Confessions of a wearable tech start-up entrepreneur

David Miller, associate creative director at Havas Health Plus, talks wearable tech with Andrew Wanliss-Orlebar, entrepreneur and cofounder of Sum, a tech start-up that produced a heart and stress monitoring system until 2015.

It was through a mutual obsession with running and cycling that I met Andrew Wanliss-Orlebar, a Brit with a French passport (just one of a thousand interesting quirks about this new acquaintance). We started riding together in summer of 2013, on some agonizing hill rides in upstate New York. During one particularly grueling July ride, in the middle of chatting about the latest Tour stage, Andrew would call out our pace stats, wattage output, and who held the record time up the hill we’d just climbed. The Strava app was still relatively new then, but it was already clear that the social component of comparing stats, bio-metrics, and GPS functions with other users was going to crush the existing players in the sports wearable universe. Andrew gave me a full download on the benefits of the Strava app, and was not only very enthusiastic about its technical capabilities, but remarkably proficient in extolling its UX design virtues.

Andrew would know about such things. As cofounder of a wearable start-up himself, at the time he was right in the middle of launching what he hoped would become the most accurate heart/stress wearable device in existence. But a lot can happen between launch prep and actually getting to market. In two years’ time, Andrew’s company, Sum, went the way of many valiant start-ups, and closed.

Recently I sat down with Andrew to chat, not only about his experience with Sum, but also about current trends in the wearables landscape, where it might be heading, and the relationship between pharmaceutical companies (and their marketing agencies) and wearable tech.

HH+: What was the goal of Sum, and when did you start to think this could be huge? What was the difference between you and the other tech in the field?

Andrew: Well, let’s first start by explaining what we did and did not want to achieve with Sum — and that there’s quite a difference in wanting to be huge and being effective. Other players, FitBit, Jawbone, etc., all came from a consumer mindset and were claiming they would solve a medical problem. These folks were not from the medical world, and they were saying, “Your system is broken, we’re gonna fix it for you.” We, on the other hand, were attempting to identify a specific medical problem we could address — in our case, cardiac health — and build our tech around that, not make a beautiful device we could deploy, and then magically it would somehow solve an issue. In other words, come up with data that the medical world would actually use instead of producing a data dump and say “Here you go, solve one of your problems with this.” FYI, Jawbone is gone and FitBit, um, is not doing so well.

Cardiac Illness is the lead killer of women in western nations, and it’s generally diagnosed at a crisis point. And the prevention is intensely behavioral. So, our premise was that if you’re primarily diagnosed after an incident, an incident brought on by lifestyle, and that incident is fatal, surely there’s a gap that can be filled by technology. We were never trying to replace doctors, but give them tools. Other actors in the space, FYI, had a very anti-doctor agenda, as in “data is God.” They had the mindset of “We’ll replace the traditional doctor-patient relationship.” Just by telling you when the nation falls asleep and gets up we’ll solve every medical problem there is. Ridiculous. Our goal was: get with doctors who might already be curious about how tech might help them, and meet them somewhere in the middle, data-wise. The ah-ha moment for us was being able to pick up heart rate variability — at the wrist — which so far no one was able to reliably track. That variability is a key predictor in determining the health of the heart.

HH+: So obviously the medical profession can track this stuff in other ways…

Andrew: Right, but the kind of device that does that is giant.

HH+: David, a Holter monitor? What are you referring to?

Andrew: You wear it on your upper arm and it says, ”You are sick.” We’re now living longer than ever, which means we are going to be living longer with maladies. We’re running around being cool, posting on Twitter, but at 75 years old. People are perfectly willing to run around with devices that say we are healthy, which for a couple of years Jawbone did. The most interesting thing at that time about wearables was that you had consumer devices trying to be medical ones, and medical devices just looking like clunky, sickly, not-attractive devices. And if the data feeds from Jawbone and FitBit were in anyway relevant to the medical world, we’d see those companies still around or doing better.

HH+: Was the exception the Apple Watch?

Andrew: Precisely. The Watch did a few key things. First, it was worn reliably, by enough people, had enough battery power, and had sensors that, frankly, should’ve never been installed. They were cutting into battery life, screen performance, etc. Yet they were put in the Apple Watch, and although they haven’t had any huge medical breakthroughs, they have an untouchable consumer appeal and have data in more hospitals and more studies than anyone else. PS: our lead heart rate engineer has recently gone to work for Apple. All the real players in advanced “heart tech,” they’re all gone now, succeeding in that space was too hard, too expensive.

Strava is good case in point about wearables. Getting somewhere with health tech is very much about changing behavior. And a device that just has some pretty flashing lights and counts your steps has a problem. You find out that you walked 2000 steps to work on Tuesday. So what? Strava made it about reward. When I find out from that app that my friend in London ran 8 miles, I feel like s**t and I get off the couch and get out there. But Strava is an app, not a wearable. It piggybacks off of a wearable that everyone already has. Purpose-built wearables for running etc., get quickly discarded after your workout is over. Stickiness was a big issue. Apple did not have that problem. It sells more watches than any watchmaker in the world, more cameras than any camera maker, more headphones, etc.

HH+: What did you hear, if anything, from medical professionals — what are they looking for, what do they think are the potential benefits and shortcomings of this tech?

Andrew: Well, times have changed. At first, medical professionals were not interested in talking to us. They were skeptical about new tech: if you’ve never had a particular set of data streams in your workflow, you don’t miss it, and the last people you want to deal with are a strange consumer group of non-accredited start-up peeps. We found great ears with people usually engaged in some kind of trial, a lab, a research facility — not daily practitioners. The interested parties were people trying to work with data who wanted to track signals with great detail in an at-risk population. And actually, it’s much easier to convince people to wear something [when they’re] engaged in a program — they’ve already filled out questionnaires and so forth. That brings up an important point. Outfitting a group of people engaged in studies might be a better market for wearables than trying to convince the entire population that they should wear yet another thing with your brand label on it.

HH+: Why did the Pentagon come knocking at your door?

Andrew: Ah, the DOD has a definite population of people working under high levels of stress, but what is hard for them to determine is who will react to different things, in different ways. Prior to exposure, we were on our way to being able to identify that. This would a) help the military understand which individuals would suffer more than others from heart stress and b) help them have better information on the stressful effects on vets returning from areas of conflict. Stress is talked about a lot in the business and medical worlds; it’s one of the top 5 concerns of employers, yet there are very few metrics behind it.

HH+: Was there a specific unit within the military that reached out to you, that wanted to deploy your device in a study?

Andrew: That’s actually classified.

(This is where I artfully pivot to an unclassified topic.)

HH+: Even for a start-up-president-guy, you’ve got a very esoteric blend of skill sets which seem to affect the way you do business, or that determine what’s important to you for your business. Like a Steve Jobs, if I may. Do you consider aesthetics, design, and typography as vital business tools, as vital as marketing skills and financial acumen?

Andrew: Well, I think there are some very fundamental areas which determine success or failure in this space. One, obviously, is an understanding of the engineering, getting the sensors right. And also, simply the realities of bringing a piece of hardware to market. In which, by the way, we’ve seen some spectacular failures. That said, is creating a compelling user experience, a desirable object, an actionable interface, not just a data driven one — are those one hundred percent fundamental to creating something you’re intending for people to make a habit out of? Yes, they may be the only things that matter in a habit-forming piece of equipment.

HH+: So what ultimately happened to Sum and your heart wearable?

Andrew: Well, lots of things are attributed to the rise and fall of a start-up. Ultimately, it was taking us more capital than we anticipated to get the technology as right as we wanted it to be, the advent of the Apple Watch was scaring off the investors around us, and, ultimately, we didn’t manage to keep going.

HH+: Wearable gadgets, as well as AR/VR, have been promising us quite a bit, a brave new future world of virtual, connected experiences. But do agencies really have a monetized model for VR? And when are our primary care physicians going to remotely dose us using real-time data given off by microsensors imbedded in our skin?

Andrew: I won’t give you the Gibson quote, but we are already in the future, in bits and pieces. We are already doing remote surgery, we already get email test results we can go over with our doctor a day later, not a week, and I know folks who are using data in studies that arrive daily from wearable devices. There are people doing “medical” type things at home that weren’t possible without new technology, like at Ancestry.com, 23 and Me, etc. But when do all those things come together? That happens when there is a consumer base that wants something, when there’s a payer that sees value in it, and when there’s a medical cohort that can deliver it. Once we get those things in place, the game will change overnight.

And something to remember, the physical wearable is a tiny part in the equation. Lifestyle and habit are more important. The economics are crucial. For instance, how much does it cost, is it reimbursed, where does it fit into medical codes? That ecology is fifty times more determinate in whether something succeeds than the “app” or the “experience,” even if it does a cool thing. There are a lot of objects that did cool things that are not around today.

HH+: What about regulatory issues, and that pesky issue of privacy?

Andrew: Privacy is more of an issue with businesses that continuously fail to take the right security measures, the Equifaxes of the world. On the side of the consumer, very few of us have ever changed our behavior because of privacy issues. We huff and puff about Instagram using our profile to determine what ads we see, and then we log on to it that same day. People are willing to disclose incredible amounts of personal medical information in the right forum, with other patients, etc. What you don’t want is putting your trust in a business that is not looking after your privacy. It’s also important to distinguish between privacy and disclosure. In the right context, people are not that concerned about their singular privacy. As soon as you’re entrusting a business with that — as we saw with Strava revealing where US military bases are…

HH+: Oh, I didn’t know about that…

Andrew: Yeah, they show where exercise is happening anywhere in the world, so all of a sudden there are these little dots running around in a circle on a screen for all to see, in a remote patch of land in northern Afghanistan. That’s because there are a bunch of guys running around inside their base. So people had no problem uploading their info on Strava, but they, like a million other companies, hadn’t bothered to give a f* *k about the security ramifications of their data.

HH+: I’m also curious about topics that our clients might be interested in. I assume a giant Pharma corp. is on top of the latest tech coming out of Silicon valley, but I know a lot of tech and design nerd colleagues of mine back at Havas would like to have insights into a) what our clients might be thinking about in the wearable sphere and b) what the agency’s position could be, potentially. I realize we’re treading slightly into the topic of the “future of advertising.”

Andrew: Well, yeah, your guys’ job is to strategize and communicate. Their job, obviously, is to be on top of the most profound advancements in medical technology. They are looking to you to be the interface between the messaging, technology, medication, and other worlds. Can you help them better understand how those other worlds function, the barriers to behavior, the changing attitudes? They’re not coming to you for medical expertise. You’d expect them to be ahead of you there. So be ahead of them everywhere else.

HH+: What are you doing now?

Andrew: I’ve always been dedicated to helping people live better, healthier lives. First I was doing that with climate change and sustainability, then came the heart health project, and currently I’m helping people grow their own food in urban environments as a path to better health.

HH+: I’ve seen the site HelloGrow.com. It’s a really smart way to check in with your “box, urban garden” remotely, like a nest for your food. Pretty cool. Any smart marketing tactics you employed in getting this launched?

Andrew: Um, let’s see… One of the key things we did is tap into just how much people wanted nature in their lives, more green in their world, things they can trust. Also, crucially, the idea that eating is something that can bring you together with family. It’s not about calorie intake. It’s one of the most formidable social glues we have. And one last thing. The reward of growing, the feeling of success in growing vegetables is truly, truly incredible. Feeling like you’re a natural-born-pant-plant-killer is not. Solving that for people is like giving them a green superhero cape overnight.