Lessons From the Formative Years of a Neurotech Startup
I’ll be honest, looking all the way back to 2018, there’s no way I could have predicted Rune would be what it is today. None of us did. We knew that there was amazing new technology and breakthroughs in the field of deep brain stimulation and neuromodulation implants in general. We knew that companies, labs, and universities were doing groundbreaking research to understand Parkinson’s Disease, to understand Major Depression, to understand OCD. We also knew that unprecedented data was emerging from these clinical studies, both in amount and variety, and that nobody was quite sure what needed to be built in order to handle it.
Fast forward to 2021. Rune has gone from a team of two to a team of twenty-two, and is still growing fast. Our platform today connects patients, clinicians, and researchers with the data that’s going to make a tangible difference in the fight against brain disease. It’s important for us to celebrate our victories. And while we’re far, far from being done, I also think it’s important to stop at certain pivotal moments and reflect back on what it actually took to get here.
Before I go too far, I also want to mention that there won’t be much neuroscience content in this article. Sorry to disappoint, but there are very brilliant people at Rune who would do those topics their proper justice. In this article you’re getting the perspective of an engineer and cofounder.
1. Find the right people, and keep it up.
This was easily the most defining aspect of our journey. The importance of this should be completely obvious to the reader, so I’m not going to patronize anyone with cliches. Instead, I’ll talk about what happened.
When the company was small — and I’m talking still-leasing-a-couple-dozen-square-feet-of-shared-office-space small — it was a big gamble for anyone to join Rune. I’m extremely grateful that we met amazing people like our Senior Neuroscientist Witney Chen, our Engineering Manager Carolyn Ranti, our Lead Engineer Girish Nanda, our advisor turned Director of Product Will Newby. We also couldn’t have done it without the early help of folks at UCSF’s Starr Lab who helped us understand both the scientific and technical challenges in this space from day one.
We learned quickly that the most differentiating quality of the “right” people is that they can see not just what you have built so far, but how you’ve built it: that you’ve built it the right way, and that you’ll continue to do so. I’m talking about both the tech and everything else. For me, at least, the lesson is to find those folks that can see past the general statistics about tech startups success and failure, and take the time to understand what you’re doing, how you’re doing it, and why it matters. These are the folks that ask you questions about their career trajectory. They question your methods (kindly), and bring in new viewpoints. They probe into our motivation for the decisions we make. In a nutshell, they showed us they cared about a positive outcome for our mission.
The second part of the lesson is to not stop looking for those folks, even when they’re tough to find, or when it’s easy to say we’ve done enough (especially when it’s easy). When we raised capital, it was tempting to “staff-up” fast. After all, from an outsider’s perspective it looks good to be scaling, right? I’m grateful that we had wonderful investors who encouraged us to grow right, to take our time exploring our opportunities properly, and to set ourselves up for long term success. We kept screening carefully, interviewing for good fit with our values, and generally putting more emphasis on bringing new energy and collaboration to the team than raking up merit badges on resumes. It paid off, and then some.
2. There’s never a good time for shortcuts
A common phrase you’ll hear at Rune is “production-ready”. As in, everything has to be. An early decision that we made even in the first year was not to cut corners. Again, that’s generally a sentiment most people agree with, so I won’t talk about it abstractly. Here’s how we approached it.
From day one, we invested in infrastructure and process. It initially slowed things down. Yes, there were days when I wanted to just chuck some untested slab of code onto a hand-spun server and call it a day. Instead, we adopted infrastructure-as-code, Kubernetes, CI/CD, peer-reviewed GitHub flow, and heavy observability. We also took security seriously, setting up least-privilege access, audits, 2-factor, and so on. It very quickly started paying off. We’ve had seamless daily production deploys since 2019, and we still do. The amount of time we took to set up a technical foundation has paid for itself more than 200x since. And when we were ready to start providing services to our first commercial partner, we were already in ship-shape and all we had to do was hand them our SOPs and ISMS.
The second part of this lesson also happens to be one of our core values. We were idealistic about the quality of platform we wanted to build, but we had to be pragmatic about actually pulling it off. We didn’t impose artificial deadlines on ourselves to rush, but there were real ones out there in the world. Patients were scheduled for surgeries, after all. What ended up working was to break up everything into as-small-as-possible pieces, and decide which pieces we could realistically get done now, and which later. Everything at Rune had (and still has) a “version 1”, “version 2”, and so on. You’ll see those phrases littered throughout Slack, our user stories, and our requirement docs. It meant we were always putting off something for the next version, but that we weren’t doing a half-baked job on the things we did work on. We rarely had to go back to fix or rewrite the same part of the product, and often what was there ended up being good enough to serve as a foundation for new features. We could build on top of our existing code and services, and over time it got things out the door faster and faster.
3. Attack the problem from all directions with everyone on your side
I’m not even sure I can call this a lesson, since both Brian Pepin and I knew this had to be our strategy from the get-go. We knew that individual labs, companies, and clinicians had been researching therapies, evolving drugs, and generally doing what they can to help. Foundations like Michael J Fox were connecting people with resources in their community. With the new generation of sensing DBS emerging, high resolution neural electrophysiology data was finally starting to shed light on what precisely everyone was fighting against. What we didn’t know back then was how exactly it all would end up tying together.
Often startups will “pivot” to different directions until they find an opportunity, but it was different for us. We already knew who the people making progress in neuroscience and neurology were, and we decided the best thing to do was give them more ammunition to do what they do best, by doing what we do best. We began right off the bat by partnering up with Aura Oslapas, a brilliant UI/UX designer and the passionate creator of the original StrivePD app for living with Parkinson’s Disease. We knew it had to all start with the patient. We then began working with folks from UCSF’s Starr Lab to understand how combined data from DBS implants, wearables, and the facts reported by the patient themselves could be combined to further research into new future therapies. We’ve gained dozens of new partners in the community since. Most recently, we’ve started helping neurology clinicians use this rich data to understand their patient’s progression and help them make more informed decisions about their care.
As we expanded, we didn’t abandon any of the previous pieces of the puzzle. Instead, we leaned even harder into them, finding ways to use one to power the other. In part, we drew inspiration from the very folks using those three parts of the platform. They were already working together, so it didn’t make sense for their tools to divide them again. Patients were the center of it all, clinicians were looking out for their best health outcomes, and researchers were working on providing both with new options and understanding. Even now we actively seek others who are part of the picture and can be brought into the shared conversation, be it new partners in pharmaceutical research, medical devices, academia, neurology clinics, or public foundations.
Going Forward
The thing that keeps me excited about our work is that we are part of a larger community of brilliant people excited about the possibilities of data-driven therapy development and patient care. We’re all in it together, and we’ll be continuing to look for smart and kind folks to join our mission.
