 Welcome back to part two of our TechCrunch Disrupt series of episodes for Building Tomorrow. I'm your host, Paul Matzko, and today we're talking about all things related to health innovation at this year's conference. Now after drones and autonomous vehicles, I would say that medical devices were the single largest category of exhibitors on Startup Alley. I'm gonna play you an interview with a startup that's producing a new kind of hearing aid that can do, well, as you'll hear, it sounds like it can do pretty much anything. I'm sitting with Dr. Dave Fabry, who's the CIO of Starkey Hearing Technologies. We're gonna talk about their new product, the Livio AI, which is a hearing aid, but much more. Welcome. Thank you for taking the time to talk to me, Dr. Fabry. Thank you very much. It's my pleasure. So this is a hearing aid that I think doesn't do justice to what this device does. So it's going to improve people with hearing loss. It's designed to help them hear what's going on around them, but maybe describe some of the more innovative elements of this device. Yeah, I mean, I'm an audiologist. My background is my 35th year in the profession. I've worked on industry and on the clinical side, and what we're particularly... What I've spent 35 years doing is trying to persuade people to address the fact that they have hearing loss and consider wearing hearing aids. In many cases, that path to hearing health is one that's delayed by seven to ten years. This product, Livio AI, is directed to try to raise... You can either try to do a number of things to address stigma associated with hearing loss. You can try to make them smaller and cosmetically appealing, and we think we've done that with the package of this. It's a good-looking small device. You didn't even know I was wearing it. But you can also do it by amping up the technology. Hearing aids, as we traditionally think of them, are stand-alone devices that are designed to amplify sound to compensate for a person's hearing loss. About four years ago, we were among the first to introduce a device that was connected directly between a smartphone and the hearing aid without an intermediary device. So we were able to stream crystal clear audio, whether it was phone calls, whether it was Siri, navigation. Any app with any audio at all could be streamed directly from the phone to the hearing aids, making it a connected device. Livio AI is the next generation on our journey as a company to move it into a multi-purpose, multi-function device. As you said, some of the things... First, we have to begin with the state of the art hearing aid to compensate for hearing loss, and that's always going to be our expectation. We're 50 years in the business. The next thing that we're interested in doing is adding features that will be of interest to people like myself. I'm a baby boomer. My parents were concerned about things, health conditions such as cancer and cardiovascular disease. Hearing loss was sort of an afterthought. It's really a disability in that many people, the older you get, the more likely you are to have a hearing loss. By the age 70, you've got about a 50-50 chance of having some measurable hearing loss. And yet, many times when people go to see their primary care doctor, they'll say, well, all your hearing is normal for your age. I hate those words. It's assumed that you're just going to have to deal with it. We say now that the data show a couple of important things that lead into why we developed this product. First of all, that we know that many cardiologists will say that the ear in the aging individual is a good overall indication of cardiovascular health. The blood supply that goes to the ears and the eyes is very small, and when you start to have blockage or risk of stroke and things like that, any cardiovascular condition, the blood supply to the ears and the eyes are often the first to go. And that's why they show up in collaboration, in correlation, rather, with cardiovascular disease. So one of the things that we've looked at is the increase in obesity in the U.S. Physical activity is declining. So with that also comes conditions like diabetes, it's elevated risk when you're overweight. Cardiovascular disease, as I said, and hearing loss are correlated. So the first thing we did in this product, we put in a motion sensor that many people might be familiar with if they wear a Fitbit or an Apple Watch or some activity tracker, and we've incorporated that in the app directly on our product as a score that can be monitored every day. There are three components that may look familiar to you. Step count, we're setting 10,000 steps a day, which in general serves as the default for most fitness trackers. We also want to encourage people to be physically active by doing exercise, a brisk walk or more. This motion sensor in the hearing aid can track the steps that you take every day and whether you're exercising. And then the final thing is just simply moving around every hour for even just a few minutes. It's good for joints, it's good for muscle, and so that part of the physical side of the equation is something that can be monitored directly in the instrument instead of having to have a secondary device, a separate device. If they're already wearing their hearing aids and we know that they're physically active, we can record a score from zero to 100 every day. That's the first time it's been introduced in a hearing aid directly. We're coupled also to Apple Health, but the nice thing is I have a dog. My dog likes to go for walks. I can just take my hearing aids. I can go for a walk. I can leave the phone behind. When I come back and range of the phone, it'll couple and it'll update the steps. So I have no step regret. Every step gets counted. That's important. It's important. Yes. Everyone counts. And then the other part, so the fitness, you know, first time in a hearing aid that we're incorporating this motion sensor that can track steps, exercise and movement, but then the brain function is really in response to research that has shown that untreated hearing loss in the aging population is correlated with cognitive decline. We know that people who previously, if they didn't have hearing loss earlier in life, they were active, vibrant, socially active, that as they start to have some difficulty, like the noise here at TechCrunch, they start pulling back. It can lead to, and data have shown that it leads to social isolation, even depression, and ultimately cognitive decline. Now I'm not here to say that hearing aids will prevent dementia, but we know that the longer people wait after being diagnosed with the hearing loss to doing something about it, the greater the risk for actually expediting that cognitive decline. And so what we've done is we've built in the other side of this Thrive score, the Wellness score in the app that can be viewed and monitored by the end user, by the patient, is first use. We know that the more people use their hearing aids that compensate for hearing loss, the better they're going to do. And when you think about it, your ears are really just a very sophisticated sensor, much in the way that your eyes are a sensor, your fingertips are a sensor, your tongue for taste is a sensor, where you really hear is in your brain. They're all feeding input into that, and so the brain is where the hearing occurs. And so we know the more you stimulate the brain by using amplification appropriate for your loss, the better your brain is going to be stimulated. The second element that we're talking about is social engagement. We employ AI and machine learning in this hearing aid to constantly monitor every environment where the person is, and what it can determine is, is it a quiet or noisy environment? Is there speech present? Are they streaming a phone call or watching a television program? The most important stimulus that most of us hear on a daily basis is what? Speech, the human voice. We can monitor that and log that when a person is around and engaged in conversation with other humans. We'll total those up and give a point total each day for the engagement that they have. And then the final piece is what we call active listening. In this case, we want them to wear their hearing aids, talk to other people, and get out in the world. Wear their hearing aids everywhere they go. Wear them when they're at tech crunch, when they're in challenging environments. Wear them when they go to a restaurant, a gym, because two things. One is they'll begin to see how much better they're going to do in those situations. And then it also allows the hearing aids to be optimized by their professional or even to a degree within the app by themselves. They have some capability of customizing the function to their liking. But most people still... Rather than having to go... Yeah, they can adjust it so that it can operate pretty automatically the majority of the time. But that in turn... We also have incorporated a telehealth feature in here that we're calling Hearing Care Anywhere. If I'm at a difficult listening situation like this, I can actually initiate a request that goes to the cloud and that my professional will notice that they receive a request that says, I'm at tech crunch and I'm having trouble hearing male voices. They can in turn send an adjusted setting without me needing to go always back into the clinic for adjustment. We're trying to make it convenient for the professional and the clinician by enabling this telehealth which we think is a large part of the future because even though people can adjust themselves, most feel most confident in the hands of the professional. The other thing that we're really quite excited about in this case and first again for the hearing aid market is real-time translation. So my wife and I were just in Paris last week and my high school French can only take me so far. That's right. So... And so what we do is we incorporate a real-time translation feature in here that can go both ways. I found it very useful two ways. One is if I'm in a situation where you're a native French speaker, you want to speak to me and I want to be able to understand it. There are lots of translation type products on the market, but what this does is if you speak French into this, it will translate into English the language that I understand acoustically to my ears amplified for my hearing loss. So it's discreet and only I hear the translated sound. The other way that I found it quite useful to polish up on my high school French similar to some of the other language training programs is that if I just switch the direction so I go French to English, then if I say, you know, where's the bathroom? And then it will go, where's the bathroom? And it'll give me a pronunciation guide acoustically, discreetly. And then I can use it to coach myself to improve. But we're really excited about that and we've had terrific response from the translation. Does it use like a Google Trans... It's using a number of different AI services that we're putting in and embedding with that. We can translate 27 languages right now. We really don't want to hitch our wagon to one or the other, but we want to be able to take advantage of that machine learning, of that AI as those improvements continue to work. We'll develop our own and collaborate with others. That's really exciting. So, I mean, we've got... You've got a translator in your ear. You've got a fitness tracker in your ear. A health, a mental and cardiovascular health medical device in your ear. Something else I saw on the product list was geotagged adjustments. Yeah. I thought that was actually cool. Yeah, and that was what I kind of showed you in the sense like here. I could go in here. I can use the GPS that's embedded in the phone so that I could tag this location and so that when I return to this situation, it will remember the settings that I made. Another feature that is quite useful that also uses that geotagging is one we call Find My Hearing Aids. This will show that my hearing aids are connected to the phone and exactly where we are right now in the Moscone Center and even kind of a divining rod that shows how close the devices are to the phone if I happen to leave them behind. So inevitably, those times when you think you forgot them at home but they're actually in your pocket, now you'll know. Exactly. In my mind, yeah, I'm working on that cognitive crime. We also have gesture control, that motion sensor, so I can tap the side of the hearing instrument and enable streaming from a remote microphone or from a TV device. Very natural user interface without having to fumble for the controls. Great, yeah. One last piece here. I know a lot of our listeners are going to be millennials, Gen Z, Gen X. So they're not thinking about the hearing aid functionality of this. So they should be because, again, like I said, 50-50 by the time you're 70. So it's going to come for us too inevitably. Right. Do you see a future, maybe this is not specifically for the Livio or for Starkey, but do you see a future in which some kind of hearing aid-style device or really just headphones that does a lot of the same functionality, is something that we all just wear all day long, whether or not we have hearing loss? Well, and I think it's a very important question you raised because right now there's a stigma associated with hearing loss and hearing aids and only about 30% of the people with measurable hearing loss actually wear hearing aids. What I'm finding with the Baby Boom generation, like myself, is I'm less stigmatized by hearing loss and hearing aids, but I have higher expectations that they'll meet my needs or exceed my expectations. I think this device is a first step towards that and to your point, I've been wearing these devices even with very minimal hearing loss for about the last three months. No one even knows that I'm wearing them and if they do and I explain what they do, they say, how do I get them? I don't even have a hearing loss and I want to get them. The issue that I see, think about the way, and I'm old enough, I'm a lot older than you, computers. We used to have the entry point into the computer was through the keyboard, then we had the mouse. Now we have touch display. Now we have voice. Think about Siri, Alexa. Think about all of the aging population and the fact that they may have some hearing loss but want to use that front end natural user interface of a voice. That's where we think the big opportunity is, is that it's the entry point into the worldwide web into the CPU of the computer, into your phone, and that, we think, has a lot of appeal not only for people with hearing loss but for everybody. Yeah, well, wonderful. Thank you for taking the time to talk to me. Thanks very much. I appreciate it and good luck with the rest of your tech crunch. Thank you. As it so happens, news recently broke that Starkey will have two major competitors soon. Apple and Google have announced that they are forming partnerships with other hearing aid companies. Now if you think about it, those AirPods that Apple likes to promote, it's a pretty good foundation for something that sits in your ear and amplifies sound, which at the end of the day is what a hearing aid is. The question is whether companies that make headphones can develop the medical device aspect more quickly than the medical device makers can develop the multifunction stuff. So it'll be an exciting race, but the fact that there are so many entrants into this space goes to show you that the hearing aid sitting in your ear that is kind of the future of wearable tech. Our next startup interview isn't about making a medical device, but they are innovating how we, or more accurately our pets, will get their medicine in the future. Listen in. I'm sitting here with Arun Girder, who's the CEO and co-founder of Pinpoint Pharma. Now Arun, you have a medical device designed to allow the, maybe I should say manufacturer, but the mixing of pharmaceutical compounds for animals, for pets. Is that right? Sort of. We don't think of ourselves as a medical device. We are primarily a compounding pharmacy for veterinarians, except that we are a 21st century compounding pharmacy. We make custom medicine for pets on demand. What's different about us is that we have a proprietary printing technology that is much more efficient, much more precise and much more rapid than traditional compounding pharmacies which largely do things by hand. And that's actually been an issue for pharmaceutical companies, or pharmacies, I should say, that are focused on compounding for humans, prescription drugs for humans, a scarcity of compounding pharmacies, especially in underserved and rural areas. Is the same thing been true on the pet side, that a pharmacy that's willing to do on-site compounding for pet prescriptions? I cannot speak about the human side because we are specifically focused on pet medicines. We find that the missing need is not so much rural or geography based. It is across the entire nation in that many veterinarians are deeply aware that different pets need different kinds of medicines. For example, you have different species, even within the same species you have different body masses, and veterinarians are used to dosing. They are trained to dose in milligrams per kilogram of body weight. But the fineness needed to distinguish between an 8-pound cat and a 12-pound cat, or even a 40-pound dog and an 80-pound dog, often that gets rounded to the nearest available off-the-shelf product. And in that sense, a veterinarian is familiar with the need to do custom dosing, but many times they are not able to get the service they ideally should have. And that's where we believe that we can step in. So is that a function of, you know, the difference between an 8-pound and 12-pound cat is half as much, again, body mass, whereas, you know, for a human being precision is important, but the difference between a 200 and a 202-pound human is relatively slight as a percentage of total body mass. Partly, partly. But speaking a little bit about humans, because we did speak with a lot of doctors, pharmacists, nurses, and other people. So far we've interviewed close to 250 people to get an idea of where the problems are. On the human side, it's not just a function of body mass. It's also about, for example, a newborn. A neonatal medicine is extremely different from normal adult medicine. So they need far tinier doses. A nurse once told me that the stomach capacity of a newborn human is about 7 milliliters. So if you are off by 0.1 ml, it can make a fairly big difference in that that's the entire stomach capacity. So how do you dose appropriately? How do you do that? Same thing with older people, geriatric medicine. If someone has partial organ failure or metabolism issues, they are going to process medicines differently. Now, having said all that, these are all things we learned when we spoke with the 200-plus people that I mentioned across the entire ecosystem. But we have chosen to focus on pet medicine because that's where we believe that there's a cleaner market. There's also a more knowledgeable population that's already familiar with custom medicine based on body mass and individual factors. We'll get to that cleaner comment here in a minute. But I'm pushing us ahead of ourselves. First, how does this system actually work? So like, walk me through on the ground level, there's a pharmacy that is working with you guys. I come in asking for a particular medicine that needs to be customized to me. How does that process then look? We are catering straight to veterinarians, so I'll tell you how the process works. From the veterinarians. It's like, let's say you take your pet to the veterinarian, they decide this is the medicine, this specific pet ought to have. It can be, let's say that you have a 12-pound cat. It's a slightly heavier than average cat. Now, your veterinarian is going to use their knowledge to figure out how much medicine this cat needs in what form, whether it's oral or not. And if it is oral, what flavor, and those things can all be customized. There is as much variation across pets as a taste variation across humans. What works for one pet doesn't work for another. The veterinarian then goes to our website and places an order. They say make this medicine in this many milligrams per dose. This many doses in this product form, whether it's oral or not. And if it's oral, it can be any, pretty much any form. Whether it's liquid, solid, chewable, all that. If it's skin absorbable, they specify that. And we pretty much print that medicine. What our technology does, it's kind of like an inkjet printer for medicine. It's how a regular inkjet takes liquid ink and puts it on blank paper. That's your final product. We take liquid medicine and put it on blank substrate. So the substrates are just inert carriers. But the medicine is added to the substrate in perfect concordance with what the specific patient needs. That's where the thing comes. And we, once we print it, which is a pretty rapid process, we just ship it straight to the client. That would be the pet owner in this case. So that's how it works. So it doesn't even, it can then at that point, it doesn't have to go to the veterinarian's office first, and then to the patient, it can go straight to the patient. Yes. We did offer the choice to veterinarians that we can ship it to you and you can give it to the patient or however they wanted to do it. But they expressed a preference for shipping it straight to the client. That way the client does not have to make two trips to the veterinarian's office. Convenience. Is that something that can be done? I mean, you can order it one day and by the next business day have it expressed, shipped to you? Or what's the time frame for that? It depends on how far away they are from us. We can print it pretty much right away in that the speed of what our process does, we can very easily make more than one dose per second, depending on the volume of medicine in each dose. It's analogous to how if you're printing monochrome, like this text, it comes out pretty rapidly out of the printer. But if you're printing something graphics heavy it comes out a bit more slowly. So it depends a little bit on how much medicine is in each dose, all that. But we can print it right away and we can ship it same day so that the client can get it anywhere from overnight to two days out. That is kind of what our business model is. Now with this with prescription printing like this did you have a background on the printing side or on the medical side? What was the background that brought you and made you kind of interested in this in this field? My background is in chemical engineering. I'm a PhD in chemical engineering that's been quite a while ago but my entire professional career I have spent in pharmaceutical production at both at the largest scale like half a million tablets an hour as well as what we are doing in the custom medicine and things in between in about 50,000 tablets an hour that kind of scale. It's not really so much about my background as we just found where the need was and I personally decided to apply my engineering background to where we believe the problems were. We collaborated with pharmacists we have collaborated with medical doctors on the human side as well as veterinarians so that's it's an interdisciplinary effort all in. I mean I think it's need to see these different fields coming together I mean you've got the printing tech you have the need for chemical engineering and dosing which obviously needs medical side and I think it's a neat confluence of fields. This I think is a good time to talk about the animal human side and my understanding is that it's actually would be no more complicated to print you know pharmaceutical drugs for humans so it's not a degree of difficulty of technical difficulty question to do with the messiness of our health insurance system and regulatory approval can you walk us through that? Partly yes we had a variety of conversations with people across the ecosystem as I mentioned and from a technological perspective there's nothing preventing us from printing custom medicine for humans. The issue was that I had mentioned earlier that the animal side was a lot cleaner and what we found was on the animal side people who are paying for the service are the pet owners and they are also the people who directly visualize or witness the problem it is very closed and localized in that sense whereas on the human side for example we have great benefits in the precision of our medicine in that we can get submilligram level dosing which is currently completely unheard of so this can easily benefit neonatal care or geriatric care or people who are using things like warfarin where the difference between 2mg and 3mg is the difference between therapeutic and overdose one will land you in the ER things like narrow therapeutic there's a variety of drugs there's a variety of patients for whom our sort of high precision printing process will really benefit however the patient we found is the beneficiary the doctor has to do something slightly differently in that veterinarians are extremely used to doing things on a milligram per kilogram basis on the human side the guidelines are not milligram per kilogram that often many times it would say something like adults take 20mg children below 12 take 10mg it is already discretized in that sense the third thing is on the human side the majority of the time it's the insurance company that pays for the medicine and it was not clear what their incentive was so the payer was different the person writing the prescription has to do something different and the beneficiary doesn't pay just sees the effects without having to do anything it was a very complicated system on the human side with the sales cycles being very long and protracted so we decided as a start up we are not going to mess around with that we are always open to dealing with human medicine as a different vertical in the future but we chose to focus all our attention on pet medicine because there the problem was much more well defined people already knew that they were not getting the exact fineness of the dosing that they needed plus there was a huge huge problem on the veterinary side in terms of patient compliance this is something that humans can for example swallow a bitter pill literally you can kind of just grin and bear it your cat spit it out first of all if your cat is small or if your dog is a smaller thing you often have to buy something off the shelf and you have to subdivide it into four pieces two pieces four pieces you might be doing that by hand not all tablets are pre-grooved and you might not get the same amount in each quarter of a pill you might get only three pills the fourth might crumble into powder you try to give this to a cat and now it claws you and doesn't want to take medicine because it's a cat it might take it but then it spits it out so now you are scratched and bleeding the cat has patted its medicine out there is this white foaming mess on the floor and you don't even know whether you gave the right dose to start with on the animal side therefore there was a lot of pain in getting animals to voluntarily take medicine so we believe that customized medicine there it's not just about the dosing levels it's about if we can make something that the cat voluntarily wants to take it will really simplify the lives of pet owners everywhere now does this mean using a different substrate that's more appealing tastes better to the animal it's a variety of things I did mention pharmacists had told us that tastes vary from individual animals as much as it varies with humans so they do not have the knowledge ahead of time to make something that will appeal to all cats but we have the ability to tune the flavor to the individual animal we also have the ability to tune the carrier form for example it can be a solid that the cat takes by mouth but if the cat absolutely is recalcitrant on that we can put it in another form depending whatever the veterinarian do we will do it unless it's something we do not question the veterinarian we completely trust the veterinarian on how much medicine this cat needs the only reason we might push back is if something just doesn't make any physical sense to us we might say hey did you confuse milligrams with grams or something order of magnitude but other than that we trust the veterinarian to know what they're doing so in theory a veterinarian could say this is the sort of thing where they could ask the owner of the pet and say what's a flavor your pet looks they like to tune the flavor they like chicken flavor they find out they put in the order make this tune the flavored and make it make it a liquid form so they can use an eyedropper to administer or something because that's how the owner says the we can use data like that these little sample packs of flavors that we can distribute to veterinarians ahead of time and they can let's say there are about 5 to 10 different flavors you can feed it to a cat or leave them all in front of the cat see which one it takes after smelling it and we just pick that flavor that's great yeah there are many ways to do this there are many different ways but the vision is that if a cat will voluntarily take medicine our COO for example is a veterinarian by background and her cat has given her trouble with going behind the couch and spitting things out but her cat is also very telling the difference between a treat and a medicine just from the sound so it can either come running to you expecting a treat or it can run and go and hide in the closet so the vision is that if medicine can be made in a form that it simplifies the pet owner's lives considerably it's about 10 to 15 minutes of struggling with the pet is now gone that's something we believe is worth it yeah anyone who's any pet owner I think especially someone who owns an intelligent cat would appreciate not having to fight to get something down their gullet that they don't want now on a cost comparison how would this process compare if the drug is going to have a different price point so we have to speak in generalities here but do you anticipate this costing more than the current prescription system where do you come out in the price point there are two comparisons to make here one is custom medicine versus off the shelf in general custom medicine is more expensive simply because you need the labor to do things by hand however we believe now we are not comparing ourselves off the shelf medicine we are comparing ourselves with other existing custom medicine and there we believe that since our process is a lot more rapid we can turn things around more quickly the economy of doing things more rapidly we can pass on to the customer to start with we are cost comparable with existing compounding pharmacies but we believe that as we scale up in future the price savings can be passed on to the customer that makes sense you are competing for a different segment of the market you are not competing against the generic off the shelf that is great to hear then we can take it back as I am listening to this and I own the pet so I appreciate the pet angle trying to get my greyhound trying to get my greyhound to swallow a pill involves pill pockets and coaxing again you have to believe that it is a treat and not a medicine so I appreciate the animal side but part of me keeps thinking this would be really nice on the human side too right the ability to customize the medicine to make it a better fit I mean it is better for you medically if it is exactly calculated to your weight and to your particular situation it is it is more convenient more pleasant of an experience if you can adapt it so it is not the giant pill if you are someone who has a swallowing issue I mean there are people like that who have medical swallowing issues like part of me keeps thinking it is striking to me that in a sense our pets will have this advanced production technology before their owners will that just is very striking to me so on the human side what would need to change before you guys really seriously considered expanding into a human pharmaceutical space that it is an interesting question we right now the situation with the human medicine was not clear that is why we focused on the animal side I would say a variety of things first is there are some doctors specializing in certain things for example pediatricians neonatologists geriatric medicine certain disease combinations like if a person has let's say an endocrine disease and cancer like diabetes and cancer they might be seeing an endocrinologist and an oncologist but the drug interactions may or may not be on each other's radar it is often the nurse or the pharmacist who becomes the final point of contact and they have to figure out which of these things are going to interact there is already some knowledge that custom medicine is needed but the tradition seems to be that on the human side they start out at the baseline of some medicine you then go back to the doctor in about 4 to 6 weeks and they look at whether you have had too many side effects or not enough therapeutic effect they adjust the dose it is either high or low depending on what happened another 4 to 6 weeks later they might adjust the dose again so it might take you about 3 months to hit your steady state and the adjusting the dose would be something like subdivide a pill which in many cases is not good because pills can be coated or it might be take 2 or take them more often all kinds of discreet ways to do it that we believe can be changed up front because this is not something we do in house at pinpoint but we are aware of many people in the field for example take your liver function test your blood draw or plasma draw or just your genetic factors or your doctor can use your entire medical history use their judgment to say this is how much you need the issue there is they might be able to calculate you need 7.35 milligrams or whatever the number is but you are torn between a 5 and a 10 so even if they can calculate it there is no mechanism right now to efficiently make what you need other than existing compounding pharmacies most of which is currently still done by hand so that is one thing that needs to change is that doctors and people writing prescriptions would need to become more used to writing things on a continuum rather than discreet levels on the insurance company side if let's say that the doctor needs to do a blood draw before they prescribe this custom amount it is not clear right now who is covering the cost of that blood test the blood test can be very rapid it can be done right while you wait in the doctor's office it usually takes no more than half an hour from what I have read in the literature by people who have come up with tests like these again it's not something pinpoint does directly however there was stymie about who would pay for that and this is not something a pre-prescription blood test is not currently covered or is not familiar to many insurance companies that sort of education we believe might need to happen all these things are completely bypassed on the veterinary side simply because they do milligrams per kilogram basis right out of the gate so they are extremely used to it well hopefully as medical community writ large sees this working on the animal side and this I'm convinced becomes a dominant way of doing compounding prescriptions for animals they'll start to make changes on the health insurance on the medical on the human medical side that makes it possible to port this over to human medicine so Arun thank you for your time, thank you for explaining what pinpoint pharma does I think our listeners will enjoy hearing about this and I'll put a link in the show notes to your website so they can look at you in more detail thank you for having me I'll admit that when I first heard that this technology which promises more accurate drug dosages at a lower cost was going to improve the lives of our pets and not people first I got a little disappointed it shows how life saving and life improving technology is being delayed for humans because the health insurance system is so tangled and messed up but I'm glad the companies like pinpoint pharma are finding ways of rolling out this technology anyways even if it means that pups will have better pills than their people do now I suppose our sign off is more fitting than usual today as always until next week be well building tomorrow is produced by test terrible if you enjoy our show please rate review and subscribe to us on iTunes or wherever you get your podcasts to learn about building tomorrow or to discover other great podcasts visit us on the web at libertarianism.org