
Patient & Consumer, Internationale Perspektive
Prävention mit Wearables: Éric Carreel, Gründer von Withings, über Urinanalyse und Remote Patient Monitoring
Eric Carreel ist Gründer und Präsident von Withings und mitgründete zuvor ein Telekommunikationsunternehmen für Gateways, das von Thomson übernommen wurde. In Folge 135 von Visionäre der Gesundheit fragt Inga Bergen, Expertin für KI und Digital Health und eine der führenden Stimmen für die Zukunft des Gesundheitswesens, wie vernetzte Geräte Menschen helfen, ihre Gesundheit selbst in die Hand zu nehmen und ihr Verhalten über Jahre zu ändern. Carreel erklärt, warum Alltagsdaten über lange Zeiträume mehr aussagen als seltene Checkups, warum der U-Scan als Urintest im Toilettenbecken ab Juni 2024 zunächst Ernährung und später etwa Nierenleiden überwachen soll, und warum Withings neue Erstattungsmodelle zuerst in den USA erprobt, während Europa den Rahmen erst schafft. Das Gespräch verbindet Produktdesign, den Umgang mit Messangst und Gesundheitspolitik.
Warum das Thema wichtig ist
Wir sagen, dass in diesem sehr langen Film in niedriger Auflösung mehr Informationen über deine Gesundheit stecken als in einem sehr seltenen hochauflösenden Bild.
Chronische Erkrankungen wie Diabetes, Adipositas und Herz-Kreislauf-Leiden nehmen zu, während Ärztinnen und Ärzte pro Patient nur wenige Minuten im Halbjahr zur Verfügung haben und Prävention im Alltag kaum stattfindet. Das Gespräch zwischen Inga Bergen und Eric Carreel stellt die Frage, ob kontinuierlich erhobene Daten aus dem Alltag dieses Defizit ausgleichen können, wer die Betreuung am Ende bezahlt und warum Remote Patient Monitoring in den USA bereits vergütet wird, während in Deutschland und Frankreich Erstattungswege noch aufgebaut werden. Relevant ist die Folge für Ärztinnen und Ärzte, Kostenträger, Regulierer, HealthTech-Gründerinnen und Gründer sowie Produktverantwortliche, die ein Digital-Health-Angebot entwickeln, das Menschen nicht nach wenigen Wochen wieder ablegen. Offen bleibt, wie sich langfristige Verhaltensänderung fördern lässt, ohne bei einem Teil der Nutzenden Messangst auszulösen, und genau diese Spannung ordnet Inga Bergen, Expertin für KI und Digital Health und eine der führenden Stimmen für die Zukunft des Gesundheitswesens, in der Folge ein.
key take aways
Zentrale Erkenntnisse
Withings wurde 2008 gegründet, später an Nokia verkauft und anschließend zurückgekauft.
Fünf Jahre nach dem Kauf steigen über 70 Prozent der Nutzer weiterhin dreimal pro Woche auf die Waage.
Der U-Scan misst pH-Wert, spezifisches Gewicht, Vitamin C und Ketone im Urin.
Der Marktstart des U-Scan ist für Juni 2024 angekündigt.
Remote Patient Monitoring ist in den USA für Ärzte erstattungsfähig, und Withings erzielt dort rund 40 Prozent seines Umsatzes.
Die Gastgeberin
Inga Bergen
Expertin für Digital Health & AI I Moderator | Founder | Angel Investor
"Visionäre der Gesundheit " Gründerin Inga Bergen ist eine der promintesten Stimmen für eine menschzentrierte Digitalisierung des Gesundheitswesens. Seit 15+ Jahren an der Schnittstelle von Technologie, Medizin und Gesellschaft. Im erfolgreichen Podcast und Newsletter "Visionäre der Gesundheit" ordnet Inga die digitale und KI-Transformation des Gesundheitswesens ein.
Der Podcast
Visionäre der Gesundheit
VdR - einer der meistgehörten Health-Podcasts in Deutschland mit über 1 Mio. Streams. Wir sprechen mit Ärzt:innen, Unternehmer:innen, Forscher:innen und Entscheider:innen über Innovationen, digitale Transformation, interkulturelle Medizin und die Zukunft der Versorgung. In über 170 Folgen, beleuchtet Inga Bergen mit ihren Gästen, Perspektiven, die Mut machen – und zeigt, wie Wandel im Gesundheitswesen wirklich gelingt.
Episoden BESCHREIBUNG
Smarte Gesundheitsgeräte und Prävention im Alltag: Withings-Gründer Éric Carreel im Gespräch
Inga Bergen, Expertin für KI und digitale Gesundheit und eine der führenden Stimmen für die Zukunft des Gesundheitswesens, spricht in ihrem Podcast "Visionäre der Gesundheit" mit Éric Carreel, dem Gründer von Withings. Sie hat ihn eingeladen, weil sie seit 2009 selbst Geräte der Marke nutzt und den neuen Urintest bereits vorbestellt hat. Carreel bringt eine seltene Perspektive mit: Er ist Ingenieur und Serienunternehmer, kennt Jahre an Langzeitdaten aus dem Alltag von Millionen Menschen und erlebt den Unterschied zwischen dem US-amerikanischen und dem europäischen Gesundheitsmarkt aus erster Hand. Außerdem engagiert er sich in der französischen Venture-Capital-Szene.
Wie kam Éric Carreel zum Thema Gesundheit und welche Vision verfolgt Withings?
Die Gesundheitsvision von Withings entstand erst nach und nach, denn am Anfang stand der Wunsch, vernetzte Geräte besonders einfach und schön zu machen. Carreel hatte zuvor ein Telekommunikationsunternehmen mitgegründet, das Router herstellte und später an Thomson verkauft wurde. Als er das erste iPhone sah, erkannte er, dass es klüger ist, in die Tiefe zu gehen, statt das gesamte Zuhause vernetzen zu wollen. Die Körperwaage war dann ein eher zufälliger Startpunkt.
Erst im Lauf der Jahre wurde ihm klar, wie wenig Zeit Ärztinnen und Ärzte für ihre Patienten haben. Angesichts der stark steigenden chronischen Erkrankungen will Withings Menschen im Alltag motivieren und sie zum richtigen Zeitpunkt mit dem passenden Arzt in Kontakt bringen.
Warum benutzen Menschen Withings-Geräte oft über viele Jahre?
Die Geräte bleiben im Einsatz, weil sie einfach zu bedienen sind, gut aussehen und lange mit einer Akkuladung auskommen. Carreel berichtet, dass auch fünf Jahre nach dem Kauf noch über 70 Prozent der Waagen-Nutzer mehrmals pro Woche auf die Waage steigen. Bei anderer Elektronik sei das völlig unüblich.
Aus diesen Daten entsteht etwas Neues: Zum ersten Mal gibt es über viele Jahre hinweg häufige Messungen im Alltag. Nach Carreels Einschätzung steckt in dieser Dauerbeobachtung mehr Aussagekraft als in der seltenen, dafür sehr genauen Momentaufnahme im Labor. Aus den Daten sollen Scores entstehen, die zeigen, ob jemand in eine gute oder schlechte Richtung läuft. Withings will dabei diskret im Hintergrund bleiben und bei Bedarf einen Arztbesuch anstoßen.
Was kann eine smarte Waage heute über die Gesundheit verraten?
Moderne Waagen liefern weit mehr als das Gewicht, nämlich Hinweise auf Gefäß- und Nervengesundheit sowie auf das Herz. Carreel nennt die Steifigkeit der Arterien, einen Nerven-Gesundheitswert, der das Risiko für diabetische Fußgeschwüre anzeigen soll, und eine EKG-Funktion zur Erkennung von Vorhofflimmern.
In Vorbereitung ist zudem eine Impedanzmessung mit mehreren Frequenzen. Sie soll Verschiebungen des Wasseranteils im Körper erkennen, die auf eine drohende Dekompensation des Herz-Kreislauf-Systems hindeuten. All das passiert durch das gewohnte Aufsteigen am Morgen, ohne dass Nutzer zusätzlichen Aufwand haben.
Wie funktioniert der Urintest U-Scan und was misst er?
Der U-Scan ist ein rundes Gerät, das in der Toilette befestigt wird und bei der Benutzung automatisch eine Urinprobe nimmt. Im Inneren steckt eine Kartusche mit mehreren Tests. Die erste Variante namens NutriBalance misst den pH-Wert, die Dichte des Urins als Hinweis auf die Flüssigkeitszufuhr, Vitamin C und Ketone. Damit lässt sich einschätzen, ob die Ernährung zur eigenen Aktivität passt.
Das Gerät entscheidet selbst, wann getestet wird, und erkennt, welches Familienmitglied gerade die Probe abgibt. Eine Kartusche hält etwa drei Monate, nach spätestens sechs Monaten wird sie gewechselt und das Gerät neu geladen. Später sollen spezielle Kartuschen etwa für Nierenerkrankungen oder für Frauen mit Kinderwunsch folgen. Dafür sind allerdings Zulassungen durch die FDA und europäische Stellen nötig. Der Marktstart des U-Scan ist für Juni 2024 geplant.
Können ständige Gesundheitsmessungen Ängste auslösen?
Ja, bei einer Minderheit kann das passieren, räumt Carreel offen ein. Inga Bergen erzählt von einem Verwandten, der seinen Blutdruck zwanghaft immer wieder maß. Carreel betont, dass die meisten Menschen sich eher zu wenig um ihre Gesundheit kümmern. Für die Betroffenen sei bislang aber noch keine wirklich empathische Anwendung gebaut worden.
Große Sprachmodelle sieht er als Chance. Sie könnten personalisierte Inhalte zum richtigen Zeitpunkt liefern und etwa darauf hinweisen, dass zwei Messungen pro Woche genügen. Withings arbeitet daran, räumt aber ein, dass noch viel Arbeit vor dem Unternehmen liegt.
Worin unterscheiden sich der US-Markt und Europa bei digitalen Gesundheitslösungen?
Beide Märkte funktionieren nach völlig anderen Prinzipien, und das prägt die Strategie von Withings. In den USA zahlen viele Menschen selbst, die Versicherung hängt oft am Arbeitgeber, und die Zahl chronisch Kranker wächst rasant. Das Unternehmen erzielt dort rund 40 Prozent seines Umsatzes. Für die Fernüberwachung von Patienten gibt es Erstattungen, weshalb Withings eine entsprechende Plattform für Arztpraxen entwickelt hat. Sie filtert die Daten und meldet nur Auffälligkeiten. Viele überlastete Ärzte scheuen jedoch den Mehraufwand.
In Europa gilt der Zugang zum Markt als langsamer, weil viele Hürden den Marktzugang erschweren. Dennoch bewegt sich einiges: In Frankreich wurde die Fernüberwachung gesetzlich verankert, in Deutschland gibt es die digitalen Gesundheitsanwendungen auf Rezept. Carreel hält Prävention inzwischen politisch für einen Konsens, auch dank der Erfahrungen aus der Corona-Zeit.
Wie will Withings vom Gerätehersteller zum Dienstleister werden?
Das Unternehmen setzt auf zwei Wege gleichzeitig. Kurzfristig verkauft es an Selbstzahler, um schnell zu lernen, und parallel baut es die langwierigen Erstattungsprozesse in den einzelnen Ländern auf. Langfristig soll aus dem Geschäft mit Geräten ein Dienstleistungsmodell mit wiederkehrenden Einnahmen werden. Carreel sieht darin deutlich mehr Stabilität.
Dabei will Withings bewusst nicht alles allein abdecken. Für einzelne Erkrankungen wie Herzleiden, Diabetes oder Schlafapnoe sind spezialisierte Partner nötig. Withings liefert die Messwerte und Scores, auf die diese Anbieter aufbauen. Im Idealfall verbindet die App Nutzer mit Ärzten, sobald Anzeichen etwa für Prädiabetes auftreten.
Was können andere Akteure im Gesundheitswesen von Withings über Nutzerzentrierung lernen?
Die wichtigste Lehre lautet, dass Geräte im Alltag Freude machen müssen, weil Menschen zu Hause keine Anweisungen befolgen wie im Krankenhaus. Carreel erklärt, dass Withings Produkte immer wieder komplett überarbeitet, wenn sie noch schöner oder einfacher werden können. Die Ingenieurskultur des Unternehmens stellt das Vergnügen bei der Nutzung in den Mittelpunkt.
Ein Beispiel ist die analoge Hybriduhr mit 30 Tagen Akkulaufzeit. Weil sie nicht jeden Tag geladen werden muss, tragen viele Nutzer sie auch nachts. So entstehen Schlaf- und Herzfrequenzdaten, die Smartwatch-Anbieter mit kurzer Laufzeit nicht erhalten. Inga Bergen bestätigt, dass genau das auch für sie den Ausschlag gegeben hat.
Im Gespräch mit
TRANSKRIPT
00:14
Inga Bergen
Éric Caril ist französischer Unternehmer, Erfinder und der Gründer von Withings, den smarten Gesundheitsgeräten, die du vielleicht aus dem Badezimmer kennst. In dieser Folge erzählt er, wie wir mit digitalen Helfern unsere Gesundheit selbst in die Hand nehmen können, warum Urinanalysen bald zum Alltag gehören könnten und wieso Europa und die USA beim Thema Gesundheit oft zwei Welten sind. Und kleiner Spoiler: Die heutige Folge ist auf Englisch. Super excited about my guest. It's Eric, the founder of Withings, serial entrepreneur, and now also really active in the French venture capital scene. I'm really excited you are my guest today. Hello, Eric.
01:03
Eric Carreel
Hello, Inga. Nice to meet you.
01:05
Inga Bergen
Nice to meet you. You have an entrepreneurial journey that is quite successful. You have founded Withings in 2008 and then sold it to Nokia and then bought it back and founded several other companies. But I have to say, I have been using Withings products since 2009. So it was my first digital scale and I'm actually a big fan and I've also pre-ordered your urine test kit. So let's jump into the conversation. And Eric, what was your vision and what was driving you into health and healthcare kind of?
01:44
Eric Carreel
So what is driving me and driving the company today is that we discover along the way that this healthcare system that we didn't know at all at the beginning. Was suffering a lot and that a lot of patients were not followed by their doctors except 10 minutes per 6 months. So it was very strange to discover that in 2020-something, people cannot be accompanied more than just by 6 minutes with their doctor every 6 months. So today our vision is really to say, okay, with the explosion of the chronic disease, it's very important that patients can be motivated along the way and can be put in touch, in contact with the right doctor at the right time. So it's really our vision today, but I have to say that this vision was not there the first day. It came, as I said, along the way. When we founded Withings 15 years ago, the idea was more to do connected device because previously I co-founded a company which has done telecom products, gateway, wireless gateway. A little bit like the Fritzbox that you have in Germany. It was our competitor at that time. And this company has been acquired by Thomson. And then we saw that the telco were dreaming that all what is in our home will be managed by them, our printer, our fridge, our music, and so on. And we have tried it and it was not working. And we understood why it was not working when we have seen Steve Jobs launching the iPhone. Where we understood that thanks to this new type of device and the API, so all this interface which makes that you can connect different things very easily together, what is important is to go deeper and not larger. And so we decided to do some connected device and really to put all our effort to make this device easy to use, beautiful, that people love to use. And I don't know exactly why, but by chance we started by a body scale and we were looking at different things and we thought that body scale could be a good start, quite easy to do. And, and then we will see. And by chance we did this body scale, but we discovered that it was much more difficult than we planned at the beginning. And we made a lot of mistakes. For example, we, we underestimated that For a lot of people, knowing that their weight could be on internet is create quite a lot of anxiety. But it was our communication which was not good at that time. But thanks to people in California and people in US, we, a lot of users came and say, okay, this is fantastic to have my, to be able to follow my weight along the time. And after step, we We have acquired a lot of users and what is very important more than the number of users that we acquired is that these users are using their device, not only 1 year, 2 years, 3 years, but a lot of years and are using continuously. For example, 5 years after acquisition of our device, we still have more than 70% of our users who are stepping on the scale 3 times a week. Which is an incredible number. You know, in all the electronic device, after 5 years, you have a very small number of people using the device. And so this is creating a new era in, in healthcare, because for the first time, I think, in the life of humanity, we have longitudinal measurements during a lot of years and with high frequency. And so we can we can learn from that. The image that I'm always trying to use to explain that, you know, when you are going in a hospital or in a lab to make a very deep checkup, it's like a high-definition picture. What we do is more like a low-definition movie. You know, I don't know how you say that in German, the Super 8 old movie. But which are very long. And what we say is that there are more information about your health in this, um, very long low-definition movie than in a very rare high-definition picture. And, and so the next steps that we are building now is really to, from the daily life of the patient, to build new type of scores to say, okay, you are going in the right direction or you are going in the bad direction. We can help you by motivation inside the app to go in the right direction for your health. And second point is, okay, now the level of the score is so low that we will organize a visit to a doctor. So we don't want to create CT. So it's somewhere we want to be a discreet guardian angel to really help the patient not to create more anxiety, but to be followed at the right time and to avoid a lot of hospitalization.
06:57
Inga Bergen
So where you're coming from is basically gathering all this data. Now you see that you have, you basically drag your customers into the Withings system. So once people start using the scale, for example, then they connect it with other devices that you offer, blood pressure measurement, for example, or activity trackers. And all this data you generate is very helpful very helpful in understanding a long-term really health profile of a person. And then the next step, as I understood, is really, yeah, then offering very personalized, yeah, tips on how to behave. And when, for example, a lifestyle or a behavior leads into a direction that can probably lead to a disease, which is usually, I mean, it builds up. And then by the age of over like 35 or 40, people start getting like heart problems or cardiovascular diseases or diabetes. And you say that with all the data you have, you can use this data and pretty much understand who is in risk and who is not.
08:09
Eric Carreel
Exactly.
08:09
Inga Bergen
And do I understand it right that at some point my Withings device will tell me now you should see a doctor, you should get an appointment?
08:19
Eric Carreel
Yes, it's really what you, it's really what, what we want to build to be very transparent. It's not yet done in large, at large scale. We have started that in US. You probably know that in USA there are some reimbursements for doctors who are following their patients who are suffering from a clinical disease. It's called the remote patient monitoring. And so we, we are in this. We have developed a Withings remote patient monitoring platform. So we, doctors through his EHR can onboard a new patient, and then he will receive all the data. We will classify the data, we'll only create alerts when, when needed, and we'll not serve the doctors with all the data but only with the alert. And so then we count the time the doctor is spending for his patient to be sure that he, he can be reimbursed for that. So all this is starting in US. The difficulty that we see today in US is that, like everywhere, the doctors have too much work to do, so they do not want to do more. And for, for a lot of them, it's a difficulty to have really to take care of the patient when, when he is in his daily life. They consider that, okay, they are ready to, to concentrate them on the patient when he's in front of them, but okay, I have to follow the patient all the day, it's too much for a lot of them. So we have to invent a new healthcare system, and which is difficult. You know, I was talking with health manager of a very large company in California, and they say there are three types of actors. There are the patients, there are the doctors or the healthcare system, and there are the insurers. Patients are moving quite quickly. Some patients, there are still a lot of patients who wait to be very ill before going to see somebody. The doctors are overloaded, so don't want to do more. But insurers are also starting to move because they have no other way. The system will collapse if we do not invent a new way to take care of patients in their daily life. And really, as you mentioned, the key point is how we change behaviors. You know, with all the Netflix series, the fact people are eating pizza all the day and so on, we have this diabetes, chronic disease, we have this obesity, we have this cardiovascular risk, which are exploding and there is no other way to help the system to not collapse is, uh, than to, to change behaviors.
11:03
Inga Bergen
Yes, I, I really find this super interesting, this one sentence you just said. You said you have to change the healthcare system. And with what you are describing, I mean, Withings is actually, actually with its connected devices, uh, I would say the first generation of really measuring behavior and measuring the health status with very easy-to-measure data points like weight, blood pressure, but also activity levels, maybe sleep, all these data points that we gather. But now we see a second generation of entrepreneurs, for example, the founder of Spotify or Forward Healthcare in the US, that are moving really towards prevention and regular checkups that gather also different data points because they will be all these measurements, these checkups will take place in a doctor's office. So it's a little bit different, but you are very much closer to the customer. And what I really like, I mean, you're an engineer, but you had this vision of making it like super user-friendly and also beautiful. To use. So the design part is actually very— yeah, it's very important because it's not just like a medical device, it is, it is really like a lifestyle element. So, so you see, I mean, all these other business models now emerging. How do you collaborate with such new concepts? Because I mean, this could— should go together. It would be really powerful, right?
12:44
Eric Carreel
Yes, I think you touch the most important point, is that when you go towards the patient or the user— because at the beginning it's a user and it becomes a patient somewhere— what is important is that you do not ask him too much and that he has pleasure to use and to create measurements. Because you know better than me that I've been hundred thousand of applications was, was start to help each of us to eat better, to work more, to sleep better, and so on. But you know, in this last year, I received a lot of companies to, to, to buy because there were some economic difficulties, as all we know. And what is very important is to see that a lot of these applications are used only one week sometimes 1 month, in very good conditions, 3 months, which is not really helping anybody because we know that if you want to change behaviors, you need at least 3 years. And I think these 3 years is also something which is quite new to say. You know, we have seen some company, for example, like Live&Go that you probably know in US, who have been bought for a very large amount. They have pushed a model which is not sustainable. What I mean by that, in reality, they have helped people to lose some weight during 6 months. And we know that if you help somebody to lose weight during 6 months, after he will take weight and will be at a higher weight than he was at the beginning. Yes. And so what is important is really to follow him and to help him to change behaviors. And to do that, you need to get measurements from his daily life. You need to be able to push him some things also during the time where he's not ready to listen, he's not ready to take attention to his health. Because we are people, we are not machine. And so what is the difference between a machine and a people? A machine can go from the point A to B linearly, but a human people will fall, will restart. And from this different experience, we can become better and we can take more attention to our health. And what is very important is that you do not lose the contact with the patient during the period where he's failing because he has other problems in his life. He doesn't want to hear anything about health. And thanks to our device, which are used very periodically and with high frequency, we get that up. And so you can go back in touch with the user at the right time in his life. And this is very, very, very important Otherwise, it's too complex and all the applications are not used after some months.
15:33
Inga Bergen
I think it's also probably an advantage to have really a physical device that is— because I find this super interesting. Still, people are buying books because they want a different experience than sitting in front of a screen. And I mean, an application that you use on your mobile phone, it pretty much vanishes within a couple of months, like, you know, in this mass of applications that people use. But if you have a physical device like a scale or a watch, it's, it's an easy reminder to, to use it, actually. Do you think that's an advantage?
16:12
Eric Carreel
Yeah. Yes, I think the scale is a good example because stepping on the scale is important because a lot of people are doing that quite easily because they want to see their weight. And what is important is now just by this simple gesture, we are getting much more data. For example, we are getting the arterial stiffness, we are getting now the Nerve Health Score to see if you are going to suffer from neuropathy and that you are at risk for diabetic foot ulcer. We are even, we have a scale where you can make a measurement of ECG to detect atrial fibrillation. And we have also a new large frequency impedance measurements that we are preparing to use for a new type of detection of events in your life, which is called decomposition. So if the intracellular extracellular percentage of water is moving very fast, it's probably that you are preparing something which is bad for your cardiovascular system. And so it can be detected just by stepping on the scale. So by this simple gesture, but it has to be on a device, as you say, which is beautiful, easy to use, with long battery life. So there are a lot of things to do. You are creating pleasure for the patient, and so he's using it. So this simplicity, this long battery life, this design, all these elements are important to get this data for a lot of years. And again, this number of years is so important to be sure that we, we keep the contact with the patient not only during 6 months, but during years.
17:55
Inga Bergen
Yeah, I think it's super interesting because now you are also stepping into other biomarkers that you want to measure that involve body fluids such as urine with the U-Scan. And I have seen it, I think, was it last year at CES? You, you launched it, or basically, are you looking for it? Do you have one on your table?
18:20
Eric Carreel
I would like to show you, but I don't know where I put it.
18:24
Inga Bergen
Uh, yes, I can tell. I pre-ordered it already. I'm waiting for it. So how I understood, it's pretty much a device that you hang into your toilet and then it automatically measures your urine. Ah yes, now I see it. It's a very beautiful device. It's like a round Yeah.
18:42
Eric Carreel
So yes, it's something that you stick to your toe legs like this. Uh, and then you're, you're just urinating on it and it kept, it will take a sample and inside it you have a cartridge, a lot of tests. And you, for example, I don't know if you see. Yes. Yes. It's the right sense. So you, you, you see, this is a specific cartridge that we named NutriBalance. Which will do 4 different tests. But then we can adapt this cartridge to each disease to do the right test for the right patients. And as it is connected, we know, for example, that this test, we have to do it 1 time a week or 1 time a month. And so you have a cartridge which can be used during 3 months, and then every 6 months you have to change the cartridge and recharge the device. But you have not to think to anything, so no over— I don't know how to say that in English. No, you have not to overload the, the, the people, the anxiety of the people with things to do because it's just put that in your toilet and it's just taking the decision for you when you have, he has to take a urine sample.
19:53
Inga Bergen
Yes. So let's first talk about all the measures that it takes and what it, what it can do for you. And then I would like to talk about anxiety, because you mentioned this word already twice. And I would like to dive into that a little bit because these constant measurements can also do something with our psychology, really. But before that, it's a NutriScan. So, so by the first version of the uScan, that's the name, and that will be launched next year, I suppose, will be nutrition and personalized recommendations for better nutrition. So that's basically it for the beginning.
20:32
Eric Carreel
Yes. So the 4 measurements that we will do are pH, specific gravity, so the quantity of water— are you drinking water enough or not— vitamin C, and ketones, which are measurements which are very important to follow if what you are eating is, is good for, for the type of activity you have.
20:50
Inga Bergen
And from that you can basically understand if somebody is living a healthy lifestyle Yes or no, more or less.
20:59
Eric Carreel
Yes. So this is more, I would say, a wellness first test. And then we are preparing in the lab, but you know, it's more complex to launch because we have a lot of clearance to do to FDA and to say medical notified body. We will launch other tests which are more specific to different type of disease. For example, to help people suffering from kidney disease, we are preparing a lot of things. As that. We are also preparing some specific cartridge for women who want to get a baby and to help them to detect the right time of the, not sure to say that in English, but the ovulation.
21:40
Inga Bergen
The menstruation cycle. Yes. Okay.
21:44
Eric Carreel
Super interesting. And to, yes. So the beauty of the system is that from this reader and from the fact that we are able to recognize among the family who is going to urine, so just test take the test on the right person, we will be able to offer a lot of variety of tests. So at the end, we consider that it is a more invasive device than a scale. And so it will be more for people who are really rating something very precisely, either because they are suffering from specific disease or because they are doing a lot of sport and they want to follow how is their body or because for a specific case, like a woman who want to.
22:29
Inga Bergen
It is non-invasive really. And I tested all these devices, these home test kits, and I never really managed to get blood out of my finger. I cannot, I can simply not, you know, stick a needle into my finger. It's really a huge problem for me. So I sit there like for half an hour and in the end my husband tries to test because he is able to do it. So I think that's really probably a core. Yeah, it's, it's really the core thing of your success is, is really having this empathy for how people want to use things and what are they capable of. And you measured anxiety also a couple of times because I feel I have a relative who got into a psychological problem because of his blood pressure. Measurement tool that he then at the end used like 50 to 100 times in a day. And the one side is that if you measure something, you can understand your health much better. You can do kind of adjustments in your daily lifestyle. But also people get stressed out probably a little bit when they step on a scale in the morning, you know, when they see, you know, my data is not so good. It's not really going into the right direction. And how do you see a role of, of a company like Withings in, in that situation? I mean, what, what do you do in order to really help people to use it in a good way, actually, and not in like in a bad way that gives them anxiety? So it's a very philosophical question.
24:16
Eric Carreel
Yes, I think it's a very interesting question, and that, that we, we And the question which come quite, quite often, what I want to say at first is that, okay, there are some person who are developing this type of anxiety and we come back on that, but there are a majority of person who are just not taking care of anything for their health. And I have to say that today we think this mainly addressing people who have some money, who have some conscious of their health and so on, but we know that there are a majority of people that we are not addressing today and that we will not address directly in B2C as we were doing because these people are not investing money for their health. So it has to be taken in charge by the insurer. It's true in a company, in a country like Germany and France, but probably it's also true in US where the clinical diseases are exploding. So we have really to also to think to these people, how we help them, because these people are never seeing a doctor until they are really ill. So we have to see how we can get some data and again be being able to alert them and to ask them to see a doctor at the right time and not when it is too late. So We have not to forget that when we are speaking about this subject. But to come back to your question on anxiety, which is a real problem for a minority of person, that is, you are right, we have to invent something and to help them with some content through the application really to treat this over-anxiety. And I have to say that It's not built today. I think nobody today has built the right application, the right empathy, as you were saying, to talk to the patient to say, okay, you have taken your blood pressure 2 times this week, it is enough, we'll see that next week, take the time to go to work and so on. And, you know, we are working on that and I recognize that we still have a lot, a lot to do to be really good. But there is a new thing which is really helping us today is that the LLM, so this new large language model, quite fantastic to develop personalized content. And we are really working on that today, how thanks to these new tools and thanks to all the data we have, we can push the right content at the right time to the right person. We are not the only one to do that. All the companies working on these fields are preparing that, but I think it will really change the way we we can motivate and accompany the, the person. We need this data, but we also need to, to talk to the patient and, and to be, to develop this empathy, which is so much important. And you know, you have probably seen that on ChatGPT-4, for example, what have made his success is also his capability to be empathic with, with the user. And so it is very important.
27:34
Inga Bergen
Yes. And it's so interesting because if you can engage people in a conversation that feels natural, and that now is by written text, but it can also be done by voice, by voice recognition. And then, I mean, you already have the devices that could possibly talk even to the, to the user at some point. And, and we know now that people actually, they feel very comfortable in conversation with AI. I mean, they pretty much quickly adjusted to it, like the large amount of people already using large language models. And it feels very natural to engage in a conversation. So I think that's a super interesting point because it will boost this whole area of health coaching. That you are now in. It's more wellness. What I also find super interesting is that you mentioned a couple of times that you now start in the US with, with new inventions because there it's much easier to get reimbursement for real health products. But I know that you're also very active in the French, yeah, in the French VC scene, really also helping politics to understand what is needed to create an atmosphere where companies can thrive and innovation can thrive. And I have to say, France is pretty good at that. I just checked numbers and direct investments from venture capital in technology are at a peak in France. They're much better than in Germany. And we know also from, from the health sector in Germany, looking at France, this whole apps per prescription model, you know, it has been copied by France, but now I would say the French state is getting or becoming much more innovative and serious about these things. So, so how do you see the markets in Europe compared to the US now, also related to your strategy? Yeah, with your investments and with Withings.
29:43
Eric Carreel
Yes, complex question. At first, as you mentioned, US and Europe are very different paradigms because in US people are paying a lot from their pocket. People are not, a lot of people are not very well followed because it costs so much. That's okay. And then the situation is exploding because, exploding because the clinical diseases are growing so, so, so quickly. So, and the last point is that there is a competition between the, for most of the people. And so, and it's quite complex because in most of the times the insurer is managed by your employer. So when you change employer, you are changing your insurer. So it creates a lot of complexity. Doctors are getting a lot of money for what they do. So the situation is very different. But we have to say that they have to move quickly because they know that their system is not sustainable. And so they are really starting to move and it's probably a field where we can make experimentation more easily than in Europe today because accepting to move quicker. Today we think it's making around 40% of our revenue in US. Then between Germany and France, I think there are good points on both sides. You know, with DIGA in Germany, you are, you are trying good things also. In Europe, the good points of last, of this year has been that we put in the law the remote patient monitoring somewhere. So a company like us who want to follow a specific disease can propose a program to follow a patient at home and be reimbursed for that. It takes a lot of time because it's France and you know, we have quite complex administration, I would say. But I have to say that all the politics are now going in the same direction and are really considering that prevention is key. The fact is that for security reasons, we have invented over the last 50 years a lot of walls before you can put something on the market. Somewhere it's good, but somewhere it's also bad because It's very difficult to push something new on the market. Very difficult because as it is new, you are not able to follow the same rules that it was before because it's something which has never happened. But the good point is that, for example, a good point is probably like for you in Germany, the COVID has helped that because during the COVID period, it was so difficult to follow patients that we have to help them at home. And so everybody has moved in his mind to say, okay, now we have really to put that in priority.
32:28
Inga Bergen
Yes. And I think it's also super interesting if you think of a, like a really, like a new healthcare system. And that's, it's much quicker developing in the US, I would say, with all these models popping up that work with regular checkups and that really want to prevent disease or interrupt the development of a disease as soon as it kind of appears on the surface and is— there is something measurable and, and predictable also. And I find that super interesting if you say the politics are also appreciating everything that allows a more preventive care, then also the— all the healthcare system and the way it's financed and what is paid needs to adjust. So your strategy is basically to look for everything that can be reimbursed or things that can be self-paid that will then be used by, by a small, small amount of people that is super interested in optimizing their healthcare. But that's, that's the strategy, so to look at both possibilities.
33:40
Eric Carreel
Yes. So We know is that if we really want to be helpful for a majority of people, we have to be reimbursed. But we know also that we have to learn and we learn as quick as possible. So what is important is to start by where you can, you can work now, when, where you can learn now. And today it's more on the out-of-pocket market where people are buying the things, are paying the things. And in parallel to develop all this reimbursement process, which takes a lot of time in each country. You know, particularly in France, because in France we have mainly one system, one global system. In Germany, you have a system, and so there is no competition. And as soon as you ask somebody to, as a ministry, to reimburse something, they say, okay, it's for 60 million people. Wow. It costs a lot of money. So they try to change hands. To change that so you can start by a small region to test and so on, but it takes a lot of time. But yes, the strategy is to do both. And even for out of the pocket, really to, in the first step, okay, people are stepping on the scale, probably are in good health, but you know, each of us is becoming older and older every day. We have now a customer for 15 years. I know some of them are at 40, 50, 60, 70. And so, you know, we know that health problems are coming when we are becoming older. And so to these people at the right time, we can say, okay, now you have to be followed by a doctor because you are developing prediabetes or diabetes, for example. And we can help you to do that. We can propose to be in touch directly through our application with a doctor. All these things are in development today.
35:27
Inga Bergen
Yes. So you could earn the full patient journey. That means, I mean, you could think Withings as a platform with telemedicine, with connections to making doctor's appointments. I mean, all these solutions exist. For example, another unicorn, Doctolib from France, who has like, they have 95% of the population are Doctolib users in France. So you could build like a whole ecosystem with different partners also.
35:57
Eric Carreel
Yes. So we, we have, as a, as a company, we have to take care not to, to want to embrace too large, because if we embrace too large, we will not be able to be good. And again, as I said at the beginning of our conversation, we have to be deep more than large. And so really, how we, we go from a model where we, where we were a device seller to a service seller. So we, we have to, to become a service provider with recurrent revenue, which is much more stable than just selling a device and restart for— at the beginning of the year, you have to do your business to sell the number of devices. But it will take time, and we have to really define where we have to go. At the same time, we cannot be good in each disease, so we have to be partners with all more specialized people for, I don't know, for cardiovascular disease, for diabetes foot ulcer, for apnea, for each disease. But we have also to increase the capability of all the tools that we are providing to them with this score, because it's us who know the measurements that we are able to do and to, to, to give the right information to the service, to the healthcare provider.
37:14
Inga Bergen
Yeah, I like that you are very humble when you describe what you do, because in the end And this is really the key to get the people on the platform. Yes. So, to get the— it's really the key to get the people on the platform, to keep them there and to provide some kind of value because otherwise people just test it and then they don't use it anymore and that's not your strategy as I understood. So, maybe at the end of our conversation you can share maybe your 3 best practices or, or principles that you use when designing this offering? It's because I, I feel lots of players in the healthcare system are really struggling to become user-centric because it's not part of the DNA of healthcare, unfortunately. So, so what do you think? What, what can other, other people really learn from your example?
38:18
Eric Carreel
What, what I think is that because we, we were at the origin engineers and not doctors, we, we, we love to make nice device. And by chance, I don't know exactly why, 20 years ago and 25 years ago, I have been touched by, by the way you can build a device with a designer and really to make it beautiful, to make it, uh, pleasure to be used. And I think something, it's always present in the company. And you cannot imagine how many times we rebuild completely a product because we consider it could be more beautiful, it can be more easy to use, the battery life could be better. It is not as natural as a movement, so we have to change something. So it's really something which is really at the beginning of the company. So, and again, we start by this and then we go, we, we, we went into L-space. So our DNA starts by this pleasure to be user-centric and, and really not only to be engineer, but to think to the pleasure. You know, the watch that I have to my wrist is a watch and people in the company have pleasure to do a true watch, not smartwatch, which are just a small smartphone that you have at your wrist. And have the pleasure to be sure that we can have a battery life of 30 days. And what is the result of that? For example, it's very interesting for— I was looking to this number yesterday. We have a majority of our users who are wearing their watch during the night. So we have a lot of information regarding the night of the user that Apple and the others have not, because as you have to recharge it every day, you are not wearing it during the night.
40:09
Inga Bergen
That's why I use Withings, by the way, and not the Apple Watch, because of the battery life. That's the argument.
40:17
Eric Carreel
Yes. And so the, and you know, the night is a fantastic time of measurement because we can follow the heart rate all over the night. We have the average heart rate, which is so important to have any information about your health. And so, you know, it's consequence by consequence. If you start by being user-centric, then you can build something. And it's really where we came from. And so, yes, I think being user-centric, specifically when you are in the daily life of the patient, because when you are in hospital, I have been in hospital some years ago for something. And if a nurse asks you to do a specific procedure, you do it. You are not the master. You are the one who is following what we say to you. When you are at home, we know that we are not ready to make any effort. So it has to be a pleasure. It has to come in your daily life very easily.
41:10
Inga Bergen
Okay, that's great. That's a great summary, actually. And I totally believe in patient centricity, user centricity, really having empathy for this. And sometimes it's really the small things that make the difference. And I'm actually excited. Do you already know the launch date of your urine testing device?
41:34
Eric Carreel
It will be in June next year.
41:37
Inga Bergen
In June next— in June 2024. So I will hopefully be amongst the first to receive it and then test it. Yes. And thank you very, very much for this conversation. It was super interesting. Eric, thanks so much for your time and I wish you a lot of success in the future.
41:54
Eric Carreel
Thank you, Inga. It was a pleasure. It was a pleasure. Thank you, Inga. Have a nice day.





