter, primarily. I just shared on LinkedIn, a recent study by the American Heart Association, that states, then the uptake on using wearables is very low for those we needed the most. And usually, people that use wearables and engage well with wearables are people that already develop some behaviors. It is not surely for active people to try and to maintain that level of health and wellness. And those who needed the most actually, if perceived barriers to enter into using engage with wearables, and the longtime, a few a few years ago, I've done a report about a one and it's 59 pages report on health, wearables engagement. And there are top five device related barriers and top five user related barriers in the user related barriers, the lack of intrinsic motivation, what this actually motivated to use a wearable, he said your activity, that is you're sleeping or you try to lose weight, to try to change your health behavior, we're trying to just you need to manage chronic disease, you actually need to use a wearable, for example, in terms of the diabetes management, you have to use the wearable, you have to use a medical device as such, what is it if there is no intrinsic motivation, the engagement will not be there and no engagement, no data, no data, no value. The second perceived barrier that we encounter is privacy or security concerns. People are actually concerned about the intrusion about finding personal data about them. Now there are attacks in cybersecurity attacks all the time. Also, within the industry, there is a lot of noise about big companies, and including Pharma is a lot of speculation about selling health data, using the data in non appropriate ways. So the third barrier that we encountered was human errors of forgetfulness. We all know that wearables have low battery issues, if we forget to charge them, or many times I leave my wearable on the top of the fridge without battery and just use it a few days later or even weeks later. So if we break that behavior, it is very difficult to come back. But also losing the device in the sense of no value, which correlates to the first item about the lack of intrinsic motivation. Many users don't see the value in using wearables, they might use it for a few months, but then they might actually why am I doing this? And nothing is challenging, because everything takes time. So yeah.

Chris:

Yeah, that's a great answer. And I'm curious what we do about that, because we've been talking to a lot of wearable startups too. And what they said the hard reality the industry has learned is look, patients don't wake up every day wanting to be engaged, right? They just naturally want to go about their lives and for the same reasons that you mentioned of motivation or privacy or just they don't want one of the things that they have to remember to do each day. I'm curious what are there any innovative solutions are people trying new things, in particular for like that, that motivation or forgetfulness type of problem. 

João:

Yeah, I would say it's possible to address some of the barriers. But one of the things that we found in the study was, in terms of device related barriers, interoperability was a big one, to get the data to different systems or to share the data. But also the lack of personalization. Most wearables in the marketplace are manufactured for the masses, they give him the same health data uniformity. But also, the lack of support and direction is really a big thing. Sometimes, if you buy a wearable, for example, Chris, you know, you have a warranty with the specification, you have the setup, you download the app, you have all these guidance. But actually, there is very little guidance and support in terms of the user related piece. Sometimes, I mean, this is very, very basic, but make sure you charge the wearables, for example, a few days or a few hours ever behavior charging every week or every hour or every day. Also, addressing the person needs, everyone is different. And there is no direction or personalization, in terms of guidance. I think the guidance piece is extremely important. I've seen recently one of the leading wearable brands buying the coaching l startup, because the coach, we need the change of behavior with the technical side. And the support and the support in many cases are actually more often than not, as the actual missing link is the missing piece. In Health,  I've been working now for many, many years. And you know, the authentication piece is always missing. And sometimes it's very simple. Just give people some clear directions and clear instructions and simple steps to follow. And I think that is still one thing that is missing with regards to using wearables.

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Chris:

Right, right now there's a certain level of friction and a certain level. Yeah, I mean, I guess consistent reminder and guidance and peer influence to keep using it. It's funny, because we've talked to a lot of these care management companies that manage the remote monitoring programs on the behalf of providers. And what they say is, look 80% of what we do is call people each day, tell them to get on the scale, take you know, put on their coffee, take their blood pressure. And you know a bit but that is what it takes to get a program that is actually consistently adhered to and adopted. Are there any companies or techniques you found that make it easier for a patient to you know, either more transparently or organically use the wearable without thinking about it right and get all of this benefit. Without necessarily someone needing to call them to remind them to get on the scale, or put on the cuff.

João:

Yeah Chris, that would be the ideal case scenario to intuitively just use the wearable with no intrusion. But the wearable requires a personal deep engagement, but also a personal intervention. I'm not talking about the external provider, a company to call the individual. But the wearable only works really well with the level of human interaction. So it's actually really, really difficult. The wearables are becoming more, I mean, more clever, if you like, because now we have patches, we have wearables in that way, in many shapes or forms, not just about smartwatches and fitness bands. There are trackers in many different ways. Smart rings, mean smart belts, patches, sensors, smart clothing is a big big trend now because the where the sensors can go in, in in the clothing and so there are many, many ways that can be improved, but also it requires a level of intervention of human in groups if you like so, I don't see a way around that yet , so

Chris:

Okay, got it. What are some of the questions about wearable technology that people should be asking but may not be asking as much? 

João:

I would say with regards to industry, for example, I was talking to a few pharma companies in the they tried to do virtual care, I mean, clinical trials, virtual clinical trials. One of the questions that comes up very often is, he sounds very basic, but it's what are we trying to measure? You know, in sometimes with wearables, diet and wearables input is not actually what they're directly trying to get. Because sometimes it's not the activity steps or the activity data that they're after, they have to do correlation between data to try to get to a certain condition or disease management or any relevance that perhaps that piece of data impacts. So what are you trying to measure? Is the data reliable and accurate, and with many, many wearables there is always a bit of discrepancy can be a 10%, or 20%. range. So that is taken into consideration. But also, one of the things that I would say, right from the outset, is what are we trying to accomplish and in what realistic measures, because we have this expectation, that wearable is going to solve the problem of wearable is going to be the miracle, the wearable will be other elements to try to solve the problem. You know, because the wearable on his own is not going to really do anything. He requires a bit of thinking around a bit of the strategic thinking around the wearable. So and that's one of the things that sometimes I see happening and mistakes made by thinking, Okay, we get the wearable done, and we'll get the usage and everything will change, and is a bit more complex than that.

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Chris:

Got it and how about AI or specifically machine learning, when combined with wearables? Like that, the promise seems straightforward. Eventually, computers can learn to detect signals, something is wrong or coming based on a tremendous amount of data. Has anyone really realized that the theoretical potential of machine learning or AI in combination with wearables?

João:

Yeah, that's a fantastic, fantastic one. Chris, I actually then a book chapter in the shed my vision is that the combination of artificial intelligence in wearables will be the game changer in healthcare. And a few years ago, I mean, artificial intelligence has been around for a long, long time. I'm not sure if you remember, but the IBM Watson, a very popular TV show in US where Jeopardy? Yeah, So the IBM Watson, I mean, always beats the human being because they can process more data quicker, very simplistically, is a computer right, with more more brainpower. I think, and this is what I'm seeing. Now, we have both sides of the coin, we have a lot of data. And we have the technology there. A few years ago, we had artificial intelligence, but we didn't have enough data to process. If we didn't have enough data from medical data, they have data from human being. Now with that, we have both. Now I see things really starting to make sense, but also the true potential of wearables to be recognized. And there are companies now that give you based on your, for example. Behavior: If you go to bed at a certain time, I use very often the aura ring, for example, I'm not associated in any shape or form. But it gives you for example, a reminder that your bedtime is approaching. So you might want to avoid, for example, drinking caffeine in the next two or three hours before going to bed. And so and that's where artificial intelligence plays a role around learning, as you mentioned, your behavior detecting patterns, or even in certain cases to detect anomalies around more severe conditions and in more serious things instead of just being normal behavior. So I believe artificial intelligence really have a big role to play combined with wearables.

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Chris:

Right? Yeah, I think you're absolutely right on that. And what do you think about Apple, you know, Google or Android fit, and these platforms? Are they going to be used as a wearable that for care delivery over time? And what is their impact on the market? Are they gatekeepers to other companies then maybe want to do innovative things on the wearable space. You know, are they enablers?

João:

Chris, it's a very, very good question. Sometimes I'm trying to figure out myself what they actually trying to do contribute into the market, for example, Amazon. Now the big tech brands are very interested in health, because health is a big, I mean, is a big industry. Also, every human being will live at a certain age, relevant around health, whether they are in your 30s or 40s, or 50s,80’s. So every every human being every correlation without that, for example, a Google bought a Fitbit for a reason. Because not just thought of the devices, but I really believe they have a big long term game plan around the health data, perhaps even artificial intelligence and, and they have plans, Amazon, now they're very interested in healthcare. So I would personally like to see them playing a more active role in actually helping people, patients directly. But I think we, we still seeing these dynamics appearing. For example, Amazon bought the big healthcare company, but then they didn't want to enter the market yet. So these new ones, these are still happening, which are slightly confusing. I actually wrote my insights around that, which are slightly confusing from an industry point of view, but but also, from an outside point of view. Are we actually in the market? Are we not in the market? What's the long term strategy in some of these companies are trying to figure out how to actually enter the marketplace and make an impact.

Chris:

Right, and given all of these big players entering the market, different modalities of wearables, and it seems like the technology's maturing, what do you think the future of wearables looks like? Or what do you think it'll look like? Or what do you hope people look like?

João:

Oh, well, that's a fantastic question. I like that when I do my keynotes around the world, I always kind of pitch my vision, it might be wrong. But I'll start with this. My big vision is that the wearables can change the world. And if they can change, for example, your reality with virtual reality, mixed reality can change your world, it does mean is the health medical world, that if they can help you to manage your condition, and improve your health and wellness, they can change your world. But also, one of the things that I predict is that in five or 10 years time, the wearables that we see will become obsolete. And it's not about fitness bands, and smartwatches, you will definitely be about very small senses, about smart clothing, about the offerings, about anything that you actually fancy, or those around your tastes, or preferences, but not just on your wrist. That's one of my predictions. The other prediction that I have is eventually. And this is more as a prediction and also an aspiration. Eventually, I would like the power to out like, the plates to be turned upside down, and the power to be given to the consumer, and not the provider, or the manufacturer or the insurance system, I would actually would like to see I have my data, I worked really hard to strive to stay healthy and fit. Now, what can I get in return? Can you give me a benefit? Can you give me a discount? Can you lower my premium? Can I, so I would like to see the power on the hands of the people. And I believe wearables can play a big role in that. I think we are a long, long time away from that. But that's what I really would love to see.

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Chris:

Right? Yeah, I hope so too. So maybe in the next iteration, we won't all be cyborgs yet. But yeah, it could be coming out. So you are the number one I would say expert in wearables and one of the top influencers in the digital health community at large And I would love to unpack a little bit your journey and crystallize playbooks for other people. Because I think it'll be helpful as more people like us are trying to enter and grow the community. How did you start building your own personal community and become an influencer? Within digital health?

João:

Oh, Chris, I actually have a very, very personal story. I mentioned that we are doing that startup back in 2015. I always had an interest in health and wellness. And that startup was a failure was called self care people. For one reason or another. We didn't make it happen. But what happened was, I always been a people person. As you can see, I like to talk and I like to interact with people. I started to network quite a lot. Back in 2015, I still have my first business cards. I had many business cards, because I work in sales for a long time back in the days in Portugal, and then many different things. But back then I called myself a digital health influencer. And why is it necessary to go online and give my business card out. The word influencer in 2015 was not on anyone's radar. People used to ask me, What does that mean? And I used to say, actually, you know, I'm an influencer, I connect people, I share the trends in industry or follow these new technology trends. And, you know, even myself, I was not completely clear what an influencer would look like, then I start to build my audience on Twitter and LinkedIn, primarily, in the industry, and I've been working extremely hard to try to keep up with the industry, new trends is not just about self promotion, I believe it's more about collaboration and help other people bringing the innovation, for example, to the forefront. Do things together, share good news, industry news operate like we're doing now. I mean, I collaborate with you collaborate with me. And yeah, it took off from there. In a few years, I started to get noticed, I, one of the things I would advise anyone to do in their own industry, in digital health, but any industry whatsoever, connect with the influences, and the stakeholders and the people that are doing, at the end of the day, whether you are a CEO of a big organization, or just the startup founder that's trying to figure it out and started six months ago, it's all about people, you know, and it's about connecting with people, interacting with people. And perhaps that's one thing that I do well, I try to interact with people, people interact with me, and things took off from there. I start to get a bit of a following on Twitter or LinkedIn presence. And I don't really have like a magic formula crease, I'm still doing these things that I'm talking about. Now try to find the good content. As I mentioned, I share an article from the American Heart Association. wearables. So you know, these things, share industry, news, reliable content, collaborate with others, keep an eye on what's new, give your personal insights, all these things are still pretty much part of my daily activities really.

Chris:

Right, right. Your playbook hasn't changed that much. Now that's great to learn. And so when we talk to digital health startups, we talk about, okay, what is a moment or a activity reaction that lets you know, you're on the right track that either shows proof that your idea has value? Or prove that you have a viable business? So product market fit? And I'm curious, in your journey as an influencer? Was there any time where you thought, gosh, you know what, I've made it like, I've crossed that chasm and I as a person, right, as an influencer, an expert within wearables. I have a product market fit.

João:

Great. Well, Chris, you already answered by in terms of I worked a lot with the startups in the past and I have my own experience I have to file is on my CV, which led me actually the file that led me to the influencer if you know what I mean, the file that led me to that route, because I was kind of on my own figured out what I'm gonna do and I start, like, doing my inroads into the industry. But one of the things that I've learned is, I have not made it as such. Yeah, this is always an , following me in, this is always an ongoing journey, okay, I create a bit of a presence, which is brilliant. But I'm still on a path of developing my presence and everything. But what you already identified is the product market fit is important. That's traction, that actually gives you the validation that you are on the right track. And many startups don't get to that place, for one reason or another, the industry is very difficult to crack. And I believe it will be even harder in the future, because the big players will eventually, unfortunately, shrink the industry for the startups. So it will be always out there. But one of the things that I believe in hard work, the hard work on your own, is not gonna guarantee success. But I believe in a combination of things within the startups, I believe the work ethic, but also the finding out what works or not really kind of are wildly on and be able to change it. Because one of the one of the mistakes that I used to see in the startup world, and I've done a lot of work around startups, Greece, and people start seeing that what they're doing is not working well, for one reason or another, they're not getting traction, and they still persevering with the same strategy for a year or two or three, they think I'll give you an example. I work a lot with startups from the Nordic markets, for example, Finland, very, very good. Health Tech, digital health. In Finland, for example, everybody thinks they create the product they're gonna sell to an insurance company, for example, there is will be only one person selling to the insurance, the different products, they might be sold yet, the insurance, they let's say, for the sake of the argument, an insurance company will will buy four different products. This is an example. But every startup's aspiration is selling to a big insurance company. But in reality it is very difficult selling to an insurance company, because the product market fit the startup dynamic with a big corporation, and also only one player will sell that type of product to the insurance company. So from the beginning, the digital health startups are up against it. You know, but also the founders, and I was in that position myself, always have this irrational thinking that they're gonna make it that way. Because it's the product. And because they work extremely hard, and because they will still believe they're going to, you know, so it is a very, there are a lot of things to consider, you know, I don't have the answer for everything. But I've been in, in a lot of different positions with my companies, and in many people's companies. And it's not always easy, the answer doesn't come to you. Right away. So, I mean, it's an ongoing thing, but the product market fit, finding something that works is extremely important in order to progress.

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Chris:

Yeah, I'm glad you're bringing this up. Yeah, and we've talked to startups that are trying to make this journey with a, you know, new wearable or a new RPM wearable and power program. And I think what they found is that, like you said, that kind of older playbook of waiting for a health plan insurance company, you know, to buy you are a pilot is something that's a lot harder to do nowadays, because of same customers or, you know, providers if they were trying to run programs. They've been burned by the problem that you mentioned earlier, which is, hey, they did pilot a lot of programs with a lot of different wearables. And it turns out, at the end of the day, patients wouldn't engage with their devices. And you know, that the program would fall on its face without a lot of hand holding. But yeah, and then I'm kind of curious what you think about new maybe, let's say pivots and how you go to market. So we've talked to many startups that, for example, are going to consumer first, and proving first that patients will engage with their program with their device. And knowing that, hey, that business model that used to be the one to start with, right, that may be where we end up, but what they need to see that customer is that patients will actually use our thing, and so they're starting there. So it's kind of the B to C to B, which has become In one of the newer playbooks, what do you think about that?

João:

Well, Chris, that's a very, that's a very good way to do things. And actually, I'll learn something from you, thank you for that is always like this b2b to c type of more traditional approach, okay, we enter a provider, the provider taxi to the consumer, the C to B to C, I have not heard much, but it's a bit of a catch 22. Because generally, and generally speaking, there are exceptions and people doing things right away and the right way and get success straightaway. But generally speaking, the consumer market is more difficult to enter and to conquer. To start with, you need more money for marketing, you need to test the product is a bit of a catch 22, you don't have money for marketing to acquire customers, you can't really prove that you have a product that people use, and many startups find themselves in that position. You know, and then, I mean, for one reason or another things take a long time or take all is much longer to fruition than you expect. There is no right or wrong answer in here. But for certain depends on a product on the market on approach. Some strategies will be much better to go B to C, to B to C to B, or even like b2b to c, you all depend. But one thing that I'm seeing now, I'm sure that you you are in the industry, you have many times that data is the new oil, and the you know, and all these things, but I think now, and data is the new currency, you know, but one thing that I'm seeing a lot, and I'm sure you agree with this is many strategic partnerships is through partnerships in collaboration. Big companies with small companies, usually big companies take a bit of advantage, they just acquire, go to the market get a specific piece of expertise, if they need a cybersecurity arm, they buy a company's much easier I'm trying to develop a solution. But I would argue that collaboration is key. And collaboration is the new currency. But it's always ours are the startups to establish strategic collaborations is always much easier. They got more power, the big companies to kind of dictate the model. But collaboration is certainly key and partnerships is the way forward. And we see that in digital health, week in week out more partnerships on the ground. And we've seen that perhaps companies that don't they don't have that competitive mind anymore. They have more of this collaborative, open approach. And I think that's certainly one of the things that can make a huge difference.

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Chris:

Yeah, that's a great point, it's just kind of too hard to do it alone. And these partnerships are becoming necessary. What I mean, do you have specific advice to wearable startups on patterns of what you think succeeds or does not beyond the partnerships?

João:

Well getting, I would say I was in the development phase with another company. And it took quite a while getting a sense of trying to break down the user barriers early on, what I really want to say with that is try to simplify the user experience as much as you can from the onset. Because what the company has tried to do is to develop a very robust product that takes a lot of data and does a lot of different things. And then get to the users, I would say try to get users to use it as early as they can, even if it's just one off data metric or two. Because simplifying the user experience is extremely, extremely important.

Chris:

Gosh and in particular, in wearables or RPM programs. What's fascinating to me is a lot of times you're creating different user experiences, there's the one that really matters, which is is the patient going to engage? But then there's okay there's the provider back end or the dashboard for the insurance company or the dashboard just for the care managers. And really what's arisen is this new type of company that feels like they have to be full stack to exist. Not full stack is in layers of coding and engineering. But full stack is in something for each role and entity that's in this kind of wearable ecosystem. Gosh, what do you think about that? It seems like to me it has the potential to really raise the complexity of launching a startup, if you're expected to have all of the pieces are, allow your customer to mix and match what they need.

João:

Yeah, I think, you know, I love what it was in, you know, I'm an advocate of wearables. But wearables certainly, naturally, bring another layer of complexity. Let's say for the sake of the argument, you got an RPM system, okay? You're trying to get people to engage the users to use monitoring, or the, or the clinicians to use it to the patient. Wearables bring another layer of complexity, they bring another dynamic, they bring one more thing that you will eventually change the dynamic of the operation, you will add more people, they would add more false, they would add more things that don't don't work the way we expect. And I think managing expectations is one thing that we don't take, not serious, but we don't consider from the outset. But the other thing is that, it's not a good practice to try to cover lots of aspects at the same time. You know, focus on one thing gets time and then roll out the other elements as we go along. What a lot of wearable companies tend to do is they try to cover lots of aspects and try to be experts in all these things that same time, and then all of a sudden, they find themselves a bit disappointed because it's such an impossible task. And you describe it. So it is one very common challenge.

Chris:

 Got it. Yeah. Or maybe use partnerships or existing platforms for the stuff that is not necessarily your unique value proposition. And if your unique value proposition is founded on patients actually engaging with your thing. Yeah, focus your energy there, as you mentioned, so about just about half of our audience is people either working at or starting up their own digital health startup. So I'd like to end by asking, really, is there anything specifically that you wanted to share that you haven't gotten to about either wearables or just your advice, as they're about to embark on a journey that you've been on in there? And are helping people through today?

João:

Oh, sure. I think I already shared the little bit on, let's say, making the right noise. Identifying, mapping out the marketplace, identifying who is who doing what, and connect with people. Okay, Chris, you got an amazing company. I'm gonna follow Chris, get one eye on what Chris is doing Oh, is helping companies. I think connecting with the different stakeholders in industry is certainly very, very important. And I have my two channel crews, you know, that I interview on the big guys in medicine and healthcare, and I have exciting things coming up. So everybody, please keep an eye on that. But also, creating strategic marketing thinking around no matter how small or big you are, because everybody starts from zero followers, you have to make a start. You know, I think on Twitter, for example, I was getting very discouraged. The first year or two, I had less than 1000 followers, I was expecting to, okay, I'm gonna go on Twitter. And every day I post two or three things, and get hundreds of followers. And it doesn't work like that, you know, it is a very slow burner, slow process. Eventually, by persevering. I created an audience and a blog to 5000 10,000 20,000 I think now I've got 25 or 26,000 on Twitter, but it's been crazy, it's been over 10 years is not like a is not this is not a quick fix, you know? So perseverance, persistence, of course, but connect with others, the word SS before I mean, connect with others with other people because they all catapult you to a different place, you know, and they will help you in some shape or form. The other thing is one thing that I've learned and this applies to startups, but also to business in general, is that it might take 5-6-7 years for a company to mature, not into a multi million pound company, but even to get some kind of success. So what we expect in the startup world is one year or two years ago, a product three years, we expect things to just ramp up in the first three years. Oh, if it doesn't work, it is a failure. But it takes a good six, seven years to get to like a maturity status, at least. So don't give up too early. Make sure that you kind of are on the right track. But there are no rights or wrongs in near trees. I mean, every company is different. Some people grow very, very big in two years. Some people take 12 years, and they're still trying to figure out the marketplace. But yeah, I've been doing many, many things. And I've seen many companies have this unrealistic expectation that they should be very successful in three years, if they know. They're not going anywhere,

Chris:

especially if they know digital health

João:

Yeah , it is a very dynamic and digital health is a very peculiar industry. It is like this expectation of things ramping up very quick. You know, it's like, speed to market and unfortunately, healthcare is slow, healthy, slow, human beings are, you know, very faulty. So digital health is a very bumpy ride, unfortunately.

Chris:

Right, well, we're happy to be on that ride with people like you. And speaking of connections, Chow, thank you so much for connecting with us and coming on the podcast. We're huge fans and aspire to learn from people like you how to do our part, and build a digital health community. And really, thanks for all that you do.

João:

Chris, thanks for having me.

Chris:

All right, thank you , have a great evening

João:

You too

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