[MUSIC PLAYING] I’m happy to introduce
Clayton Lewis, who is the CEO of Arivale. And Arivale was the
startup of the year. I hope that you read
the description. He’s an Ironman triathlete,
accomplished executive, a person that’s very passionate
about wellness health. He has a really
kind of rich career in this space over the last
couple of decades, I believe. So today we’re going to talk
about what his company’s doing, what his personal motivation
behind the wellness is, what are their latest
discoveries in the area, what are the tools and the data
that his company’s generating, and how is that influencing
lives of his customers, of friends, family, community,
and how it can influence the world in the near future. So let’s start with– like, can you give a
short introspection of your motivation
of your successes so far, your failures? And we can go from there. So, for whatever
reason, my whole life I have been really passionate
around health and wellness. And so I was raised in small
towns in Wyoming and Idaho. And my sister shares
a story that when she was 6 years old everyone
had a piece of birthday cake, and then all of a sudden, boom,
the birthday cake was gone. [SNAPPING] And I threw it away. I’m like, OK, you’ve
had your piece of sugar. And not that you need to
be this crazy or possessed, which I’m not. But it’s interesting
to think about sort of what brings
passion to each of you and what’s most interesting. And so my very
first business when I was in college, which was back
in 1977 in eastern Washington, was I opened a health bar. And so way before
people were thinking about supplements and
juicing, et cetera, I was just drawn to that. Then for about a decade
I worked in politics. And so I was one of the youngest
chiefs of staffs in Congress and worked for a
Congresswoman who was the only
microbiologist in Congress. This is sort of the
theme, weaves through. Then I did five startups
and took two of them public. And so was fortunate to partner
with really extraordinary entrepreneurs and then help
them scale their businesses very quickly. Then I went and did a startup
in health and wellness, and it was backed
by Maveron, which is a consumer-only
venture capital firm founded by Howard Schultz. So then Howard and
Dan Levitan asked me to join as a
venture capitalist. And so for eight years I
looked at health and wellness. And I walked away
thinking, OK, this is a very tattered category. And I think the
wellness category has failed for three reasons. So the first reason
is, people on the whole don’t wake up and think,
today I want to be healthy. You know, chocolate
cake, risk of diabetes tends to be a
pretty clear choice. Eat that cake. You know? [LAUGHTER] The second– what’s
interesting– and especially you know
this in your world– data actually paralyzes people. And so it’s so interesting
because consumers are spending millions of dollars. You know, how many people do
you know who have a Fitbit? They’re trying to
take 10,000 steps, and they have absolutely no
idea where they’re going. Because the data is not linked
to something they care about. And then finally–
this may be heresy, but a lot of young, brilliant
entrepreneurs would come in and say, oh, it’s all about
the app or the shiny device. And we believe passionately
at Arivale you actually need a person in the relationship. So, as a venture capitalist, we
at Maveron target individuals we want to back. And so a gentleman who’s our
co-founder, Dr. Lee Hood, was at the top of my list. And the reason is, Lee is one
of the first scientists that mapped the human genome. He’s considered the
father of systems biology. If you’re a scientist it’s
an extraordinary honor to be invited to join one of the
National Academies of Science. Lee’s one of 15
people in all three. But then, wearing my
venture capital hat, Lee’s founded or
co-founded 15 companies that today are valued
at roughly $200 billion. So he’s always launched
companies into industries. And so I’d been courting
Lee for about four years. And he said, Clayton,
let’s go have dinner. And I’m thinking, game on. I get to back Lee Hood. And he said, OK,
science and data is to a point where we can look
at individuals as a system– look at their genomics,
look at their blood, look at their gut microbiome,
look at their saliva. And by taking this holistic
view of individuals, we can actually help them
optimize their wellness and, more importantly,
avoid transitions to disease, in both the
short-term and for decades to come. And so he’s sharing this
vision with me and he said, we’re going to change the world. We’re going to launch a brand
new industry, which we’re calling scientific wellness. And it’s going to be the
biggest company of my career. And he’s the founder of Amgen.
And he points to me and says, you’re going to be the CEO. And so here I am. [LAUGHTER] ALEK ICEV: OK. By the way, for
full disclaimer, I’m [? alpha ?]
customers of Arivale. Whenever the service was
announced I talked to my wife– OK, I want to try this. My background was also
in bioinformatics, so I was really kind of thrilled
that you guys kind of started that, and how the company
is growing and providing kind of more features
and uses and so forth. Right? So in that vein, can you
explain more with the changes that you’re facing
in the field, kind of bootstrapping on your startup
from ground zero, a growing operation. You know? Can you share a little bit
more details about that? CLAYTON LEWIS: So when
Lee came with this idea that it was all about the data– because, of course, Lee is a
scientist, so he would think it was all about the data. And I shared sort of my
view of what I’d learned in the wellness category. And, in addition
to my work, I’ve also been on the Harborview
Medical Center Board for 14 years. And so we’re a trauma I
hospital for 23% of the land mass in the United States, and
we’re also the public hospital. So we do about $100
million in charity care. We treat everyone
exactly the same. The individuals that work at
Harborview are extraordinary. I’m also on the board
of the University of Washington Medical Center. And when I first
joined sort of doing volunteer work and governance
work and health care, I thought, OK, everyone should
have access to health care. But, of course, as
you dive in, you learn it’s not
really health care. It’s ill care. Because on the whole, in
America an average individual spends 17 minutes
over the course of a year with their
primary care physician. 17 minutes. So in that 17 minutes
they’re basically going to make sure you
don’t have any symptoms. And I have such respect
for health care workers. I mean, clearly. I’m on two boards. But those individuals are
trained to treat problems. They’re not designed
or trained to optimize your current wellness. So when Lee came
with this idea I had been following
another company in town where I was trying
to recruit out the CEO to start
another business called “Free and Clear.” Now, what I loved
about Free and Clear is they had the most
efficacious smoking cessation, behavior
change, weight loss program in the country. And it was all about
behavior change. And they had scaled
to where they were on boarding– they had
gone from 40,000 individuals a year to 400,000. And about a year before
they’d been sold to Alere, so I raided the company. I got their chief
translational science officer, their head of coaching,
their chief business officer, even their director
of finance to come help us build this company. And we decided to
do a test in 2014. And so basically Lee and I
recruited 108 of our friends and we did what is called an
“institutional review board approved study.” And it looked a
lot like this room. You know, people came. Everyone thought they were
healthy, all actively-engaged in the health care system. And so we created this
dance dynamic data cloud. So first we did
whole-genome sequencing and we tried to be really clear. Genes are not your
destiny, but it gives us some really interesting
insights into predispositions. So that’s quadrant one. Quadrant two we looked
at was clinical labs. And so when you get
a typical physical they’re going to look at
about 30 different analytes. We look at north
of 90 because it’s these analytes that are a
reflection of your life choices to date. Then we take a
saliva measurement and we look at four different
day part measurements of saliva, because
that gives us insights into hormones, cortisol levels. Are you really
managing the stress? Look at gut microbiome. It’s a nascent field, but
in the context of a system it’s pretty fascinating. And then, of course,
assign a coach. And the coaches are
registered dietitians. So these 108 people, as they
went through this journey– I’ll share my story. I was one of them– turned out 90% of them
had meaningful nutritional deficiencies. Meaning, nutritional
deficiencies impacting the health
journey they were on. 70% over time were moving
towards chronic disease states. And it doesn’t mean on Wednesday
you’re going to get diabetes, but look at heart health
dimensions, diabetes, stress markers, optimal nutrition. And 3% were living
with diseases. So I’ll share some stories. So at that point I’m a venture
capitalist [? advancing ?] in health and wellness. I was president of the board
of Harborview Medical Center. In the middle of training
for Ironman Canada– and I had done this experiment
about the past four months where I’d gone on a paleo diet
because I thought the paleo triathletes seemed to be faster,
and I’ll have brilliant blood markers with this paleo diet. And I embraced it
wholeheartedly. And so I sort of said to
Lee, my co-founder, yeah. I’m going to be the healthiest
person in this study. And so my data comes back and
the first thing my coach says is, you’re pre-diabetic. And I’m like, oh, there’s
been a data switch. Like, that cannot be me. ALEK ICEV: A different person. CLAYTON LEWIS: And so she helps
me understand I have genetic variants where I actually
cannot process a paleo diet. I need rich, dense,
complex carbohydrates in every single meal to
normalize my blood sugar levels. So how counter-intuitive
is that, is that paleo made me
pre-diabetic with very high inflammation markers? So what she then
helped me understand is that, of the 108 people, I
had the highest mercury level of anyone in the study, to the
point where in the future– I like to say– it
was going to impact my neurological functions. And so think about it. I get a physical every year. You know? I’m actually engaged. No one’s ever told me this. So, once again, the value of
a coach, registered dietitian backed up by a clinical team,
backed up by a physician. So she says, you have
variants that about 20% of the population have,
where you do not process toxins as well as some people. So that might be the
reason for your buildup. Do you eat a lot of tuna sushi? I’m like, no. I’m a salmon guy. And so further exploration–
well, how old are you? And I was 56 at the time. Do you have a lot
of old fillings? And for about a decade
my dentist has said, you know you should get
these fillings replaced? And I’m like, yeah, next year. Next year. And so these old
amalgam fillings had been leaching
mercury into my body. Because I have
these variants where I don’t process toxins as well
as some people, they built up. And so all of sudden I’ve
got insights and reason to get these fillings replaced. Had them all replaced, and
it took my body about a year to normalize my mercury levels. On the more extreme side– and one of the first things
the coach does is says, why are you here? You know? What’s being healthy look like? What do you want to be
doing in five years? What do you want to
be doing in 10 years? So this individual
shared– he and his wife are passionate about hiking. They live to hike. And he was starting to have
cartiledge issues in his ankle. And his physician’s sort
of like, early 60’s, they’re there. That stuff happens. And so we do the
genetic profile, and he’s got a predisposition
for hemochromatosis, which is the body doesn’t process iron. And so then we, on
our standard panel, look at ferritin levels, which
is an indication of iron– highly elevated. Now, we’re a wellness
company so we don’t treat, we don’t diagnose,
we don’t prescribe. So we say, take this data
and go have a conversation with your physician. We actually got a thank
you note from the physician because he said, I didn’t have
access to genetic information, and so I wouldn’t have thought
to look at the ferritin levels. And the great news is that,
when you catch haemochromatosis early you just have to donate
blood on a regular basis and that normalizes
the iron level. So we did this study of 108
people, dramatically improved– I mean, all of them
said, you know, you materially
improved my wellness. And so we decided
to launch a startup. And so we launched Arivale
two years ago last July. And as a startup initially
we raise $36 million, have raised about another
15, and so have raised about $50 million to date. And like every good startup,
have lots of scar tissue and lots of successes. But what we’re most
passionate about is– we’re at about 4,000
individuals now have gone through
the flagship program. And every individual that signs
up, they get an email from me with my cell phone number
and my email address. And so I talk to lots
and lots of people who go through the program,
and just so passionate because of the impact that these
individuals on this journey of what they’re doing
to change their lives. Does that answer the question? ALEK ICEV: Yeah. CLAYTON LEWIS: Perfect. ALEK ICEV: Yeah. Great. So let’s spend a little bit into
this kind of very nascent field of industry. For example, I did
the 23andMe test. You know? So I guess 23andMe
launched before Arivale. CLAYTON LEWIS: Mm-hm. Definitely. ALEK ICEV: And I went with
a different kind of niche, providing you more
of introspection of what are your
genetical pre-disposition for different diseases,
what’s your ancestry, and everything else. And I think that they
did it amazingly well. It had great interface,
great data analysis. And then somewhere
in the middle, they didn’t accelerate the
trend to get from that point to a full recommendation system. Right? So based on the data,
based on collecting on different signals like
your blood test, saliva test. And basically, you
know, I believe that you entered into that
space very efficiently. I see, like, other
kind of startups kind of getting into the area. So how do you fill
that whole space? I mean, it’s more nascent now. We have a couple of players. How do you see that
whole space going? CLAYTON LEWIS: So
as an investor I met with Anne, the
founder of 23andMe. And very thankful for what
she’s done, because she spent hundreds of millions
of dollars creating a brand. And it’s interesting because
both 23andMe and Ancestry– what they’ve done is they’ve
raised consumer awareness to think, OK, genetics. I can learn my ancestor,
and that’s kind of fun. You know? And for $99, what the heck. It’s a transactional purchase. And so from a general
consumer awareness, it’s sort of either
people are thinking, I need to know about my
genetics for a disease state, or let’s find out
where I’m from. And I think Anne’s
done a good job there. What’s interesting, obviously,
is that the data she has is from a SNP panel. It’s a relatively-limited
amount of genetic information. And it’s one data set,
one moment in time. And so when we looked at that– I’ve yet to meet a person
who went through 23andMe and said, oh, it
changed my life. I’m much healthier because
of what I’ve learned. And so what we’ve been
very focused on is– or even really clear
with our members– genes are not your destiny. And we actually don’t even
coach to genetic variants. We’re coaching to the clinical
analytes, but what we’re doing is looking at the
variants to help us understand why
we might be seeing what we see in the blood data. And so first the distinction
is, we’re a system– genetics, data, gut
microbiome, saliva– trying to look at you as
a system because people have signals from
different parts. Second, we refresh people’s
blood every six months because it’s the
change in the analytes, the change in the data
are, are we moving you from red to green? And I’m in year
three of the program, and I’m now just turning my
attention to my cortisol level. Because I had to get
the diabetes in check, then I had to get the
cortisol work in check. And what’s important– we
organize these five health dimensions– so diabetes risk, heart
health, inflammation, optimal nutrition– for
each of you in the room they would be stacked
ranked based on what we see going on in your blood. Then within each
health dimension, the analytes would
be stacked ranked to what you need to work
on, what you need to watch, and what is optimal. And what’s great about
that is, it’s dynamic. But then let’s say you
go to heart health, we’re going to show
you genetic variants that impact some of
the lifestyle decisions you need to make. So, for example, we look at LDL. And I’ll geek out
a little bit here. So our scientists have curated
over 1,000 genetic variants related to LDL. Because what’s interesting
is a single genetic variant is rare in and of itself
and has limited impact. But you put 1,000 genetic
variants together– we create algorithms, we
look at the weighting. Some are positive,
some are negative. And now we’ve done studies. And so it’s been
fascinating that for LDL, the bad cholesterol,
we put roughly– at that point we
had 3,000 members– into five quintiles
and came up with a genetic predisposition
for having high LDL. And everyone mapped
beautifully to their genetic predisposition,
unless they were on a statin. So then how do we use
that information to coach? So let’s say you
come in and you have a brilliant genetic
predisposition and you have really high LDL. The coach knows
we’re going to be able to give some interesting
lifestyle recommendations that are actually
going to impact that. Where, on the
flip-side, I genetically am screwed from an
LDL perspective. I eat right, I exercise. I’m in category
5, and genetically that’s where I’m going to be. And so my coach says,
make sure you’re talking to your physician about
a calcium scan of your heart, maybe a carotid artery to sort
of see– are you building up? So that’s where the genetics,
once again, can bring to life to sort of give
visions of, when we’re looking at all these analytes,
what should we be looking for. Does that answer the question? ALEK ICEV: Yeah. Yeah. So to build up a little
bit on what you said, I want to kind of venture
into all the baseline studies. Right? Basically, what’s a
baseline for health for every individual
on many of the tests that they are providing? Right? For example, the blood
markers– they have categories for decades that– OK, if you’re in this category
that everything’s fine. Right? But that vary on a individual
to individual basis. Right? And then fine-grain–
you go more into the depth of every scale
then you can have, like, a more kind of
fine-grained outcome for every individual based on
the differences in the genome and everything else. Right? And basically all the
devices in the classical kind of health industry– they
rely on those standardized measurements. They’re the same for everybody. Right? So are you guys thinking
more about that field, going more in that– CLAYTON LEWIS: So right now
the message is primarily, optimize wellness. But what’s interesting is to
look at genetic predisposition both for wellness
and for disease. And so we’re now launching
some clinical trials. So I’ll give you one example. Our co-founder, Dr.
Lee Hood, believes that Alzheimer’s is
probably actually eight to 10 different diseases. And so, if you go in and
understand someone’s genetic predisposition, well, it
could be then the omic that’s triggered the
disease– say it’s a protein or a metabolite or a clinical
lab or even something in your gut– if you understood the
genetic predisposition, for different
individuals then, you’d actually look at
different omics to say is the disease triggered? And if it’s triggered,
what would be the right– could be in some cases
pharmaceutical– solution? What would be the right
lifestyle recommendation to actually slow down or reverse
the transition into the disease state? So this first one we’re
launching with Alzheimer’s, we’re taking 200
individuals that have early cognitive decline. And the first thing
we’re doing is going in and creating these
dense dynamic data clouds to understand what’s
unique about them genetically. Then we run– if you’re
not into science, you may not know this
publication called “Nature Biotechnology,”
but it’s considered if not the first, the second
most premier scientific journal in the world. It’s a peer-reviewed journal. So we submitted a paper on
the first 108 individuals. And what our scientists
did is that we came up with a correlation network
where we looked at someone’s genetic predisposition. And then we found
what were the signals to that genetic predisposition
to metabolites, proteomics, clinical labs, gut microbiome. And for this paper the
scientist just pulled out 32 different signals. Of the 32 signals that we
identified the correlations, turned out two were
already drugs on market. One’s a drug in clinical trial. And the other 29 there
was no paper or research we could find. Now, what’s important
about that is that many of you
in this room right now may have a disease
that started in your body. And you may not have
symptoms for a year, and in some cases for a decade. But when you finally
have symptoms, that’s when you’re going to
show up and present yourself to the health care system. Well, imagine if we understood
your genetic predisposition and we understood which
omic is unique to you that we should be tracking,
if there’s something that’s relatively high-risk,
and starting to do that at a very low cost. So here’s an example. An individual– been in
our program for two years– very sadly shared with her
coach that she’d been diagnosed with stage 4 pancreatic cancer. And so stage 4
pancreatic cancer tends to be fatal because it’s stage
4, because it’s asymptomatic as it’s going through
its whole journey. So we biobank blood from
every single blood draw, which we do every six months. So with the permission of
the individual we went back and we analyzed the prior four
blood draws over two years and did a really
extensive proteomic panel. Turns out there’s a protein
that was completely out of range from the other 3,000
individuals for this individual, completely out of range. And she was the only outlier. As we did research
on that protein, it turns out it’s linked to
the function of the pancreas. So imagine if we understood
genetic predisposition for pancreatic cancer. Not hard to do. Then think if we actually can
identify what is the omic– you know, a protein
metabolite that says the disease is triggered,
started its journey, and knew to intercept it long
before real damage is done. Another example, the
individual comes in. She has a protein that in our
first interaction with her is materially out of range. So we work with an independent
third-party physician. He called her, said, you need
to go see your physician. She’s like, well, I had the
flu during the blood draw. And he said, OK. Well, that could have been it. Six months later,
still out of range. So once again,
physician referral. Says she’s going to do it. Doesn’t do it. Six months later. Now we’re 18 months in. We’re like, our chief
translational scientist called her and said, we
don’t know this is serious, but you really want to
go have a conversation. Turns out she had leukemia. And so once again,
it’s interesting now as our company is getting older
to look at these transitions from wellness to disease. And, of course,
the big idea here is to avoid the transition
to diseases because of where the science is. And so that’s part
of what we’re doing. Another example would be– because we look at
gut microbiome– which is so nascent. I mean, it’s very nascent. And what’s interesting
is that there’s companies launching that
are only looking at the gut. And we have a number
of individuals that are experts in this. So, as we look at the
bacteria in someone’s gut, there’s certain
types of bacteria that if you’re over
indexed on TMAO, if you eat red meat in both the
short-term and the long-term, you’re going to do meaningful
cardiovascular damage to your system. So we now give everyone
a TMAO score to say, your TMAO is highly elevated. You, on the whole,
want to avoid red meat or we need to figure
out how to drive better diversity in your gut if
you’re passionate about eating red meat. So there’s a few examples. ALEK ICEV: Wow. That’s impressive. So this is what I’m thinking. Right? How do you see the future
going into this field? Like, one, we here
at Google [INAUDIBLE] that we live all the
days on real-time data. Right? That keeps coming
100% of the time. And we’ll process that and we’ll
build systems to process that. Right? Hearing, in the field– you know, it seems
to be nascent. Right? You’re taking the blood once per
six months, the microbiome test once per year, then you do
a saliva test once per year as well. Right? And then the DNA
probably sampling gets fixed because
it’s your code and you don’t need
to repeat that. But then, you know,
how do you see– you know, do you see any kind
of future investments going into the field to make this
more kind of real-time? Now it’s hard, right? It’s hard to inject the
chip and get your blood test through a WiFi
real-time transmitted so every day you can track
that or get your microbiome analyzed every day. But do you see the
future going there? CLAYTON LEWIS: So, three things. One, when we did our initial
study two and a half years ago, we were spending $10,000
per individual on the assays because both the
number of assays and the frequency
of the assays– we didn’t know where the signal
was going to be coming from. So for two years we
burned through a lot of venture capital where we
were doing all of this data. We’ve now reduced the assay
cost down to roughly $1,200, and we’re given all of the
exact same information. And so one of the first
things to be thinking about is– of course, you’ve all
heard about Moore’s Law related to genetics. I know when Lee did the
first whole-genome sequence, god knows how much it was. We were spending roughly $1,400
on whole-genome sequence, and now we’re doing a
SNP panel because we’re getting the same data. You know? So in two years the company went
from spending roughly $1,500 to $175 on genetics, same data. Second thing that we
did is that, as we now– with these first 3,000
individuals every six months we were doing the
full panel of omics. Well, now we know
if certain omics are in the green
they’re not going to move into the yellow
or red within six months. So we do what’s called reflexive
testing at a six-month mark, full testing. So what we’ve got to do
is get the cost down. You know? For the first offering
of roughly 70 days for all the blood and all
of that genetics right now it’s $999. A lot of people,
that’s too much money. And our goal is to
democratize this. And so, you know, it
was so sad to follow what happened at Theranos. Because if microfluidics
would have worked, that would have been a brilliant
way to make it, A, much easier, and B, much more affordable. But we do believe technology
cost and the assay cost will be coming down. So that’s job one. Job two. Health care is basically
a giant ocean liner. And it’s very slow to change. But what’s been
interesting in my 14 years as trustee is that– when I first joined
the board our KPIs were all around
billings codes where we had to bill for the
pill, the device, the hour. We’re now in
volume-based pricing. So if you show up
and you have an event and you’re coded for
that event, I show up and have the same event and
am coded for that same event, you stay three days,
I stay two weeks, we’re going to
make money on you, we’re going to lose a
boatload of money on me. And so the primary KPI right
now in the health care system is length of stay because it
has very perverse motivations. And, of course, it’s
all billing codes. And there’s very few
billing codes for wellness. But there are starting to
be some interesting signals. So the Boeing
Corporation two years ago issued an ACO contract where
they said, here’s 20,000 lives. You, major health
care systems, can bid to take care of
these 20,000 individuals. But oh, by the way, it’s
a fixed-price contract. So you’re going to
take care of them and not raise your
rates for five years. And historically we raised our
rate every year 12% to 16%. So we bid on it– “we” being
the University of Washington health care system– the
Providence St. Joseph health care system bid
on it, and off we go. Three years in
Providence pulled out because they couldn’t
figure it out. And we at the University
of Washington’s system– it’s the first time
in the boardroom I hear, like, how are we going
to keep these people healthy? You know? And so actually trying
to think about not optimizing treating illnesses,
but actually keeping people healthy. So there’s going to
be some change there. There’s going to have
to be some change. There’s three drivers
of human health. Three drivers of human health. Any sense of what they’d be? Help me out here. AUDIENCE: Exercise and rest. CLAYTON LEWIS: Exercise, rest. Great. Any other– AUDIENCE: Diet. CLAYTON LEWIS: Diet. Well, you’re generally spot-on. So, three drivers. In the course of your
lifetime, 30% of your health is determined by genetics. 60% behavior,
lifestyle, environment. 10% the health care system. And so think how
crazy it is that we’re devoting 18% of our GDP
to the tiniest slice. Now, go one level deeper. So what’s the primary
tool physicians have? Pharmaceuticals. Right? So there are studies that
indicate, of the top 10 grossing drugs in the
United States today– the top 10 grossing–
the most effective helps one out of four
people that take the drug. The least effective
helps one out of 24. So think of the billions
that we’re giving people these pills that are
actually not helping, in many cases hurting,
especially when there’s combinations of them. Because that is where
that science is to date. And so we’re in conversations
with some pharmaceuticals right now– one example. So non-small-cell lung
cancer, late stage. There’s an immunotherapy
that’s binary. Either it works or
it doesn’t work. If it works, you live. If it doesn’t work, you die. And they don’t know why. And so that pharmaceutical
company has come to us and said, we want to
put 200 people that have this disease, late stage– we want you, Arivale, to create
these dense dynamic data clouds for these individuals
so we can understand is there a genetic profile
that this drug actually works or doesn’t work. And then, is there
an interesting omic that we could identify also that
would help us understand that? So n of one data
has the potential to make both the health care
system much more effective and clearly pharmaceuticals. I think I got on
a tangent there. ALEK ICEV: Yeah. Yeah. So let’s go along a little bit
more into that, into this area. So I’m observing, for
example, what Craig Venter is doing with the Human
Longevity Institute and that initiative as well. So it seems that they are doing
a slightly similar approach to what you have, but on
top of that implementing with the detailed, most advanced
MRI scans and all that stuff. So where do you see,
from the data points that you are collecting overall
today, what are you missing? One of the big things. Is that the MRI, something
else, more real-time data? How do you see the field
growing one, two years from now? CLAYTON LEWIS: So Craig
Venter has the company called Human
Longevity Institute, and its price point
is roughly $25,000. And you go to San Diego,
and it’s cool and it’s sexy. But we’ve had a lot of people go
through HLI and a lot of people go through Arivale, and what
they say the distinction is is that you assign a coach. I talk to my coach–
some people every day, texting and apping with it. And that coach is
taking that complex data and translating it into
actual recommendation based on what I’m willing to
do and what I want to do. So that’s distinction one
from a market perspective. On the assay side, Lee
Hood and his scientist at the Institute
of Systems Biology continue to have a lot of
assays that they want us to do. And so for participants
we actually do a couple discovery
assays where we can’t share the data
back because they’re not yet from CLIA-approved
labs and it’s not necessarily actionable. But behind the scenes, in
addition to the blood, saliva, gut microbiome, we’re looking
at proteomics and metabolites. And that’s where there’s some
really interesting signals of when we look at these
correlations of genetic risk, then understanding what
omic is that linked to. And so, as I shared for the
example of the person that had pancreatic cancer or
the person who had leukemia, that was by looking at
proteomics and metabolites. And we continue to do
discovery work, but part of it is– a nascent
startup that’s funded by venture capital
is always trying to figure out that
balance of where to make those investments. But some of our partners now
are coming to us and saying, OK, I’d like to discover it. So back to Providence
St. Joseph. They have put 1,000
of their employees into Arivale for three years and
they’re doing a clinical trial where they’re
saying, OK, we want to be a health care system that
actually keeps people well. And so we’re putting
1,000 of our employees in to learn what is the impact
of scientific wellness in terms of reducing health care claims
cost, improving health overall. Another example
would be Colgate. So I didn’t appreciate, half
of the world’s population uses a Colgate
product for oral care, and so they have
numerous brands. So they heard about Lee Hood. They heard about Arivale
P4 medicine and came to us and said, the
future of oral care is going to be
some degree n-of-1. And their thesis
is there’s about five meaningful different
types of oral microbiome. And based on each of you
in the room maybe falling into one of these
five categories, they are developing
tooth care or oral care that would be much more
impactful for you based on your unique microbiome. And so we’re now involved in
a clinical trial with them to understand how would we
look at the overall system of an individual and determine
what is the right oral care. So starting to be a lot
of n-of-1 experiments to understand we’re
unique and, of course, we’re all treated
exactly the same. ALEK ICEV: OK. Cool. So I’m very optimistic about
your field and I think that– CLAYTON LEWIS: Thank you. I am, too. [LAUGHS] ALEK ICEV: –you are against
taking 18% of our GDP and repurposing that in
the long run [INAUDIBLE] successful to something much
more better for everybody that lives in this country and
hopefully in the world, right? CLAYTON LEWIS: Yes. ALEK ICEV: So let’s go
kind of one step beyond. Right? You know, your personal
thoughts on all the initiatives by Aubrey de Grey, [INAUDIBLE]
longevity, where the lines, where the borders. Let’s say I’m an
Arivale customer, I follow all of your
recommendations and advices, I’m in the perfect health. You know? Like, where is the
frontier beyond that? CLAYTON LEWIS: Tell me– ALEK ICEV: So Aubrey
de Grey is the guy that leads the Longevity
Institute and he’s one of the most vocal
exponents of basically solving every disease, cardiovascular,
Alzheimer’s, the major cancer, the major cause of that. And then beyond that,
you know, addressing the senescence
issues in the body. And then having a theory
that, at some time point– you know, it’s not 120 years
the maximum age of humans, but it can be extended
for who knows how long. Right? So your thoughts into that. CLAYTON LEWIS: Well,
I’m going to give you, I think, an answer that’s
not going to fit in. So what we aspire to do is help
people optimize their wellness and avoid disease for a life
filled with joyful moments. And actually what we do is–
every week in our team meetings coaches get up and share stories
from individuals in terms of what they’re actually doing. And the first thing a
coach is going to do is say, why are you here? You know? What does it mean to be healthy? Why do you want to be healthy? And of course what’s
interesting is, most people actually don’t
even think about that. You know? Have you thought about what you
want to look like in 20 years and what you want to be doing? AUDIENCE: Yep. CLAYTON LEWIS: Excellent. But not a lot of people have. And so what we aspire
to do at Arivale is help people live full,
joyful, robust lives where you’re not focused on
being ill [INAUDIBLE] well. But we’re actually–
especially me– I’m not actually thinking that
living forever is necessarily a goal or an aspiration. And so we have a
little bit of a joke internally where right
now if you get to 100 and you’re healthy
and happy, you tend to die relatively quickly. And so our goal is
to get you to 100, have you lead full, rich lives,
and then you’re on your own and you’ll probably have a
system failure and go quickly. And so we actually don’t
spend a lot of time thinking about beyond the 100s phase. ALEK ICEV: OK. OK. I’m just going one step further. One you solve the reality– CLAYTON LEWIS: Yeah. That’ll be the next startup. ALEK ICEV: The next startup. OK. OK. OK. AUDIENCE: Is that kind of
like the theory of aging is a disease itself. ALEK ICEV: Yes. Yes. Yes. CLAYTON LEWIS: But also, what’s
so interesting about that is that, once again, all of us
have these different n-of-1s. So another story
with Alzheimer’s. So we’ve taken our
roughly 4,000 clients now, we’ve created polygenic risk
profiles of their likelihood to have Alzheimer’s. And now we’re diving in and
saying, OK, what’s unique? And so we put them into
five quintiles again. And so the fifth quintile,
the people at highest risk– started to say what’s unique
about these individuals? Well, it turns out the
typical person, as they age, the amyloids in your
brain start to increase. And so there’s an indication
that that actually might be a protective
function that helps preserve cognitive function. So for quintile number
5, at highest risk, this group, as they’re
aging, their amyloids aren’t increasing. So once again,
how interesting is that when you think about these
major chronic disease states that, as we’re all
living longer, what is the implication
of what we need to be looking at
to make sure we’re living healthy lives as we age? ALEK ICEV: OK. So I have one more
question and then we’ll give it to the audience. CLAYTON LEWIS: OK. ALEK ICEV: So basically,
on scaling things. I’m like, you [? have a ?]
interesting model with personal coaches
and everything else. Is that scalable? Right? So basically I think
all of us in this room are kind of
fine-tuned to building artificial-intelligence systems,
or at least observing them, into our real lives and
basically automating everything that we can. And to scale. Right? To build on a world-wide
infrastructure and systems across billions of users. Right? Can you scale that model? CLAYTON LEWIS: So
the back-end of how we think about
scaling is that a lot of what your company’s
been extraordinary at. And so when we
initially launched, the reason I went and
raided Free and Clear is that they had scaled
within five years from serving 40,000 individuals
a year to 400,000 individuals a year with a comparable
coaching program. But, of course, 400,000
is not very many. So when we initially launched
the company, for every coaching call, the clinical team spent
roughly two hours preparing chart notes because we had data
coming from 14 different labs, giving the chart
notes to the coach, and then the coach coming
up with recommendations. So two hours, to roughly
a 45-minute call. Two hours of prep and post. Right now the prep and post
is down to about 20 minutes. And the way we’ve
been able to do that is that we have
machine learning that is tracking every
single recommendation that the clinical team’s making. So now, as the data’s
coming in, about 70% of the recommendations
are automated. And so it’s the exception
rules that are going back out to the clinical team. And our goal by the end of Q1 is
to get recommendations roughly at 95% automated. Now the control, obviously,
is that the dietitian, who’s licensed, is looking at
that data and saying, does that make sense? Second thing is that Free
and Clear– their model is basically their
coaches, registered dietitians, work from home
across the United States. And so we see it to be a
really interesting opportunity in terms of scaling that aspect. Third is leveraging technology
to amplify the relationship. So right now the
individuals that are using the Arivale
app on average are checking in on the
app 14 times a day. And it’s the app
and the bot that’s extending the relationship. So, as I said, I’m
working on sleep. Because, like every startup
CEO, I believe sleep is not required. And so I have a goal right
now with my coach where I’m going to quit
working by 10:00 and I’m going to
go to bed by 11:00. So my phone– at 10:00
the Arivale app pops up and it says, swipe right if
you’re going to quit working. And then at 11:00 it
pops up and it says, you know, swipe right if
you’re going to go to bed. Well, I often don’t swipe. [LAUGHTER] But she sees my Fitbit data on
my dashboard because it’s all synced together, and so– you know, I got a text
from her after I’d been on the road
for about a week, like, oh, how’s that
going five hours a night’s sleep five days in a row? I bet you’re really
being a great CEO– my goal– and your
Ironman performance is probably right on track. Isn’t it, Clayton? You know? And so how does technology and
bots leverage these objectives. So there’s big
opportunities there. And then finally, in
the back end right now we’re building the
Arivale affiliate network. And the objective for the
Arivale affiliate network is– we already have
physician groups and hospitals coming
to us and saying, OK, we want to roll this
out through our panels and our patients. And what can be interesting
about that is also potential reduction in cogs. Because of the $1,000
in assays right now– none if it’s reimbursed. But it looks like, as we’re
talking to these physician groups, they might be able
to get reimbursed anywhere from $250 to $300. And so, one, it’s
about technology automating the recommendations. Two, using technology
to extend and enhance the coaching relationship,
not to replace it. And then a work-from-home
model, and then leveraging other systems. But we spend a lot of
time thinking about it. ALEK ICEV: Yeah. Cool, cool. All right. So– AUDIENCE: I guess a
couple of questions. First question. Like, from your
talk I still wasn’t be able to quite
figure out what’s the relationship of your company
with the insurance companies. CLAYTON LEWIS: There is
no relationship with us and the insurance companies. Because insurance is basically
about treating illness and getting reimbursed
for curing a problem. We’re about trying
to keep you well. And the insurance companies
are not very focused. Now let me tell you just
a brief story though that’s interesting. So I’m always out
raising venture capital. And so New York Life recently
invested $5 million in us. And so New York Life
has 7 million clients across the United States. And their business
objective is to have you live as long and
healthy as you can, because every month you
live is another month you pay a premium, and another
month that payout is delayed. So we’re going to do a test
with New York Life, testing their brand halo in the
state of California, where they want to be the
whole insurance company. And so if they give you peace
of mind for your family, for protecting your
business, now they’re going to introduce
Arivale and say, Arivale can help you live a
healthier, longer life. And then their actuarial teams
are going to go in and say, hm. If Arivale achieves the results
they have with our first 4,000, where for
every single analyte that’s out of range, within
six months we on average drive 20% improvements. Meaning we take analytes
that are out of range and move them in range. They said, we roughly have in
reserves $1.3 trillion dollars. I mean, a lot of money. And so could we,
if we help people stay healthier longer,
how that might impact our overall business model. So interesting alignment. But insurance insurance–
there’s nothing yet. AUDIENCE: Second question is– like you said, your company
is just two years old. CLAYTON LEWIS: Yes. AUDIENCE: And I would say that’s
earliest age for a startup. So what’s your end goal like? What’s your vision? Where do you want to be? CLAYTON LEWIS: So
three end goals. One, the democratization
of wellness. And so our objective
ultimately is that the wellness industry will
dwarf the sick care industry. And so this category that
we’re going to launch– not just by ourselves,
with a lot of partners– that there will be
more money putting into staying well and
optimizing wellness than there will be
in treating symptoms, and it’ll be very affordable to
people from all walks of life. Thank you. AUDIENCE: Being well won’t
produce that much money as being sick, right? So how do you manage
to tackle that? CLAYTON LEWIS: So,
tell me one more time. Being well– AUDIENCE: Being well–
like, if you are well, insurance won’t
pay for anything. Right? There’s no point
for the insurance– I guess, in other
words, how do you democratize this wellness
program and how do you sell it? Insurances are
basically invested in people getting sick. ALEK ICEV: There
are many entities in the industry benefiting
off somebody being sick. CLAYTON LEWIS: Exactly. So the perverse incentives,
financial incentives are our current system. And so one thing that
will be interesting, and I think will
start to happen is– much like the example
of the Boeing ACO I gave you– the state of
Washington has issued an ACO. So we’re going to have to change
the incentive of health care systems. And what’s happening
right now is we’re migrating from
volume-based care, which is where we’re at right
now, to value-based care. And we’re at the
earliest stages of that, but I actually believe that
is where we’re going to go. And so when I’m out talking
to health care systems and to pharmaceutical companies
I say, look at your outcomes. Congress alone is not going to
continue to put up with this. We all know that the health
care system today is broken. Way too much money is going in. The challenge is that it’s
so slow to change that– as a startup here, I was
trying to figure out, am I cutting edge or
am I bleeding edge? [CHUCKLES] And so we’ve got
to figure out how to get the right partnerships. And that’s why I was so
excited that Providence St. Joseph said, we’re
putting 1,000 employees in because we actually want
to change the system. Three weeks ago Spectrum
health care system, Grand Rapids, Michigan– So they invited me in to
be the keynote speaker at their annual meeting. So 300 people in the room,
all their board members, their CEOs. And, you know, I’m
basically giving my talk, saying, you’re the 10%, but
you’re taking 18% of the GDP. What’s wrong with that? You, the physician’s,
spend 17 minutes– 17 minutes. You can’t help those
folks in 17 minutes. Let’s look at the drugs
you’re giving them. After I gave that talk, which
was somewhat provocative, they immediately said, we
want to form a joint venture with you. We want to figure out how
to introduce Arivale to keep some body of individuals safe. So we’re definitely
plowing early ground there. And I don’t have a clear path. And so the question is– everything in life, especially
if you look at business, it’s gradually,
gradually, then suddenly. And when the suddenly happens
a transformation takes place. And Seattle– we’ve
driven a lot of them. So think of real estate. So I was president and
COO of Market Leader. And so Market Leader–
what we were doing is trying to give people the
keys to the multiple listing service. You know? So my mom’s been a realtor
forever, and I’m old. So it used to be in the old
days you couldn’t buy or sell a house without a
realtor because they had the keys to the MLS system. So I had all the data. And so Zillow came along,
opened up the keys, and now we have
companies like Redfin. And we as consumers,
when we buy and sell, we go and have a conversation
with our realtor, which is very different than we
did before they had data. You know? Same thing with travel agents. Back in the day if you wanted
to find the least expensive airline ticket, you had
to go to the travel agent because they had all the data. And so what’s interesting
about Arivale is, we’re making our participants
much more sophisticated, individuals
understanding their data. So a lot of them go
and have conversations with their physician, which
are much better-educated conversations. And so we believe also
that, one, there’s going to be changes by payers. Two, consumers are going
to demand a different level of engagement and expectation. And then three, as
the prices come down and we figure out how to have
conversations with people– you know, much like
23andMe, people are curious. The top-selling item
on Amazon Prime Day– top-selling item, 23andMe. And so think about that. Consumers now, as I
said at the start, they’re interested in
genetics related to Ancestry. We’ve got to get
that bridge now, genetics about staying well. So that’s how we think about it. I’m optimistic. AUDIENCE: Sorry. I actually had one question that
was related to all this, which is that– do you
know how many, like, health dollars that are moving
towards flexible spending accounts? Because I intuitively
feel like– I don’t know. Google certainly has told
all of our employees, you’re probably going
to be better covered under our flexible
spending accounts than a lot of– like, the
GHIP, the Health Investment Plan, than you will be
under most of the PPO or whatever it was. CLAYTON LEWIS: Right. AUDIENCE: For most
cases just you end up having less
out-of-pocket expenses over the course of a year. And I sort of wonder
if that’s the case, that there are more health
spending dollars that are moving to people
that have the ability to make the decision? Is that the case? CLAYTON LEWIS: Intuitively,
I think you’re right. I don’t have that data. AUDIENCE: OK. CLAYTON LEWIS: A
quick example there. Intuit. So Intuit decided
to launch Arivale across their organization. And the first thing they
did is say, OK, we’re going to let 200
individuals who have Intuit enroll in the program. Oh, by the way, we– Intuit– have paid our
employees to participate in wellness programs. We’re going to charge
them $1,000 for Arivale. And so we’re like, hm. Great. So we drop onto
the Inuit campus. We’re there for 48 hours. And there was only 200 slots. When registration opened, an
hour and 10 minutes later, all 200 were taken. And Intuit had objectives
around BMI, weight, they had objectives
around diabetes. And so within six months, we had
exceeded both of those metrics by 50%. So then they said, OK, we
want to enroll another 200. And now they’re rolling out
throughout their whole company. Now, what Intuit does is
they put $1,000 a year into their employees’
HSA account. And so they now
can use that money to pay for the Arivale program. So we see more and more
where companies are funding flexible spending accounts,
health savings accounts for people to deploy
against wellness offerings. AUDIENCE: Hey, Clayton. Thanks again for
joining us today. CLAYTON LEWIS: Of course. AUDIENCE: Question. Would love to hear your
point of view on the data, whether it’s with Arivale
or another company, being used for means that aren’t
consistent with your mission. Because I totally
agree with the mission. But think insurance
companies using that for preexisting
conditions and the like. CLAYTON LEWIS: So my old boss,
Congresswoman Louise Slaughter, actually passed the
GINA Legislation. And the GINA
Legislation prohibits discrimination based on
employment and health care, doesn’t prohibit discrimination
based on long-term disability and life insurance. So, interesting. Our philosophy is that
you own your data, and we will not share
your data with anyone. And the first thing that
happens is that when your data comes in it’s all
de-identified from any personal health information. So even if our data sets get
hacked on the research side, it’s been stripped of all
identifiable information. And even these relationships
we have with employers like Intuit or Colgate or
Providence St. Joseph, we say, you can’t get access to
your employees’ data. And so there has to
be a bright line. Because one, if
there wasn’t people wouldn’t have confidence
about coming in. Two, part of what keeps me
up at night is data security. Because we’ve got some of the
most prominent individuals in the country, both business
leaders and elected officials, in our program. And they’ve said, you
know, if my data goes out it would take my stock price. And so not only would it be a
company killing event, but– we have eight values. And one of our values is trust. Another value is privacy. That said, you know,
bad stuff happens. And so it’s a small company
with only 175 employees. We have three on data
security and a team we hire outside
firms that come in and try to hack us
down to where they’ll call in to the
customer care line and say, oh, this is Clayton. I need so-and-so’s information. And so we do a lot
of things where we’re trying to be focused
on protecting that. Does that answer the question? AUDIENCE: Yeah. So just being clear,
insurance cannot use that. CLAYTON LEWIS: They
don’t have access to it. AUDIENCE: OK. CLAYTON LEWIS: But to be
clear, the GINA Legislation– well, two things that
we’re doing right now. Right now, because we are a
health and wellness company, we’re only giving you
genetic information related to health and wellness. So we’re not giving you
information about BRCA. We’re not giving you
information about Alzheimer’s. We’re not giving you
information about any of those highly-impactful
disease states. So we’re not even
giving you information. The GINA Legislation,
for life insurance or for long-term disability–
some insurance companies will say, OK, do you have
this information? And, you know, they’re
asking you to disclose. We’re not– you would not
get that information from us. Because, A, we haven’t
disclosed it to you. Now, the future is
going to be interesting. And what I would say
is that the current FDA is being more thoughtful
about understanding that genetic information
should be given to individuals, and they should
own their own data. So there’s been some vast
transformations there. AUDIENCE: I think that
probably answered my question. So I feel the health
care industry is a heavily-regulated industry. And my only real question is– I just want you to comment
on the FDA regulations. For example, at one point
FDA prohibits companies that report relations with
cancer, with [? GINA. ?] And then at one point
maybe this ban got lifted. And from your point of view, how
to overcome these challenges? CLAYTON LEWIS: So the
FDA is interesting. As I said, I worked in
Congress for a number of years. And the FDA is a
bit of a black box because there’s not, like,
this playbook that says, OK, this is what’s happening. And things are
evolving so quickly. And their positions are
evolving, especially with the new administration. And so what we decided to do
out of the gate as a business is to embrace the
regulatory practice. So the first thing that happens
when an individual signs up– in every state we
operate, we have an independent
third-party physician. And that physician orders
all the clinical labs. The clinical labs all
are CLIA-approved labs. And then we have a licensed
professional dietitian, licensed in the
state where you live, coaching you on what she or
he is allowed to practice. So we made a business
decision out of the gate to embrace the regulatory
environment so we wouldn’t have the 23andMe experience. We also, because we’re trying
to change people’s lives, we believe it’s important to
have the right professionals engaged in the conversation. On the flip-side– I’m friends with Senator Patty
Murray and Maria Cantwell. And Patty Murray is
the ranking Democrat on the Senate and Health
Human Services Committee. So we’ve been going in
and having conversations with her and her team. And she actually hired a
number of former FDA staffers to try to help us
sort of figure out how do we have thoughtful
conversations with the FDA on saying, let’s
look at the fact that we are scientific data. Let’s look at the
fact that there’s consumers that take
this information and use it in a
very powerful way. And once again, thank
you to 23andMe for being a leader in this space. And they went
through and now had a number of genetic
variants approved where the FDA has looked at how
they present that information. The FDA has reviewed
it and said, OK, that is fine to give that information
directly to a consumer. The FDA, as you
know, originally was concerned because
there weren’t licensed professionals involved. You know, there weren’t
physicians reviewing it. There weren’t dietitians. And so we’ve taken a
different business model to embrace the current
regulatory environment and completely
play by the rules. But it is challenging. Like, the state of New York– the state of New York is the
only state that we cannot operate in. And we’re going through
their regulatory process. It’s going to cost us hundreds
of thousands of dollars and take about a year. And think about that. 49 other states–
we’re completely embraced their
regulatory environment. New York is unique in terms
of the amount of money we have to spend and the process. And so there are some legacy
states that are challenged. But we love the state of New
York, in case you’re watching. [LAUGHTER] Is there a last– ALEK ICEV: Yeah. I think we are right on time. CLAYTON LEWIS: Fun conversation. ALEK ICEV: So I would
really like to thank Clayton for coming here
today to talk to us, and I hope everybody
enjoyed the talk. CLAYTON LEWIS: I really
loved all your questions. I brought brochures and
business cards over there if you want more information. And thank you so much. Thank you for being a member. And I loved your questions. Great to have the
conversation with you. Thank you. [APPLAUSE] Your questions were great. Thank you.