Hamish Grierson

I speak to Hamish Grierson, the Founder and CEO of Thriva, a company that allows people to take at home blood tests, help monitor and prevent commonly known health conditions.

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[0:00] Maiko: In today's episode I'm talking to Hamish Grierson, CEO and co-founder of Thriva. Thriva is helping people with personalized health advice by providing regular and affordable home blood testing kits. Next to the baseline test which assesses general health conditions, the company also provides specialized tests, for example, on diabetes. Thriva has raised about one and a half million in funding from the likes of 500 startups, Seedcamp, Taavet Hinrikus, the founder of TransferWise and a lot of other prominent angels. It's great to have you on the show, Hamish. 

[00:30] Hamish: Great to be here. Thanks very much for having a chat.

[0:33] Maiko: You actually personally, you used to run international payments and remittances for Travelex. So, how did it happen that you transitioned from that sort of FinTech background into actually setting up a health company?

[0:46] Hamish: Yeah, so maybe, slightly unusually, maybe not. We are a trio of co-founders, all of whom came from financial services originally. And the short answer to your question is that we ended up with in a position where myself and Elliot were working together at Travelex and really all we were doing was innovating in financial services by building consumer centric product, and difficult to do quickly within FinTech actually, but that was fundamentally what we're setting out to do. And I'd become very interested, personally in, I guess, originally nutrition. And I'd gotten slightly swallowed up into paleo dieting in a bit to look better in my wedding suit, which is entirely vanity derived originally. And I essentially got switched on to what you probably think of as the Tim Ferriss wormhole. So, I became really interested in how much control you can have over your body and health, if you like, became a bit of a hobby. 

[01:46] Hamish: And I'll talk a little bit more about that later because we see that show up a lot of in our customers. And Elliot had, since he was about 14, or 15 been dealing with a hereditary condition, which meant that he has elevated cholesterol actually common I mean, if you just met Elliot, he's fit as a fiddle, you wouldn't know to look at him. And he'd been getting regular blood testing for many years. And one day I started asking him about that process and how he dealt with it and whether or not he'd ever sort of run experiments on himself to try and maybe reduce his reliance on the drugs that he was taking, or, you know, generally try to shift away from the standard medical interventions. Out of curiosity, I wasn't presupposing that was the right thing to do. And he sorts of laughed at me and said, well, actually, I've got no data. And really, from there on out, the two of us became fascinated by why it was that within health, though it impacts millions and millions of people at an acute angle, all the way through to optimization. And there is so little out there that is consumer centric and affordable, intuitive and I suppose you know, certainly, from our perspective, really importantly, actionable. 

[02:55] Hamish: And that led us to a conversation around what actually happens if you materially bring down the barriers, to enable people to understand what's happening inside their bodies. And the very, rapid conclusion we came to, when we started, you know, bringing the requisite medical expertise to really help us understand the internal mechanisms within the body, is a great deal of good can be done. But it does start with taking the friction out of access to the information; that you walk out on the street and say to people, hey, have you heard of a blood test? Of course, everyone's heard of a blood test and typically, they can give you a rough indication of the sort of things that might be valuable. Okay, do you do that proactively? Now, of course, I don't. And, yeah, I mean, for us, and I could talk for a long time about the problems with the system, but really foundation for us, what we think the NHS is fantastic at and really should be left alone to be able to continue being great at, is sick care, and serious care. You know, if it's just able to do those things fantastically, actually, we think it's incumbent on innovators in the health space to help people to stay well, you get sick, by all means, you know, those systems are there and they're fantastic, well the best in the world actually. 

[04:11] Hamish: And, but the opportunity that we see for the population at large, is using products and services that can keep you out of those systems. The final part of the story I really should add is that Tom, who's sitting just over there, was the third leg of the Thriva tripod. So, we realized very quickly that Thriva was going to be a technology platform at its heart. Neither Elliot and I were technologists, so we bought Tom aboard and two became three and that was back in the early part of 2016.

[4:42] Maiko: I totally see where you eliminate the friction. I think, I myself have been using Thriva and before that I wanted to do a blood test, but it took me, I think a year because the NHS system just you know requires me to go somewhere and you know, to make an appointment and to explain myself why I'm doing this. And you know, it was frictionless for me to just go ahead, order, do it get the results, done, right? But what's the massive problem you're trying to solve? You've talked about preventative health and that's the big vision, are you trying to replace the NHS or are you trying to create or prevent NHS of prevention here? What's the kind of massive problem or massive vision that you're trying to accomplish here?

[5:24] Hamish: It's a lovely way of putting it, the NHS prevention.  Look, I think, to understand where we think of ourselves, positionally relative to the existing services be either private or public, and everything else, you have to unpick a couple of key concepts that we think are really interesting. And if you're sick as a definition, that's really well understood, what is unfortunately really badly understood is what well, theoretically represents. And depending on who you ask, you are either sick, or you are well. Now you're going to talk to most people who are not in a hospital or in a GP surgery and ask them about the kind of things that they are living with, everyone is living with this amazing array of questions, curiosities, minor problems, and desires, optimization, requirements that sit under this banner of theoretically well, but in practice very much not. Everyone is just, you know, out there being absolutely fine and these things, as you might imagine the sliding scale. 

[06:24] Hamish: So, whether it's, you know, understanding why I haven't bounced out of bed in the way that I used to, you know, why is my libido slowing down? Why can't I shift the weight? What's my diets doing to me? What about the stress that I've been living with for the course of the last year, because I've been working 3 am shifts at the law firm or, you know, less extreme versions, you know, farmers probably work just as hard, you know, what is it about my ethnicity, or my family history that I might have inherited, that is important for me to understand? Really, when I talk about the big problem that we're trying to solve, we're trying to equip people with the requisite information as in the appropriate information, to be able to make massive advancements towards solving or improving some of the things that they wrestle with every single day. So, we have started out, as you rightly pointed out, by taking all of the friction out of access to regular blood testing, but we're just about to launch a saliva-based cortisol test that looks at the map of your stress hormone over the course of 24 hours. It's a hugely important determinant of a whole variety of different things, it can impact how you put weight on, because it changes how the body metabolizes glucose and stores fat, it can have an impact on some of the key thyroid functions. 

[07:42] Hamish: A microcosm example of something that is in theory, it stresses this tiny thing over here in isolation, but in practice, it can have this huge set of consequences if it's something showing up in the physical mechanics of you know, how you actually operate internally as out of whack. So, I think the, you know, the interesting thing that we found, when we started out people compared us to the GP, blood testing versus blood testing. And if you look at where Thriva's today, and where it's going, certainly over the course of the next six to nine months, what you're going to start seeing is actually this is not comparable to your GP, we are massive fans of what the GP primary care product can deliver. And what we're trying to create is something as I say, that keeps people out of that system, providing them with, yes, paid for at the moment directly by the consumer, as opposed to being free at the point of need. But nonetheless, products and services that, as I say, address that wide set of health issues that people live with.

[8:36] Maiko: As much as we have gaps in the UK and NHS and we might not focus as much on preventative care, if you look globally, there is a lot of countries that might struggle much more with the health systems than we do here in the UK. So, I'd be keen to learn a bit more about your global vision, is your vision also to deliver this to remote areas and countries that might not have a doctor and you know, in a 100 miles radios, for me to be able to manage my health, what's the global ambition here with Thriva?

[9:03] Hamish: So, I think, you know, first principle is, it is a global ambition, you know, we do want to take it outside of just the UK, though, I mean, actually, we do perceive that the opportunity within the UK is material. And a couple of things just to, I guess note from our view of international expansion, the first is, to some degree, if you're taking the exact same operational mechanics that we have in the UK to another country, example a country where you don't have a particularly robust postal service. Unfortunately, just the exact operational map that we have today wouldn't necessarily stand up in, you know, the outer reaches of parts of Africa or Latin America, as much as we would love to be able to get to those people, precisely because actually, they are probably the ones most in need, you know, Babylon had done some really interesting work in Rwanda, for example. Now, that said, there are countries where there are leapfrog opportunities that don't map exactly to what we're doing in the UK, but where cost of labor is comparatively so much lower, that you start being able to put people out into the wild to collect the data. 

[10:07] Hamish: Now, the data could be a blood sample, a saliva sample, a fecal sample, depending on what's appropriate. And where you've got a sufficiently high degree of mobile penetration and internet penetration, that you stop being able to close the loops, assuming, of course, that you've got a relatively standardized laboratory processing capability. So, that's how we think about the the geographies where you don't have the ability to sort of map directly to what we do in the UK. Outside of that thinking, you've got countries that are, you know, more like the UK, the US being a primary example of that, where actually, we think the opportunity is really to do something similar to what we're doing here. The only addendum to that is, you do have places like Brazil, Russia, Estonia, to name but a few, where there's actually a relatively well ingrained cultural norm of going and getting a blood test or having someone come to you in certain places in India, but what is markedly missing is the product, the service and the data intelligence that sits on top of that data. 

[11:11] Hamish: So, oftentimes, people might go for their annual bloods typically, actually, and you're walking out with a PDF, if you're lucky, maybe it'll get emailed to you. And that's what you have, that's your product experience, it's not a service at all. And our way of thinking about what the opportunity might be within markets like that is, okay, we just care about the data. If I could magic it out of your body without you having to prick your finger and provide a small sample of blood, of course, we would do that. So, if you've got the information sitting there, and you're already culturally woven into this idea of popping in for a blood test once a year, maybe more frequently than that, we can start using that information, plugged into our system, doing all of the CRM engagement, intelligence and insight delivery, lifestyle advice and change supplementation that we're doing in the UK, it's just by slightly different means.

[12:00] Maiko: There is nowadays, a bunch of tests I can do right? So, there is DNA testing, 23andMe, there is blood testing, like you guys do, there is gut biome testing, by companies like Viome, so I can probably do a range or a dozen of tests on the regular basis. What I'm interested in, on the one hand, can we over test as well and drive ourselves crazy with all these tests and then on the other hand, where could this move to? I think I always have this picture in my mind, like, what if we could just have something in our body that tells us in real time, if something is wrong with us, you know, looks at the blood constantly, obviously, all might be a bit further away from that vision. But where will this all go? Will we all be doing like 20 tests every month and just like go crazy about our health? Or what do you think will happen with all this personalized health and prevention?

[12:53] Hamish: So, to answer your first question or observation, I think you're absolutely right, I think there's a real danger, of over testing, stimulating, I guess, at a worst case, panic, where that wouldn't be any information for information sake, as the likes of Facebook and Twitter are finding out. Actually, you know, it doesn't live in a moral vacuum, you need to be really conscious that when people test, they're provided with information, that information is going to do something to how they think and how they feel. So, we set a very high bar for ourselves that no one should either take a test that they don't need, or not have a test made available to them that they do need. Now we are going to start cutting across, we're doing a big project at the moment looking at microbiome analysis. 

[13:39] Hamish: Now, with microbiome as an example, gut health, as it's otherwise considered, not entirely the same thing. The science actually really isn't there yet, in terms of being able to say, this exact makeup of microbiome means, A B C D, and therefore you can do things G E F and down, I forgot my alphabet there for a moment, it's been a long week. They can start addressing some of the things that we've seen as problematic, so a huge amount of it is, quality rather than causal. Same thing with DNA, so that we are probably like, most health care, or health tech providers aware that in a perfect world, you'd have this mixture of predisposition for inherited diseases, born of understanding of DNA, you'd understand how your microbiome, or your gut health is evolving over time and you'd certainly understand what's happening within your blood chemistry. And because actually, the three of those things, you know, it's a correlating picture would be fantastic. The issue that you always have to balance off is where is the science? Where is the customer understanding at? And how much does it will cost? Two and three, to some degree related, of course, because if it costs 500 pounds, then clearly, you're going to threshold, the addressable market or throttle address market. 

[14:55] Hamish: But yeah, I think if you look at the Thriva product today, just to give you a small example of how we're trying to kind of tackle this issue, having done a test, we take two data signals, what you've told us you're focused on could be, you know, or told us is important to you, I'm a vegan or vegetarian, and what we've seen in your blood work to surface other potentially relevant tests for you. And we explain exactly why they might be relevant, let you link out to the research that we think is the most compelling form of the research. And obviously, we work with our medical director and all of our experts to make sure it's credible. And then we let you decide, you know, we're not trying to force you to do it, that's absolutely antithesis of what this is about. So, that, you know, if you are vegan, and you don't know that, you might want to think about your omega three and six ratio, because you don't tend to eat much oily fish if you're vegan or vegetarian and omega three is typically found in oily fish. And if you're not supplementing, it might be something that you want to think about. So, that's just a little example, but, yeah, you know, super interesting, absolutely has to be down with responsibly.

[16:01] Maiko: What's the science fiction here, like, what kind of ideas would you have, where science could move, where, you know, you might not even post anything to me anymore, it might be some sort of device that's attached to me, or that makes it almost real time to detect diseases? Is that something that you think about at all?

[16:20] Hamish: Well, I've trialed some of the early products, actually. So, it's, with very niche applications that's actually already here, so it's probably on the clunky end of the spectrum, this is not ready for mass market adoption, in some senses, yeah. But Albert's had a product, it's a little patch called the FreeStyle Libre, and it looks at your glucose levels, it's particularly valuable to diabetics who would otherwise have to prick their finger, put it on a glucometer. And, it's fascinating to see what combination of foods and alcohol generally spike or don't and what the shape of those spikes are, it's super interesting. Now, look, that is, something that is, you know, pretty much only used by diabetics, and the, forgive the pun, the bleeding edge of the quantified self-movement for now. But that is certainly something that's coming on stream, I think what you're going to see hardware manufacturers challenged by, you know, the idea is, I can just do this over the watch. 

[17:20] Hamish: Actually, the research seems to suggest the power of a device that's trying to, essentially investigate something beneath the skin depth, so far, as I've understood the science, it'll burn the skin before it's able to accurately see what's happening beneath it. So, it might be that you have to have a little needle, maybe, or eventually something will sit within the body itself, rather than trying to bridge the gap. I think that's actually probably more likely that we can get into some slightly dystopian conversations about, you know, where microbiology and if you ever read the why posts on where the combination of machine learning AI and robotics gets to, but it's, it's a slightly scary picture, but we're a long way off from that. And just as a, very briefly, I think, you know, there are companies, of course, try to create, I'll call them set top, you know, what I mean, it's at home testing. Again, super exciting, we would love to partner with some businesses like that, to start seeing whether it's appropriate for our customers.

[18:20] Hamish: The one thing that we know, to be true, and certainly in the UK is health is not in this sense, a build it and they will come, product, you know, or market, they, the manufacturers, people like us have to be able to communicate to consumers or potential consumers, what they're actually going to be able to do that is a value to them with immediate effect. And, you know, some of the challenges that the likes of Fitbit have is, they've got very high takeoff rates, as in people take them off. Because what you hear is people don't act differently on the basis of information. So, it's coming, I think it's probably still at least a couple of years away, before its mass market ready, it always has challenges of, okay, this is a new way of testing, does it have the same credibility? But there are some brilliant businesses attacking their space, so yeah, we're excited, we'd like to partner with them.

[19:10] Maiko: I'll move back from the crazy future visions to the reality of starting Thriva, actually. So, when you first started out and had this idea, okay, all these tests that the NHS is doing in their labs, we want to enable people to do them from their home, or at least collect the samples from the home and do the testing. What were the main challenges you had to overcome with that? What's problematic about testing at home and how did you solve for that?

[19:37] Hamish: There are lots of things that are problematic about testing from home, I mean, we have a unique opportunity and challenge, barriers to first use, don't get much higher than bleeding, we have learned. And so, the sorts of things that we had to spend a huge amount of time on were, people around described them as product design. Now our product transcends digital and physical, but we set a very high bar, internally, with respect to anything that we put out in front of a customer. For the simple reason that, we know it's scary, lots of people haven't even considered that you could test your blood at home yourself and that it's pretty much painless. So, you know, the education, the engagement, the credibility, and a huge amount of that is born of, how the end to end interaction flows. How easy is the information to interpret? How well do the instructions tie back to the kit design? And how do you talk about the results? How do you expose information as part of the results in a hierarchy or in a framework that doesn't overwhelm and doesn't basically create the kind of panic that you're actually looking to prevent in the first place? 

[20:55] Hamish: So, we put a lot of work into product design. Now, that was, of course, a lot of thinking around the regulatory environment, we had to get some legal advice to make sure that we were not doing something that needs to be regulated. And we're not, we happen to be applying for regulatory approvals to be able to do some other really exciting stuff, but we didn't need it in the early instances. And I think just to point out something that is pretty obvious, actually but not until you find yourself running a company that has both physical and digital characteristics to it, you have to create a huge amount of operational mass to bring this to life, right. And we have lab integrations, multiple, we have kits, we have suppliers, we have a network of freelance doctors, we have a doctor interface portal, a digital version, of course. And I guess the net of that means that when you're scaling up the business, you can't prioritize from day one, just building, you know, killer applications. And using the data, because let's be honest, you know, there's still a huge amount of work to be done in thinking through the on-boarding funnel to get people to understand this, the product and refer it and thinking about the messaging framework that you can use to try and help people understand it when they're prospecting. 

[22:23] Hamish: So, it was just a lot of stuff to do and actually, we're kind of just hitting our stride in terms of putting out product features and services that are kind of at the core of the thing that will be ultimately really differentiated about the business. And look, I'm super proud of the team, they've done an amazing job. But yeah, I guess the reality is that when you're doing a business like Thriva, it's just takes a bit of extra groundwork.

[22:48] Maiko: Obviously, there's this prominent case of Theranos in the US, roughly in your space, but with a different methodology, so I don't want to compare you guys. But did you find that there was some sort of backlash or questions that suddenly people kept asking you about your methodology and maybe you can say how that might be different and how that's actually backed by science, right? So, did you face any backlash or anything or people questioning you?

[23:17] Hamish: Yeah. I mean, it's a very logical question. And almost none and I mean, one or two, if that, customers, however, every investor. So, thanks, Elizabeth, that didn't help. Though, I'm being slightly facetious, but the reality is that it's actually helpful in that it grows awareness for something that can be done without needing to run the risk of building another Theranos and add a huge amount of value to people's lives today. And that's a good thing. The increased awareness is helpful, there's no two ways about that. And, you know, fundamentally, where we are innovating is not in the way the blood, to use an example, comparable to Theranos, actually gets tested, labs analyze Thriva, and the same labs that process results from the NHS. So, if you go to the doctor, and you get a lab test done, you don't question the credibility of the information you get back, you shouldn't, in the same way, question it, because it comes from the same source with Thriva. So, yeah, it's massively a pretty short conversation with investors because they get it pretty quickly but doesn't stop it coming up.

[24:25] Maiko: And lastly, before we finish, I'd like to ask you a question, what are you most excited about with Thriva? Let's say in the next year, you mentioned earlier a little bit, your strategy that's going to develop and expand from what you're currently doing, what really drives you, what's most exciting, and what should people watch out for?

[24:41] Hamish: So, I think the short answer to that is, we want to help people full stop, that's, you know, the net of Thriva, we either win, or we lose as a company, because we either do that effectively, or we don't. And today, the number of health areas, if you can describe it like that, that we're able to help people with is relatively limited. So, we can help people pick up things like vitamin and mineral deficiencies, you know, linked up to their diet, we can pick up long-term risk indicators for heart attacks, and strokes and diabetes and things like that. But rapidly coming out our testing types that enable us to really add value to people who've got other types of health concerns or problems or curiosities, whether that is a gut health, curiosity, linked to, you know, their mental well-being potentially as a huge amount of research now, looking at the gut brain access, and how those two are very powerfully correlated, whether it's, you know, thinking about other types of blood test that, you know, help us provide value to women who are trying to conceive, all the way through to, you know, people who might be on a particular diets and how we interpret their information, will just get significantly more personalized, because we've thought about the appropriateness of the information set that we put in front of someone who's on a keto diet, and therefore shouldn't be worried about elevated LDL cholesterol, or maybe should, depending on what else they've told us, right. So, to summarize, it's about weaving personalization into absolutely all corners of the product. And that isn't something that we expect people should be trying to get out of anywhere else.

[26:27] Maiko: I wish you all the best on that journey. It's exciting what you've achieved so far, and definitely will be ordering my next test soon. So, thanks very much for taking the time.

[26:36] Hamish: Absolutely, my pleasure. Thanks for having me. 

[26:41] Maiko: Thank you.

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