Nanowear’s Venk Varadan on the Next-Gen of Wearable Technology
Many of us wear wireless, battery-powered medical sensors on our wrists in the form of our smartwatches or fitness trackers. But someday soon, similar sensors may be woven into our very clothing. Harry’s guest this week, Nanowear CEO Venk Varadan, explains that his company’s microscopic nanosensors, when embedded in fabric and worn against the skin, can pick up electrical changes that reveal heart rate, heart rhythms, respiration rate, and physical activity and relay the information to doctors in real time. And that kind of technology could move us one step closer to a world where we’re far more intimately connected to the medical system and doctors can catch health problems before they turn into disasters.
Nanowear’s leading product is a sash called SimpleSense that fits over the shoulder and around the torso. Last month the company won FDA approval for the software package that goes with the SimpleSense sash and turns it into a diagnostic and predictive device. It’s currently being tested in a network of clinics as a way to monitor and manage congestive heart failure.
Varadan trained in biochemistry at Duke, earned an MBA at Columbia, and spent about a decade in pharmaceutical sales and marketing and technology investment banking before co-founding Brooklyn, NY-based Nanowear in 2014. His father Vijay Varadan, MD, PhD, now an emeritus professor in the Department of Engineering Science and Mechanics at Penn State, is the other co-founder and the company’s chief innovation officer. “Nanowear’s technology was actually the culmination of his life’s work,” Venk says.
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Harry Glorikian: Hello. I’m Harry Glorikian. Welcome to The Harry Glorikian Show, the interview podcast that explores how technology is changing everything we know about healthcare.
Artificial intelligence. Big data. Predictive analytics. In fields like these, breakthroughs are happening way faster than most people realize.
If you want to be proactive about your own health and the health of your loved ones, you’ll need to learn everything you can about how medicine is changing and how you can take advantage of all the new options.
Explaining this approaching world is the mission of my new book, The Future You. And it’s also our theme here on the show, where we bring you conversations with the innovators, caregivers, and patient advocateswho are transforming the healthcare system and working to push it in positive directions.
Everyone’s used to the idea that if they’re being treated in a hospital, they’ll probably get wired up to sensors that track their heart rate or respiration rate or blood oxygen level.
We’ve talked on the show before about a new generation of portable medical sensors for everyday life, like continuous glucose monitors for people with diabetes.And some people even wear medical sensors on their wrists in the form of their Fitbit or Apple Watch. Some of these devices can go beyond fitness monitoring to alert wearers to problems like cardiac arrhythmia.
But what if medical sensors were woven into your very clothing? My guest this week is Venk Varadan, and he’s the CEO and co-founder of a company called Nanowear that’s taken a big step in that direction. Nanowear has developed a way to put microscopic nanosensors inside clothes .
If that cloth is worn against the skin, it can pick up electrical changes that reveal heart rate, heart rhythms, respiration rate, and physical activity and relay the information to doctors in real time.
Nanowear’s leading product is a sash called SimpleSense that fits over the shoulder and around the torso. And last month the company won FDA approval for the software package that goes with the SimpleSense sash and turns it into a diagnostic and predictive device.
But Varadan says that in the future the nanosensors and the software could be put into even more places, like headbands, conventional clothing, or bed sheets. It’s just one example of the explosion in mobile health technology that’s putting more power into the hands of patients and that’s one of the topics in my book The Future You.
So here’s my full conversation with Venk Varadan.
Harry Glorikian: Venk, welcome to the show.
Venk Varadan: Thank you, Harry.
Harry Glorikian: So, look, we all know that with with technology startups, there’s always this sort of chicken and the egg question what what came first in the mind of the inventors: the market need or the product that needs to address it. You know, ideally they come together simultaneously and there’s a back and forth dialogue between founders and potential customers. And you end up with what the startup community calls–what is it?–product-market fit, if I talk to my, you know, my Silicon Valley nephew of mine. So in the case of Nanowear, you know, did you start to think about the problem and how to solve it? Or did you start out with the technology? Which in your case involves a way to embed these tiny nano-pillar sensors into cloth and then look at ways to make it sellable. So which one was it for you?
Venk Varadan: Great question, Harry, and again, thanks for having me on the podcast. We were squarely the latter and I think most entrepreneurs are the former. But we had this great advanced material, a cloth based nanotechnology that could pick up really, really high fidelity clinical grade biomarker data off the body. And we didn’t really know what to do with it. Do we start as a consumer company? Work on fitness, B2B, sports? Do we think about industrial safety, military use cases? They’ve been trying to figure out smart textiles forever. Or do we go into health care? And I think stubbornly so, and a little bit of altruism, we chose the harder route, which was health care. But I think it was probably more premised on that we believed in the quality of the sensor. It was doing something from a quality and quantity standpoint that no other on body sensor or non-invasive sensor out there could do, whether it was consumer grade off the shelf or health care based electrodes. So all we really knew when we started is that we wanted to be a health care company, but we didn’t know the right application to start with.
Harry Glorikian: Yeah, I was going to say, let’s, let’s pick the hardest one and see if we can get over that hill. So let’s back up here and talk about like the medical need you’re trying to address. I mean, at a high level, why is portable diagnostic sensing so important for people’s health?
Venk Varadan: I think it was always important because of an access issue, right? Not everybody can go see a physician or can do high cost diagnostic tests that require a facility or diagnostic tools in person. And there’s a cost even to running a blood pressure cuff or checking your heart with a stethoscope or running a hemodynamic monitor, all the way up to more expensive tests like sleep studies and sleep labs. So I think it started, remote diagnostic needs started with an access issue, and it’s not like we haven’t had telemedicine in the past. But even that was sort of limited due to access issues. You needed a broadband network, you needed particular devices, you needed smartphones, and there were a lot of industry, I guess, pressures holding this sort of need to sort of push health care out into the more wide stream for those that have access issues. And we all said that this was going to happen one day. Virtual care, telemedicine, remote monitoring at home, replacing offices at home. And it was a nice sound bite. And COVID kind of forced the issue and I think completely accelerated that 10 year frame on the need, right? Because folks were still sick. Folks still have chronic disease. Folks still needed acute procedures. But you weren’t really able to do a lot before, during and after, if you had to have these people camped out in the hospital or in outpatient clinics or acute surgical centers. So that’s when while everybody thought it was cool and one day I’ll employ these digital technologies, it really took COVID to shut their business down or they didn’t have any patients, to force them to adopt. So I think a lot of our, companies like us, we were all doing the right thing. And we also are the first to admit that we got fortunate that the pandemic sort of accelerated the need for our solutions.
Harry Glorikian: Yeah, I mean, I remember I put together, god, it’s got to be like 15 plus years ago, I put together a distributed diagnostics conference, because I was like, “This is going to happen.” And, well, OK, eventually. But so let’s talk about, let’s step back for a minute and talk about some of the specific medical conditions where continuous, high resolution, high fidelity data is useful. Like, I know we need to probably start with congestive heart failure.
Venk Varadan: Yes, so that’s where we actually started before COVID. That was the sort of market need where our technology, our ability to sort of simultaneously and synchronously look at biomarkers from the heart, from the lungs, the upper vascular system in a sort of contiguous way and sort of map the trends over the same period of time as you would with a stethoscope or blood pressure cuff and electrocardiogram or hemodynamic monitor if they were all in one platform. That’s really what we’re replacing as part of our solution and our device-enabled platform. But the economics of heart failure and the business need were really what was pulling us there in the sense that there were penalties from CMS to avoid that next hospitalization within 30 days. And many of these patients are, one in four are being readmitted within 30 days. One in two are readmitted within six months. So this isn’t a problem that we can just medicate our way out of. We have to understand when decompensation of the heart is happening before symptoms show up, because once symptom show up in fluids accumulating in their lungs, it’s already too late. So I think there was a good product need for us, as well as the economic need with reimbursement and solutions for something that can be done outside the body that a patient could be be using at home.
Venk Varadan: And then I think, you know, COVID hit and the market applications really just exploded beyond heart failure. Heart failure is still on our roadmap. Our clinical study to prove that ALERT algorithm of, we take all these data points, send it into the cloud, do a risk based predictive algorithm to predict worsening heart failure or decompensated heart failure weeks before fluid accumulates in the lungs. That’s still firmly on our roadmap. We’ve just got to restart the study that was halted due to COVID. But the same product that does the same parameters with a different sort of algorithmic use cases opened up a lot of other applications that now have a business need and economic need to use us. So the two that we’re starting with is pos-procedural or post-surgical follow up in an acute use case setting. And the second is outpatient cardiology longitudinal care for someone who unfortunately probably has to see a cardiologist for the rest of their life.
Harry Glorikian: And if I’m not mistaken, congratulations are in order because of an FDA approval.
Venk Varadan: Yes, so we actually got our third 510K just two days ago. September 21st, sorry, September 22nd, we got our third 510K. This is actually an example of our of our first digital-only clearance. So our first two clearances, our first clearance in 2016 was primarily around the advanced material, the nanotechnology, to get FDA comfortable in its safety and efficacy profile. The second was for our product, which is the SimpleSense shoulder sash, which simultaneously and synchronously captures data across the heart, lung and upper vascular system biomarkers, feeds that data through a mobile application and into the cloud. And then this clearance is sort of for an end-to-end digital infrastructure that circularly includes ingestion of our 85 biomarkers and then analytics circularly across our spectrum that continues to sort of process and then has the ability to push insights or algorithmic alerts down. So that last part is not included. But if you think about it, Harry, we kind of had a strategy before we got to the AI part. Now everything we submit with FDA has nothing to do with the device, has nothing to do with software infrastructure, has nothing to do with what would be MDDS or what wouldn’t be. We can simply send in statistical analysis on the AI algorithms based on the inputs that we’ve already cleared and then looking retroactively on the outcomes. So it was it’s a nice win for us to kind of show that we’re not a device company, we’re a device-enabled platform. But I think what it’s really exciting the market on is that we’re ready for AI diagnostics. We hope to have a first one and our fourth 510K, I guess here with FDA pretty soon in the complex chronic disease state. So really exciting times for us.
Harry Glorikian: Yeah. And I mean, as an investor, I mean, I, you know, I’ve been in diagnostics forever and I, you know, I’m so focused on Where’s the data? Show me the exponential nature of the data and then what we can do with it and really like blow that up, right? That’s where I see the value in these platforms and technologies. But there are technically other methods that had been used, right, that you might say you might or might not say are competitive in some way. But one of them is called a Holter monitor, right? Which people put on their skin to monitor, you know, electrocardiogram and EKG rhythms outside the hospital. And I don’t want to say the name wrong, but I think it’s SimpleECG for yours and then the SimpleSense vest, [how does it] compare to that. What are the alternatives? How long do you wear it and how do you compare it to the existing status quo?
Venk Varadan: Sure. So, you know, a Holter monitor has a specific use case. It’s looking at your electrocardiogram rhythm to see if you have a rhythm or abnormality, right? So we one of the metrics we capture is an electrocardiograph, right, and we do multiple channels of that. So it’s not a single lead. So we could certainly compete against that application and just look at rhythm abnormalities in the same way. Companies like iRhythm have that, and Apple Watch has that 30 second feature on it. We are not playing in that space. And the difference between us, even though our signal quality, we would argue, is much cleaner than a Holter monitor that’s using standard electrocardiographs, with those you have to shave your chest, you have to stand the dead skin down. You have to put gel on for the electrode to get a conductive signal. We don’t have to do any of that because of the nanotechnology. But what the nanotechnology also affords, in addition to a better experience and better quality, is the ability to do more than just a Holter monitor, right? So imagine if that same Holter monitor wasn’t just looking at rhythm abnormalities, it was also looking at the acoustics of your heart and your lungs, the sounds of your heart in your lungs. It was looking at the flow characteristics. The blood injection times, the fluid accumulation in your lungs. It was looking at your breathing rate, your breath per minute, your lung capacity, your changes in lung capacity over time, if it was looking at your pressure related issues at the aorta, systolic and diastolic blood pressure. In addition to being a better experience in all of these and sort of kind of replacing a Holter monitor and a stethoscope and what have you, the real value is being able to do all of that at the same period of time over the same period of time. So even if I’m monitoring for, our use cases are about 30 minutes to an hour in the morning, 30 minutes or at night. And because we’re getting such dense quality and quantity of data over that time period, we can actually see trends across the cardiopulmonary and upper vascular complex, which is actually the first company and platform that can do that. And that may not have been important before COVID. But COVID, I think, was revelatory in the sense that COVID may have started as a respiratory disease, but it affects the heart. It affects the upper vascular system. You can get a DVT from it. And I think it opened the world’s eyes into understanding. We’re not looking at all of these systems, the heart-lungs-upper-vascular system that all work together and work uniquely in each of our own bodies. We’re only getting a risk based signature on just cardiac rhythm or just breaths per minute or just the sound murmurs of your heart, whereas we’re doing it now.
Harry Glorikian: Yeah. So for a guy like me, like, I’m like, Oh my god, how do I get one of these? I want one of these right now. I’m thinking like, Oh, I could use it right after I work out. And I’m, you know, forget the I’m sick part of it. I want to use it as a wellness monitoring and sort of to see, get a baseline. Tell me where I’m going, right, over time. That’s what I’m always discussing with my my physician is we need a baseline because I don’t know how it’s going to change over time. If I only look at it at that point in the future, I don’t know what it was. So, but the other side, I think to myself, there are physicians listening to this show that are probably all excited about this. And there are physicians going, “That’s a lot of different data points. How in the hell am I going to make sense of that?” And so I’m I’m assuming what you’re going to tell me is you’ve got this amazing software that lets you visualize, you know, and make sense of all these different parameters together.
Venk Varadan: And that’s exactly right. You know, we were actually stubbornly annoying to our KOLs, our clinical teams, as well as our original customers in beta rollouts, because Harry, we agreed with you. We looked at where Gen 1 and Gen 2 sort of digital health companies struggled in health care. Health and wellness is a little bit different right? I mean, to each their own, right. I mean, if you market well, you’ll find that pocket of people that want to be overwhelmed with data or what have you. But we really listened to what digital health was doing for the provider and patient relationship. There were some good things there and there were other bad things, and the bad things we realized actually wasn’t monolithic between clinics. Some people thought that bad things were “I’m alerted too often.” Others wanted to be alerted all the time. Some were like, “This is noisy data. It’s too unclean.” Others were saying, “I just need, you know, 70 percent C-minus level data,” right? And then we were thinking about all of those aspects which we couldn’t get consensus on. How do you bring all of those aspects that gives control to the provider so the provider can say, how often are they alerted, how much data and the raw signals do I want to look at, how much do I not want to look at? And really, with the thesis of building the platform on them, spending less time than what they do before? Because I think Gen 1 and Gen 2 products unfortunately actually added more time in adjudication and frequency of the provider being notified, and also cause some anxiety for patients as well because they were looking at their screen and their data at all times.
Venk Varadan: So we really tried to be sponges of all of those different devices that were tech enabled and sort of moving from hundred-year-old devices to now Gen 1, Gen 2, pushing into the cloud. And really listened on… And I’ll tell you, it was mostly from staff. It wasn’t necessarily from the physicians and the surgeons themselves. It was mostly from triage nurse, from health care staff, the people that are running around coordinating the follow up visits, coordinating the phone calls from patients that were doing poorly or feeling bad after feeling sick after a procedure. And I just think we just kept our ears open and didn’t go in saying, we know what you need. We were asking, What do you?
Harry Glorikian: All right, so let’s talk about the technology itself, the SimpleSense wearable sash. How does the cloth sensor in the garment work? I mean, on a microscopic level, what are the kind of changes that this nano pillar detects and how?
Venk Varadan: Yeah, so not to get to sort of, you know, granular into the physics, although I’m happy to Harry, if you if your audience ends up sending me some questions. But think about our ability to just detect a difference in potential action potential from point A to point B. And it’s an oversimplified way of describing what we do, but the reason we can do it better than anybody else with any other sensor — and that’s what really feeds the cleanliness and the quality of our data and allows us to derive so many biomarkers that other others can’t, which obviously feeds the ability for AI — is because we’ve got these billions of vertically standing nano sensors per centimeter of surface area. The differential or the potential difference that we can find because our signal quality so clean is so narrow. Whereas other sensors that might be treated as noise, we can consistently see deltas from point A to point B and know exactly what caused those deltas, right? And that’s unique to us and our vector orientation. And it’s probably a little too wonky here, but if you have a vector across the largest slice of the heart, across the largest slice of the lungs, across the upper vascular system in its entirety, with that finite ability to get really microscopic level changes in potential, irrespective of what signal you’re looking at. Because once you we know what signal we’re looking for, we just set the frequency bands for those, right? Right. And that’s really, in a nutshell, how it works across the multiple parameters that we can capture from a biomarker standpoint.
Harry Glorikian: So you said 85 biomarkers, right? We’re not going to go through all of them because we’ll be at the end of the show. But what are the kinds of, let’s say, physiological data that you’re pulling in and that you’re differentiating on?
Venk Varadan: Sure. So I probably summarize it into several different buckets that each have maybe 20 or 30 derivatives under it. But, you know, cardiopulmonary biomarkers. So the coupling between the cardio and pulmonary complexes, impedance cardiography, thoracic impedance and then looking at not only the means and the median trends across those metrics, but the standard deviation. So one of our board members famously said, Nadim Yared, the CEO of CVRx, You will learn so much more from the standard deviations than you will from the trends. Don’t just look at the sort of the trend. So that’s an example. Cardiopulmonary: We look at the electrical signals of the cardio complex and electrocardiographs. We look at a combinatorial methodology of cardiographs, acoustics, BMI, height and weight. And then we tie activity, posture, movement. What is your sleep orientation? Are you sleeping on your left side? Are you sleeping on your right side? All of these sort of things together actually enable some really interesting insights from a machine learning standpoint. And again, the beauty of our ability to sort of understand them and see more biomarkers. Eighty-five is where what we know right now, what we’ve validated. There’s probably a lot more that we will discover under certain disease states. But what we’re able to sort of mesh together from all of those are really cool aspects like blood ejection times. That’s not a physical, raw metric we’re getting. That’s a derived metric and combining a lot of these aspects cardiac output, stroke volume, you know, these are things that could only have previously been done with an arterial line in your body and in a hospital system. So I don’t know if that answers your question.
Harry Glorikian: Well, no. I mean, listen, I mean, this is why I invest in this space because, you know, theoretically, as I get older, I may be a patient and you know, the better these technologies get, the better off I’m going to be. But so let’s talk about for a second, where did where did this originate from? And I think your dad, your father had something to do with this, if my research is correct.
Venk Varadan: He sure did. This may be a little bit of a long winded answer, Harry. But but for your audience, I’ll tell the story because it’s important for dad to be happy at all times, even though I’m 40 years old. So, Dr. Vijay Vardhan is our co-founder and Chief Innovation Officer. My father, 40 plus year academic researcher in the fields of materials, research and biomedical engineering and this was actually, Nanowear’s core technology was actually a culmination of his life’s work. Back in the 80s and the 90s when I was still a young pup and he was convincing me to go be a doctor, he was doing research in this field, and it wasn’t even called nanotechnology back then. There wasn’t a term for it, but he was doing defense related projects in the ability to detect very minute signals at very, very, very, very difficult detect detection environment. So an example is submarine coating, right? Submarines when they’re below water are picking up their external environment information through sonar. The deeper they get in the ocean, the harder that sonar frequency is to be able to differentiate. Is that a a school of plankton? Is that a whale? Is that a thermal geyser that’s sending me the signal? Or is it a Russian sub, right? And his thesis was, if I have a really big footprint of sensors and exponentially higher surface area of sensors and not just one sensor or two or one hundred but billions across the hull, I can start to differentiate over time the nuanced differences between the sonar a whale emits, the sonar a thermal geyser emits, or oh, by the way, what are our friends in the USSR emitting, right? And that’s an example in really, really hard to detect environments. He did the same with observatory jets and missile defense systems at 75,000 feet, you know, the opposite, very high frequencies at very high speeds. So that original thesis, the human body is also a very complex environment and hard to detect environment as well, right? So long story short, he kind of took that same thesis over many years of playing around in the lab and publishing papers and doing great work for our government and our Department of Defense, but also with an eye to the future on what could this do in the human body one day?
Harry Glorikian: Right. Well, that’s great. I mean, it’s I’m sure he’s very happy that you two are working together to bring this to market.
Venk Varadan: He’s not as disappointed in me about not going to med school anymore. Let’s put it that way.
Harry Glorikian: Yeah. Keeping parents happy is is a is a difficult thing. I know many people are like, Are you going to be a doctor or are you going to be a lawyer? You know, I know the I know the joke. So you’ve got FDA approval for a number of, as you said, you’re building on top of, this layering that you’ve been doing from an FDA approval standpoint. What did it take to get them to sign off? What sort of evidence did they need to see?
Venk Varadan: Yeah, it’s a great question. I think that we kind of had to create our own playbook with them. I’m sure if they’re listening, they don’t want to hear this because you’re not supposed to sort of commend and compliment the agency. They’re just supposed to be there as sort of the gatekeepers. But we used to hear just a lot of horror stories like, “Oh man, you know, working with the agency, it’s really tough. You know, they’re really tough on this.” I mean, we always looked at them as our partners, you know, we were bringing a novel technology to the world. We chose to go into a regulated environment because we believed in the promise of saving patients. We were not taking a sort of anti-regulation attitude that I can fix this, government get out of my way. I’m a patient first. I like living in a country with FDA where something is scrutinized that I have to take when I’m sick. And I think that attitude and going into it from us as a product and R&D team, first of all, helped in clarifying our understanding of FDA’s processes because it’s a lot, and you really need to dig through the guidance in that. But I would say this is really hats off, Harry, to our founding engineers. I mean, they went from being engineers to really understanding process, and that’s really what FDA is. Our first clients we met with, we went down to Washington 11 times in person to demo to ask questions continuously. And “Hey, we read this part of the guidance. Does this make sense for us?” And we shut up and listened when we didn’t agree with them. We said, “But what do you think about this? Doesn’t this solve it?” We weren’t trying to go around them, and so we were trying to develop sort of new understandings of it.
Venk Varadan: And I think collaboratively we put together a good playbook with FDA to clear a material that they had never seen before. Right? It would be one thing if we use the standard electrode like all Holter monitors do and combined it with something, and did different things on the software side. That would be somewhat straightforward because they know the data that’s being generated is often the standard electrode. But for us, we had to do a lot of different and in many cases, much more rigorous testing, which that was painful. Don’t get me wrong, but totally worth it, right? I mean, our sort of boundaries and our understanding of what FDA put us through, it turned out to be a boon in disguise. I mean, our whole team can sort of run through the needs now of FDA and we feel very experienced and very well equipped on how they think. And now that they’re comfortable with the sort of data we capture, all the great things we can do on the AI side, which is still scary to a lot of people. You just say I’ve got a black box and I’m combing electronic medical records, and here’s what the unsupervised learning tells me. I was a regulator. I’d be like, Wow, I’m not touching that with a 10-foot pole, you know? So it’s different with us, right? I mean, we can define everything that’s coming in and we can define the outputs. Yes, the AI in the middle is the magic, but we’re not sort of defining everything until the outcomes, right, which is where I see a lot of companies got into trouble. So I think it was worth it with the FDA.
Harry Glorikian: Well it’s funny because, I mean, I always say to people, I’m like, Listen, they’re not the enemy, actually. They can make your life easier because and I say, people tell me, “Well, I’m not going to go until I’m absolutely done.” I’m like, If you wait that long and they tell you you’re wrong, you just spent a whole lot of money for “and you’re wrong.” Right? So you should look at them as your partner. Right. And I’m assuming you went to, you worked with the digital health group at the FDA.
Venk Varadan: We worked predominantly, consistently we work with CDRH [the Center for Devices and Radiological Health] and now actually as a as a board member on Advamed, sitting on the executive leadership group for digital health, Advamed is a trade association that helps with FDA and with CMS on on industry innovation. CDRH does have its own sort of digital health group within it that’s focused on a lot of these issues that we’re talking about A.I., data privacy, cybersecurity, which in this sort of next decade, I think is going to be the main sort of frontier for the industry government relationship that we all sort of signed up for when we decided to go into health care, because even the most sleepy widgets right that we use consistently, they’re all tech enabled now. Everything is digital, you know?
Harry Glorikian: So yeah, and I mean, they’re they’ve been creating that from the ground up. I remember talking to the the gentleman that runs it and he’s like, I feel like I’m running a startup because, right, most of the stuff that we’re, you know, we need to figure out has never been done before at the regulatory agency. And so we’re sort of creating it from scratch, right? So I mean, in a way that that’s good because he understands the pains that the companies are having to go through in creating something that hasn’t been done before.
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Harry Glorikian: So let’s go back for a second to, you know, 2020 in the first wave of coronavirus pandemic, right? You partnered with some medical centers in New York and New Jersey to start using it to monitor patients. And what did you learn from those studies and how did the device help improve treatment?
Venk Varadan: There were two things I think. One, it was all anybody was talking about, and there were so many unknowns about it that we recognized that this was a, you know, a virus that was affecting the cardiopulmonary complex. Those that were getting sick and we’re going to the E.R. had issues there, and that’s what we were doing. And so in the same way that we’re looking at potential use cases with the ultimate goal of assessing someone’s risk, right, which is really what we’re what we’re doing as a remote diagnostic company or a remote hospital at home patient monitoring company, we went into COVID with that same thesis in doing so. And obviously in our backyard in New York, we got punched in the mouth first in the USA. With that, pretty much everybody I know was infected in March. We were all riding the subway together, you know, up until the last day as sardines. So it was not escapable here. And we’re a dense city, right? We all sort of live on top of each other and our hospitals almost in a week. There were patients in the cafeteria. They were we were making tent villages for additional beds in Crown Heights, Brooklyn. It was completely overwhelming. And so we really feel it felt like we wanted to do something about it now. We would have gotten on patients right away, but. We did have to go through the IRB processes, which would take time, unfortunately, but we learned a couple of things and the two things actually that we learned are is that we’re not necessarily super helpful in a acute virus that hits you really fast.
Venk Varadan: The patients that this is sending to the ICU, it’s doing so very quickly. It’s rare that someone is sick for three or four weeks. They progress so badly that then they go to the ICU. They have a drop pretty quickly when it happens. So what we found was, our study was really to go on patients while they were in the general ward, and the endpoint would be when they were transferred to the ICU because they had gotten so sick a morbidity event or they were discharged. And I think we were unable, to be candid, we were unable to find the lead up to that point because we just simply didn’t know what patients were coming in. I would have loved data on them from 48 hours beforehand. Right? We could have learned so much, even very basic functions that Fitbit and the Apple Watch are trying to market. “I saw a spike in heart rate from the all patients that got infected with COVID 48 hours before.” That is the premise of where I would have loved to go with our granular data, but we’re not the type of device that somebody just wears at all times, whether they’re sick or not, right? So I think that was a learning experience for us that if there’s an unknown of when something’s going to hit, it’ll be challenging.
Venk Varadan: For infectious disease that becomes chronic disease, I think we’re going to be in much better shape, and I think we could definitely do a longitudinal study for the long hauler community, right> You know, the folks that have been infected with COVID and have literally seen symptoms for a year or two, I think there’s a lot we can learn longitudinally from there. And that’s really where I think our study with our with our great partners at Maimonides Medical Center in Brooklyn and Hackensack, New Jersey and others across the country would, we would be more than happy to to participate in some of those longitudinal studies because, you know, we don’t know what the long hauler is going to look like in five to 10 years, right? Or even people that have been infected before the vaccines now. That’s still a let’s figure it out type thing. So it’s not you have to balance sort of running a sales product business versus a research part, but with the right resources and the right partners we would love to continue that work in COVID because it’s not going anywhere as you know.
Harry Glorikian: Well, listen, I actually want you to put it into a T-shirt and send me one so that I can wear it and monitor myself. But let’s talk about where this technology is going in the future, right? The SimpleSense sash looks, you know, comfortable, convenient, way more comfortable than, say, a Holter monitor. But you’ll correct me if I’m wrong, but it’s still a specialty device. It isn’t made from off the shelf materials, et cetera. But do you think there’s like we’re moving to a day where you can sort of embed these sensors in, as I said, a T-shirt, familiar cloth items. I’m looking at digital health and saying it has the ability to monitor me and sort of help identify problems before they come up so I can get ahead of them. And so that’s how I’m thinking about this technology, because those sensors look pretty small and thin, at least from what I could see visually in the picture.
Harry Glorikian: We’re the first to say we don’t know when we don’t know, Harry. I know the market wants you to always have an answer for everything. A lot is going to depend on the additional aspects that we all use in technology stack. Where does 5G take us? Where does increased broadband take us? You know, 10 years ago, we didn’t realize everyone in the world would have a smartphone, right? Villages in India and Africa, they have these now, you know what I mean? They may not have running water, but they’ve got, you know, a Samsung device, right? And so we may have never thought that monitoring in remote places like that because we couldn’t find an economic model to sell shirts or bed sheets for a dollar out there. But maybe with the volume and with the right partners, that’s where we could go. We certainly built our our stack with that sort of dream in mind. We filed IP and got patents awarded to embed in clothing and bed sheets and upholstery on cars and seatbelts and on the steering wheel and. You know, this could be in the gloves of a pilot one day. You know, this could replace your sort of neurological monitoring. We’ve got a prototype of a headband that’s calculating all your EEG and EOG signals could replace an 18 lead one day. I think when you throw in real good advances in automated supply chain and 3D printing, there’s a lot that can be done in this space and it’s going to be done through partnership. We’re not going to do it all on our own.
Harry Glorikian: No way. I was going to say Venk, get to work, man! What are you doing? Like, you’re using this in a in a medical application, but I really want to understand: so especially if, you must have believed in it because you filed the patents, but do you think that this sort of sensor technology could just be a normal part of preventative health care in healthy patients?
Venk Varadan: I think that was always the goal, Harry. What can we do to really help a physician provider and ultimately a payer understand someone’s risk without them coming in to a hospital or doing a visit? Because really the only people you should be seeing in person are people that need to be seen, not me, for an annual physical. Not you for an annual physical. Not, you know, somebody in the villages in Africa who really just needs to understand why they have a fever, whether there’s something really wrong inside them. That’s where I think this should go. It always was that case. We never knew what the right problem was to start to build a business around it. But this should replace your your annual physical, your annual checkup for healthy people. This should replace the follow up visit for your post-surgical, whether you get a knee replacement and angioplasty or a stent in your heart and should replace your chronic disease visits. If you have sleep disorder or heart failure where you know, do you really have to go get a $10,000 test every three months to see if you’re regressing, improving or if you’re staying the same? I think that this can democratize all of that in some way, and it’s cloth. We all wear clothes every day, right? So yeah.
Harry Glorikian: I mean, I look at I’ve looked at all these technological advances and I look at them as deflationary in a sense right. We’re allowing people to get higher quality care from these technologies because of the information that comes off of it and then utilizing AI and machine learning and, you know, different forms of data analytics to sort of highlight trends and problems or hopefully, no problems, and then if one comes up, it sort of sticks out like a sore thumb, but it gives you a longitudinal view on that patient. And that’s where I see all of this going, I mean, COVID has just pulled everything forward a lot faster than. You know, anybody could have guessed, and I agree with you, if you look at 5G and all these things coming together, it’s just it’s going to take it one more leap forward that much faster. I mean, I can imagine a partner for you would be Apple or Google thinking about, you know, clothing. Or Lululemon, for that matter, I guess. But somebody that that can incorporate this into their into their materials and make it more available. Because I got to believe that there’s a consumer application that somebody could take advantage of rather than just a hardcore medical need, if that makes sense.
Venk Varadan: No, you’re absolutely right, and again, this sort of went through our strategic thinking when we were thinking about what we wanted to be when we grew up. And we think that the our unique cloth nanosensor technology, which good luck trying to replicate and copy that for anybody who’s interested, I mean that again, this was 40 years of work that sort of how to create it and we’re bulletproof, protected from a from a patent standpoint. But we think this can enable all of those markets. Our thesis was always, Harry, if we could start in health care we’d have the need-to-have population. The people that don’t have a choice, right? I mean, I can go out for a jog or I don’t need to go out for a jog, right? I can run with a monitor but I don’t need to. But there’s a good percentage of the population that doesn’t have a choice. They must be monitored. If we could start with that, need to have population and prove it, prove that it works, that it’s changing outcomes. Why would the nice-to-have market use something that you know, is already working for for sick people, right? And that was kind of always our thesis. We don’t really have a timeline on when we’re going into the consumer market, but because, you know, there are different aspects that are involved there from a business standpoint, customer acquisition marketing are the obvious ones, but sexiness, fit, we did not focus on “Do we look cool?” We were focusing on, you know, design is important on everything, don’t get me wrong, but we first started with “make it work.” We didn’t start with “It has to be this big” and then figure it out, right? We started the other way around.
Harry Glorikian: Well, and if you think about all the existing wearable technologies, they incorporate a sensor that everybody understands very well, right? There’s no question that temperature monitoring, there’s no question that, you know, if you can have a CGM on you, you can sort of understand what foods affect you positively or negatively. You’re right. We need the scientific publication to prove that the technology that you built does what it needs to do, and it’s probably all the time going to give you new information. You’re going to be like, I didn’t know we could figure that out, right? Which is the beauty of having 85 biomarkers. You’re going to find something new all the time, but you could easily see that certain applications would then become accepted and then make its way into mainstream.
Harry Glorikian: Yeah, absolutely. And I think the more that folks are using and the cool thing or not, maybe not cool, maybe it bothers some people, I’m sure, but technology goes one way. It does not go backwards, right? And COVID sort of shifting virtual care into the forefront, which is what technophiles did before. “Oh, I just talked to my doctor on the phone.” I would have laughed. I was like, What can they do with that right before I started Nanowear, right? But that’s not going back right. If you don’t have to go see your position in person and you’ve got an alternative now that replaces it, why wouldn’t you do that right? So. Yeah, I think as people get more accustomed with devices, they’ll understand how to differentiate from them. You know, I’m not taking shots at our friends in Cupertino, but there’s only so much you can do on the wrist, righ
Harry Glorikian: Absolutely.
Venk Varadan: If you’re not going across the heart, across the lungs, across the brain, you’re going to be limited in what you can do if you just have an armband device that’s picking up your pulse rate and your skin temperature, you’re limited in what you can do, right? So I think what we’re excited about, maybe not just on this form factor in this product, but understanding its application around the body. You can’t put a smartwatch around your body, but you can put a cloth around your body. You can put a sheet around your body, right? I think that hopefully the understanding is going to come that there is a delineation between something that’s great for the consumer and something that’s great for, you know, the health care population. And where does that nexus come together? I think that’s going to be driven by patients. I don’t think it’s going to be driven by us. I don’t think it’s going to be driven by the provider or the payer. I think the patients are going to demand, you know, as they are doing now, right? I mean, the reason providers are buying our solution right now is because the patients are demanding it right. The payers are kind of demanding it. To some extent, cardiologists would love to see 40 patients a day in their office again. They were really used to that, right?
Harry Glorikian: Yeah. This is a longer debate over a beer at some point.
Venk Varadan: It is Friday!
Harry Glorikian: Listen, it was great to talk to you. Healthy congratulations on the on the latest approval and look forward to seeing other approvals as as you’re taking this thing forward. And you know, I can only wish you great success. I mean, obviously since I’m an investor, I have a soft spot in my heart for every entrepreneur out there.
Venk Varadan: Thank you, Harry, and thank you for the opportunity to spend some time with you and and your audience. Hopefully, it’s the first of many and I can come back and give an update in a year or so. And hopefully by then, it’s not just about FDA approvals, but I’m showing we really built sales here because I know investors care about that. Just selling our product in the enterprise for the first time this month in September, and early numbers are great. So it’s a really exciting time. I think six and a half years into the journey and being able to do it starting with dad has been pretty special. So so thanks for having us and appreciate you following our progress going forward.
Harry Glorikian: Excellent.Thanks for participating.
Venk Varadan: Thanks, Harry.
Harry Glorikian: That’s it for this week’s episode.
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