Bring the Lab Home
Digital x Healthcare winner Bisu share their vision for healthcare startups
Technology that allows us to monitor our bodies is changing how we manage our health. Data that was once only obtainable by visiting a doctor is now at our fingertips. A tap on the wrist informing you of how many steps you’ve taken or calories you’ve burned is one thing, but a readout of what’s happening inside your body is another. Bisu is making such data easy to obtain with their home health lab, an elegant and easy-to-use system that supports a range of tests that you can perform yourself.
The Japan-based startup, which has offices in Tokyo and Atlanta won the Best Innovation Award and the audience-selected Moonshot Prize at the American Chamber of Commerce in Japan’s inaugural Healthcare x Digital competition on December 1.
The ACCJ Journal sat down with co-founders Daniel Maggs and Wojciech Bula—chief executive officer and chief technology officer—to learn more about how the company was formed, the challenges they have faced, and how they aim to help people live healthier, happier lives.
Photo by Miki Kawaguchi/LIFE.14
How did the idea for the home health lab come about?
Maggs: I was working in a Japanese company as a product manager and was looking at Internet of Things services. I had known for a while that I wanted to start a business and to make something new. I was really interested in hardware devices because of the challenge and the ability to learn more about our bodies. There was a whole wave of new devices starting to appear, and I saw this as being something where you could build a meaningful business—not just in Japan but all over the world.
We all need to be healthy and productive in old age far longer than our grandparents did. So, I feel that it’s not just a challenging and interesting market but it’s very meaningful work, because we’re satisfying a very basic human need to be healthy and happy, and to live as long as possible with the ones you love.
And during that exploration period, I met Wojciech, who was, at the time, at the University of Tokyo.
Bula: I’ve been a scientist for more than 15 years, working for various universities on projects related to electronics, microfluidics, biology, and some IT. I was getting a bit tired of the number of publications in which you have to appear by the end of the year, so when Daniel approached me, I was really interested. I wanted to build something impactful and I felt this home health lab concept was a very good niche. It’s not a diagnostic that you will use once per quarter or maybe twice a year. This is something you can put into someone’s hands and they might use the information they obtain to change their life.
How did the company come together?
Maggs: In the early days, when we were still doing market research, trying different kinds of technology, and creating very early prototypes, we incorporated a US company in Delaware. That was in 2015. We did that from Japan because it meant that we could do it cheaply, could avoid having to change our visas for some time, and, because we weren’t running a Japanese company, it would be easier to get money from more globally minded investors. We now also have a Japanese company as a subsidiary.
What challenges did you face?
Maggs: In the early stages, you start with a bunch of assumptions about what you think the problem is that you are trying to solve and what your product is likely to be. We had two:
The device would be installed in the toilet
We would be checking for signs of disease
On the second point, we spent some time talking with doctors to learn about patients and chronic conditions. We came to understand how these conditions develop slowly over a very long period of time. So, the key is not discovering whether someone has a condition or is on track for one, it’s to try and get them to change their behaviors. Intervention and prevention are key.
That made us think about what things we could detect. And we also asked why a person who is on the track to chronic disease would be motivated to check for a problem when they’re not already motivated to take care of their health. You want people who actually care about their health, who want to invest in it.
On the toilet side, people have been talking about healthsensing toilets for a long time. We’ve seen prototypes, but they are extremely expensive and complicated. No one’s really made a successful one yet. We took a step back and thought about a different approach. We decided to go portable so that the product could be used anywhere, not just in one location, and actually could be used by multiple people in a hygienic and easy way. This is one of the best decisions we ever made, because it meant that the product became a lot more scalable. A reader could be in a company toilet, at home, or in a gym.
We could also do new kinds of testing that have never been done, so we’ve made tests for pet health and a saliva test for oral health. We have one for baby health that is a diaper with an embedded removable test stick. There’s a whole pipeline now that would not be possible if you were stuck in one location with a toilet.
Were there design challenges?
Daniel Maggs
Maggs: With a hardware company, it’s really important not to fall in love with the technology. You must always try to be focused on the best means to an end.
We’re trying to provide a really great experience. The challenge is that we are bringing medical-grade technology to the consumer market, and it’s a new technology—at least for the field in which we operate. That’s challenging for a couple of reasons. One is that you need to have a very clear and simple way to explain the concept. The other is that investors—because many are not that technically minded—are more interested in building a big business quickly rather than in something being genuinely innovative.
One thing that is satisfying about this business is that we really feel we’re doing something that’s going to move humanity forward.
The challenge for us is that we have this technical foundation that is needed to realize the product, but we must translate it in a way that’s very simple and human and relatable. For example, our website looks quite nice now, but we had to go through many iterations trying to make it less technical, with less jargon, to the point where the visitor is like, “Ah! I get it!” That was a learning experience.
Wojciech Bula
Bula: The technology you’re developing should solve a problem. That’s actually a first trap that a hardware startup can fall into. Take a smart toilet. It sounds like a great product, because it’s derived from great technology. But is it a good product? Especially in terms of detecting the biomarkers of early disease, it sounds great. But as a user, would you pay for a product that scans for five or 10 biomarkers out of the huge spectrum of all the diseases you might have? Probably not. You want to have the whole overview; but there’s no technology that does that yet, no technology that is giving the user peace of mind.
If you go this route, you are giving the user a bad experience. We avoided the trap by not loving our technology too much. We changed the prototype a few times, started from scratch, started to focus on the user and what they want. It’s a standard textbook way of doing business, but it’s more difficult to actually apply than to talk about.
How important are aesthetics to consumer adoption?
Maggs: I think it’s essential. People’s perception of urine testing is that it’s something you would normally do in a clinical setting. You are kind of in the position of patient and you’re almost performing an experiment on yourself. We wanted to get to the point where testing your urine is simple, elegant, and pleasant, where you would have a very positive association with using the product and it can be part of an aspirational, positive lifestyle.
Bula: It should be a device that people would truly like to usenot just a pleasure to look at but also engaging. If you are looking to design, it is definitely a language with which you talk to the user. If the design is functional but less sophisticated, then it shows a lack of respect for the user, because the language you’re using is not personalized, not the best language you could use. So, it was definitely worth the effort to create the design we have.
That is also at the core of how we want to establish the interaction with and relation to the user. It’s about respect. It’s not about marketing or selling them things they don’t want; it’s about really addressing their needs. Design is part of that.
How the device loads and how it works also matters, as does being environmentally friendly. We spent a lot of time trying to make it as energy efficient and modular as possible. If something breaks, the user potentially can replace the part, or we can fix the device. That’s part of being environmentally friendly. We deeply believe that the device should last, can be repaired, and have a low environmental impact. That is also part of respecting the customer, because we know that they also care about these things.
How did your market research guide you?
Maggs: The key is to make things easy for people, to deliver a pleasurable experience, with minimum effort and zero pain, at a reasonable cost. Our thesis is that if you can get to that experience, you can get a lot of people to use the product.
Initially, I was very much in this sort of “biohacker” world of health optimization and health tracking. After a while, I realized this is a small market. It’s an important market, but for some people on the outside it’s harder for them to approach your product if they see you as being in this category. They might say, “Well, I’m not a biohacker, I don’t identify with this. It’s kind of interesting, but I guess it’s not really for me.” So, you want to position yourself in a way where your messaging is wide enough to welcome those potential users but not so soft that the enthusiasts won’t come at the start and be the active adopters.
Probably the most important thing I’ve done in my role in the company has happened during the past five months. I’ve been working through a process with our marketing team—they’re actually an external agency, but they’re very good at this—to really go into depth about who we’re trying to speak to and what their needs are. What are their external problems? What internal emotional problems are they experiencing? How do you speak to each person?
“It's really important not to fall in love with the technology. You must always try to be focused on the best means to an end."
I’ve walked through this thing called StoryBrand, which I highly recommend. It’s based on how, in a movie script, you have a hero who has a problem, and there’s a villain stopping them from getting to where they need to be. It can be an embodied villain or it can be a situation. Then along comes a guide, someone there to advise them, who gives the hero a plan and calls them to action. And by taking this action, they achieve their success and avoid the failure that they were afraid of. StoryBrand basically takes that framework and lets you describe that for a consumer in relation to your product. At Bisu, we have three basic target segments:
Those interested in weight loss, and looking and feeling good
People in their thirties, forties, and fifties who want to take care of themselves as they age
Fitness enthusiasts trying to get the extra five percent
Each segment has their own fears. People who are struggling to lose weight may feel guilty that they don’t know what to do and lack control. Those who are more on the wellness side may feel that they’ve lost something they had before, and they want to regain that sense of vitality, excitement, and joy. And the last group may be insecure about not being at their best or being mediocre, not being number one.
That framework has helped us clarify things and apply some discipline to how we talk about the product and issues surrounding it. Words are like emotional real estate. When you choose words, you’re occupying some emotional territory that people either do or don’t care about. It’s a really delicate art.
How does your podcast help your business?
Maggs: Podcasts are useful for several reasons. One is because people are looking for personal, intimate conversations. Podcast content has very high engagement. It’s a really good way to literally have someone’s ear, to get into the details of something without necessarily jumping quickly to the next YouTube video, and it’s a good way to build your brand and authority. I think it’s a very important format. It’s one of the highest-growth formats and is less saturated than video.
You’re typically working with two kinds of people in your podcast:
Experts who are going to reinforce a statement you want to make
influencers who are going to help drive traffic
Before starting the podcast, I was thinking in terms of the things that we track and are relevant to us. We’ve done six episodes on these topics. Now, I’m thinking more in terms of the things that we need to educate people on by a certain date to help set up that understanding before launch. One speaker I’m quite excited about is a former astronaut who wrote a book on learnings about health that have come from activity in space. We have interest from NASA, because urine testing in space is very difficult, and he is one of the researchers with whom we’ve submitted a joint application to the agency. So, my aim is to do a podcast interview with him.
How can home devices help sustain the healthcare system?
Maggs: I think user experience—an emotional connection—will always be key, because people need to be in a sweet spot between the cost—in terms of time, effort, money—of using something. The lower those barriers are, the more often the device can be used. But it has to have some kind of corresponding value. We see some devices from companies that are very good at sales and marketing, and, at the beginning, they sell lots of product and raise a lot of money. But, in the end, the reviews catch up with them, because what they’re advertising is not really what they can do.
We need to balance the desire to make money and build a business with a desire to actually feel that what we’ve made is legit and robust. My impression on the science and technology side is that the next five years are going to be very good for us and a few other companies we see in the health and wellness space. But probably it will be another five to 10 years before we finally have legit health tracking at home as a standard thing.
Even the early wearable devices are pretty shaky on the quality of data such as step and calorie estimation. For the latest Apple Watch, they basically filled a whole warehouse full of exercise equipment and got the executives to wear calorie estimation devices to gather the reference data set for the watch. They went to a huge amount of detail, but a lot of products don’t do that. And then the ones that are on the medical side are almost all about treating patients. So there’s a gap in the middle. I think the main focus is going to be not on the technology but the problem you’re trying to solve and how you make using the product a joyful experience.
If you can do those two things, I think you’ve solved 90 percent of the picture.
Bula: There are some very sophisticated tests in the research stage that, potentially, can be dropped into a product such as ours. But the question is actually, why would you do that? For the sake of just putting it on the market so that people can use it twice a year? This is not really a good thing. So, I think we should be careful.
“Words are like emotional real estate. When you choose words, you're occupying some emotional territory that people either do or don't care about."
We simplified our technology to broaden the number of bio- markers that we can measure to give you direct information on what’s happening to your body. That can give you better insight into what you can do to change your behavior and achieve your goals. I think this is the most important thing for a product like that to go to the mass market. The technology is secondary.
How will your Healthcare x Digital wins help you?
Maggs: We are somewhere between the traditional medical biotech world and the consumer world, so it matters for us to have valida- tion and recognition from the medical industry, because we care very deeply about quality. I think there are more consumers now who are more cynical about hardware devices, because many didn’t live up to expectations or weren’t accurate.
It’s also important to us because we would like this product, one day, to be used by patients as well. We have a roadmap that this will eventually be in the hands of people with diabetes, chronic kidney disease, hypertension, and so on.
These things are not essential for launching our first products in the consumer market, but they put us on the radar and also help doctors understand that we are legit, and they can take us seriously, even though, initially, we’re actually not going into their space. So, we very much appreciate this. And also, we are a US company, we’re European founders, and we’re in Japan. I think it’s smart for us to try and build connections that touch these different points.
Any advice for those entering this year’s Healthcare x Digital competition?
Maggs: It’s important to look at who’s sponsoring and what their goals are. In our case, we had three very well-known pharma sponsors: AstraZeneca, Bayer, and Eli Lilly. When considering your pitch, sponsors are looking for some kind of credible basis, some proof of progress or form of validation. It doesn’t have to be fully peer reviewed.
They also want to see something that ties into their business interests, so reading up on press releases, seeing what they’re doing on things such as digital healthcare, and how they’re working with startups can provide helpful clues about how to present your pitch. It can also be helpful to get some soft feedback before you apply—not asking someone if the tech is good or not, but if they have any suggestions about what angle is good for this presentation and so on.
Any last words for startups?
Maggs: We want to encourage more people to try and run global startups from Japan. Not necessarily to be like us, but I think this hybrid model we have of a US company with a Japanese subsidiary works really, really well.
We also have a relationship with the Japan External Trade Organization. They’re fantastic. We consider ourselves to be a Japanese startup, but we’re also a global startup. And we’re Euro- peans. And an American company. We all have these different faces, and we can use those faces in the right way, depending on what we’re trying to achieve.
Bula: It’s nice to come back to the roots of the startup. You should start your own way and not care about what other people are say- ing. Do your stuff and do it the way you feel you should, because the disruption won’t come from textbook startups doing things how a venture capitalist asks them to, because that is how they’ve done it a couple of times before. That’s not future proof. I would say to find your own way and just do it.
About Healthcare x Digital
A program of the American Chamber of Commerce in Japan (ACCJ), Healthcare x Digital is designed to give innovators the opportunity to pitch ideas to top executives from some of the world’s leading healthcare and pharmaceutical companies.
It is led by the ACCJ-Kansai chapter and four committees:
Healthcare
Information, Communications and Technology
Alternative Investment
Secure Digital Infrastructure.
To solve Japan’s most critical community healthcare and individual patient challenges, we believe the private and public sector should join forces. We seek to foster partnerships that lead to the creation of eco-systems, by bringing together private innovators, private sponsors, and public sponsors.
Join us to discover Japan’s most innovative healthcare ideas and develop partnerships to make them a reality.
Participation and sponsorship details: accj.or.jp/hxd
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THE JOURNAL
Vol. 58 Issue 2
A flagship publication of The American Chamber of Commerce in Japan (ACCJ), The ACCJ Journal is a business magazine with a 58-year history.
Christopher Bryan Jones, Publisher & Editor
