We'll be right back.
We also talk about the techniques and tactics he's used to optimize his sleep to allow him to perform at the best cognitive ability that he can, as well as other trends that they have seen in underlying health data and things that everyone should try to do to optimize their sleep so that they're better able to perform their job the next day.
We also talk about trends related to artificial intelligence and what the future of AI can do for the healthcare industry.
Finally, we talk about the vision that he has for Aura in the coming years, as well as the opportunity that he sees, with different wearable technologies being brought in, to serve as a personal coach for your health, as people try to take more control of the ultimate outcomes for their health and their lives.
Really fun conversation that you'll hear with Tom now.
Tom, thank you for doing this.
Oh, thank you.
Appreciate it, Logan.
So I wore my Oura ring for you today.
I've been wearing an Oura ring now for...
I don't know, 18 months, maybe.
My gateway drug, if you will into sleep tracking, was some guy around the corner was like hey kid, you want some of this.
And I was like, oh, they eat sleep.
That got me in a little bit.
Yeah.
And then I switched, I added a Garmin to my repertoire.
I like the health tracking and all that.
But I was told that Eight Sleep had the best sorry Eight Sleep, that Aura had the best sleep tracking of it.
And I found that to be the case.
And so now what I do is I wear this normally for sleep or when I'm showing off to podcast guests.
And then I'll have the watch on 100% of the time.
So thank you.
I've enjoyed having it.
The fidelity of information is great.
We appreciate your business.
And, of course, sleep is one of the things that everybody has to do, but no one does particularly well.
Or do they know how they do?
Because they're asleep, right?
For obvious reasons.
So yeah, it is interesting.
You were saying a minute ago that, as you think about sleep, It is this thing that you have to do.
But hey, what is it that makes it so great?
I only need to wear this device when I'm sleeping.
Well, what's interesting about – I looked at this when I first came in and said –
There are a number of people who only wear it during sleep, but that's the minority.
So we looked at it and we said in a 24 hour period, what is the mean wear time?
And the mean wear time is 22 hours and 20 minutes.
Interesting.
What do you think the median is?
Well, the median is 23 hours.
Yeah.
I was going to ask pretty sure.
Yeah.
And and of course, there's probably 10 of people that are me and 7 of people who are, who are like you.
And that was really like a wake up call because we're like, Oh my God, like people are wearing this.
Like they wear, you know, a piece of jewelry that they just don't take off.
And you think about it when you go to bed, depending on who you are, you mostly take things off.
You probably take your watch off, you take your glasses off, take clothes off, change your clothes, but you probably don't take your ring off, your jewelry off.
It stays with you.
And that's really powerful because, of course, humans being what they are the cognitive load that's a big problem for anybody living in our modern world.
And so if you can make it easy painless, low effort, low cognitive, you know not another digital mouth to feed.
It's very powerful.
I, I, for a little while, my wedding ring was a little, uh, undersized when I originally got it.
I got married, uh, 15 months ago or 30 months ago.
Thank you.
Yeah.
And it was a little, uh, maybe it was aspirationally sized.
So to what I was going into the wedding, I don't know.
Uh, But I wore it for a little while as my wedding ring.
My wife didn't like that for whatever reason.
I think she felt like it was sort of subverting the whole concept of a wedding ring.
Married to aura.
Yeah, exactly.
I think that's what it was.
But yeah, I...
I don't know exactly.
I think during the day, just having on one ring rather than two, I guess.
I don't know.
There's some aesthetic thing for me personally.
It's so funny because rings around the world are totally different.
I think in the US, I think you're probably right.
There's sort of a minimalist, no ring aesthetic, all that kind of stuff.
It's very typical, although we see a lot of people with wedding rings that are aura rings.
That's very...
It's sort of the classic male use case.
But you go outside the US and like rings are a thing.
You know what I mean?
And I wasn't paying attention to rings before I joined Aura.
But like you go to India, it's all rings all the time.
Europe, all rings all the time.
It's interesting.
I think we've had an impact where you see chunky big rings on women and men in a way that you have not, I think in my entire lifetime, observed general adoption of them.
So, as I went down this journey of adopting the aura ring and tracking my sleep and all that, it's a fascinating path to go down, because you find out a lot about yourself and just the different behaviors and habits, I guess.
For people that are listening, besides purchasing an Aura Ring.
A lot of people, I think, are very professionally driven.
I'm modestly funny, but I assume they're not listening to this for my...
For my humor, I think they enjoy learning and trying to get better at their job and all of that.
And performance.
Quote unquote.
Even in a knowledge worker, office job is an important thing showing up and being there.
So, outside of purchasing an Oura ring, what are some of the things you've changed in your behavior since you've adopted this, since you become CEO?
You know, the classic things for me are I have improved my sleep and we can talk a lot about that.
And there's lots of evidence to support that that really helps with cognition and long-term health outcomes.
But I really changed the way I just move my body.
I used to go for sort of like the hard workout and push myself.
Now I just try and go for consistency and frequency.
I really changed the way that I consume alcohol and caffeine.
I drank way less caffeine.
I drank almost no alcohol.
And that's universal actually across the aura base.
You see that as like literally the number one behavior change that happens.
It's pretty crazy.
Like I assume some alcohol executives have some dark board with your face on it or something.
Well, they're going to go for Huberman first.
Yeah, that's right.
That's right.
Between you, Atiyah and Huberman, I think.
It's pretty crazy.
I mean, that is the single.
It is the big one.
Thing.
And I know if I've had a couple of drinks on a weekend or something I am.
I don't even want to have it that close to my bed.
I think I lock it in another room because I'm afraid.
What's funny is, of course, like you know, if you've had six tequilas, that tomorrow is going to suck yes right, you know that.
And and the thing is, maybe you could.
You could do that when you were 21, but when you're like 31 or 41 or god you know, forgive you 51 wow, it's such a big difference.
But the thing that's interesting is that you realize, you learn that even a small amount um, you know, depending on who you are, maybe it's half glass of wine actually will mess up your sleep totally.
And that's the big insight.
I mean, and you and you might not otherwise know that maybe you feel a little groggy the next day after a half glass of wine, but what you realize, you see it in your numbers like wow, that actually really affected me.
I had to.
I mean, I think I, I think I knew intuitively that I would be a little cognitively slower the next day, even after a single glass of wine.
Yeah.
But.
But socially we've come to, or at least there was a.
10 years ago people were like oh, one glass of wine, come on.
Like you can, that doesn't affect you.
Well, according to the French, it's actually really good for you.
Yeah, it's healthy.
It's healthy, which we can go into all those medical records and all that stuff.
So caffeine, alcohol.
So caffeine, alcohol, actually the way I eat, I'm wearing a CGM now.
I wore a CGM for most of last year.
I learned a ton about that and we can go deep into that.
The short story is, there were all these things that I thought were really healthy, that had been either marketed or branded as health foods.
That turned out to be really bad.
And they weren't that the foods were bad.
They just happened to be bad for me.
So for example, white rice.
I love Chinese food.
I still love it.
But the thing is, if I eat as much as a couple of spoonfuls of white rice, my blood sugar spikes.
And that's about me.
That's about me not being the same as everybody else on the planet.
And you got that from CGM?
Got that from CGM.
And there's also ways that it interacts with your sleep and your stress, and what you ate before and whether you're moving before or after.
There's all sorts of things.
There's a study that just came out.
Really interesting.
And I think people suspected this was true, but the study verified it.
Basically said same person eats the same meal, different blood sugar outcome, right.
Based on their stress levels, their cortisol levels, what time of day?
All these things that are confounding variables.
So really interesting to see that.
And then the last one I would really highlight.
Maybe this goes to your sort of like, you know, being a CEO, or maybe just being a human being in today's world.
Actually, meditation, mindfulness.
And I'm I will tell you, I'm sort of a cynic about this stuff until I started being in my current job, where I was like well, I really could use something that would take the edge off.
That's not, you know, a Xanax or something like that.
And it turns out that actually a little mindfulness goes a long way, even if it's just breath work.
The thing that convinced me was I was reading up on the practices of the US military, and they teach this to like their special forces operators.
Like.
This is how they fall asleep when they're like whatever in the field deployed in wherever you want to be Afghanistan Iraq, wherever it is.
So it turns out that's a really powerful thing.
And my wife, lover, amazing woman, she says to me, duh.
3000 years of human history would demonstrate that like, some kind of religious practice is really, really powerful for your physiology and those two things your mental state and your you know how you're feeling and your body are all linked.
And I'm like, no, no, no, no, no.
But now actually as I have, like I don't I don't want to call it a big mindfulness practice, but I, you know, I'll do stuff to kind of check in and take a breath, and find myself taking 10 deep breaths, and it makes a difference.
And so maybe to back up a little bit, you came into the business how long ago?
Well, just about three years.
Three years ago.
And maybe you have a short version of what you were doing before and what led you to the company.
Yeah.
Yeah.
Well, it's not a direct path.
So, you know, I didn't start as a doctor or a wellness person or, you know, fitness.
I always did fitness stuff, but I'm mostly a software person.
I grew up at a company called Macromedia and later Adobe.
I did some time at a company called Homeway, which was sold to Expedia and became Verbo for those of you who don't know Homeway.
And then I did some time at a company called SurveyMonkey, which was really about the premise being that you gather data at scale using the web.
And what can you derive?
What insights can you derive from that?
And really interesting.
And all that stuff was a good tee up for SurveyMonkey.
Because?
Sorry for Aura?
Because Aura, in a way, is actually a large scale data collection entity.
I mean, that's one of the things we do is we sit on this huge population data asset.
It's also interestingly people think of it as a hardware company, but it's actually a software company.
And most of the value is in the algorithms and in the personalization of the experience based on your biometrics.
That's what the system is.
That's what the power of it is.
That's what people love about it.
And then the last thing is it's a subscription business.
And I spent most of my life in subscription businesses.
So it was a pretty, you know, easy onboard.
I'd always been a fitness and kind of like exercise nut and, you know, kind of even from a.
High school when I used to race bikes.
You know I'd record every ride and the distance and the pace and the cadence and all the things that were the metrics of it in the early days of cycling computers.
So it made perfect sense to me that this is what you would do.
It's just a lot less work, but was, you know, really, really compelled by sleep.
And so it was a great opportunity to jump in and it's been a little bit of a rocket ship.
And so in you, as you outlined, we're not CPG hardware background and all that.
And so the board initially They weren't as interested in your candidacy for the job.
They were supportive.
Ultimately supportive.
Maybe initially skeptical.
Well, I would say they weren't skeptical.
You know, Aura, I think, had a pretty interesting cult following at the time.
And a lot of, you know, pretty high-powered people, I think, were interested in the role.
I had the distinction of being someone who had lost sleep in the fall just before they started the search, because we'd sold a company and it was in the process of being unsold.
I was having some struggles in my family life.
One of my kids was going through a really tough time and I lost sleep.
And by the way, I am a championship sleeper.
I could fall asleep in a drop of a hat and stay asleep for 12 hours.
And I lost sleep.
And it was really a wake-up call.
And I started researching the product.
And I used the product.
And it changed my life in the space of about six weeks.
It changed my sleep habits completely.
I mean, not literally overnight, but, and the impact of that was so profound.
I was like, I need to be involved in this company.
I need to be.
There's so few products that actually really change your life or change you know society at large, but when you touch one, you know it.
So i, i did.
I wrote them a letter and i said hey, you guys really need to, you guys need to hire me.
They're like well no, we're not looking for you, we're looking for someone else.
And i was like no no no, here's why it's a, it's a software and data play and that's what this is and that's what i do and that's what i just did at serving i And I want to go back to all the health stuff and the learnings you've had on CGM and sleep and all of that.
I guess I'm curious, as you're parachuting in, that is when?
That's 21?
Yeah.
I guess I started April 1st, 2022.
April 1st, 2022.
So the market, probably when you were initially expressing interest or starting to think about it, was a little bit of a different market than I think Dicey would be Dicey.
Yeah, Dicey.
I think the company had come out of a phase of...
You know kind of blitzscaling and was you know spending you know almost 100 million on marketing and losing about that much.
Wasn't even that big.
And you know I looked at it and was a little bit like wow okay, this is really interesting, but we can't be a marketing-led play where the cost of customer acquisition is 120 bucks per.
That's just not going to fly.
So it was in the environment of people stopping to fund these things.
COVID was a huge updraft for a lot of companies.
And as we saw with Peloton, a huge downdraft.
There was an element of that that was certainly concerned about that.
There was the war in Ukraine.
It was a dicey moment.
An interesting time to get involved.
I guess as you looked at the business – I was going to say asset, but that's a little too pejorative in some way.
But if you looked at the business that was were there – were there paths that you saw, or like other companies you look to and you said Hey uh this, if we can do this, here's a, here's a comparable business we can aspire to be like, I'm sure, Apple.
And there's some really visionary ones.
But I'm sort of racking my brain trying to think about Peloton has had its ups and downs and hardware and subscription uh, Fitbit way back when on the wearable side.
I'm curious, did you?
So to answer your question, was there a company that we could model at?
The answer is really no.
That's sort of what I thought.
Which is scary in our world at Yeah.
Times, right?
Or on the flip side, it's like a signal of opportunity.
Exciting.
Because if you can really capture something that is new and unique, then maybe you're going to be a better position.
That's the entrepreneur eponymous versus the investor.
Right, right.
It's exciting.
It's scary.
Well, and I think both are true and probably in equal amounts.
I think the things that when I looked at it – it looked like a hardware company.
And, of course, you know hardware companies lower gross margins.
You know hardware companies not recurring revenue, hardware companies maybe being subject to an upgrade cycle or could be commoditized by, you know, foreign competition, producing something for a fraction of the price because of labor.
You have to deal with this whole supply chain thing which I heard about in my little software world.
Totally.
You never had to deal with like literally not having enough things to sell, because you normally made so many things.
Boats and planes.
Yeah.
Yeah.
So, and that was actually intellectually like super stimulating, but that was so.
That was sort of one piece of it.
The other piece of it was I think the conception of the company at the time was really was fitness.
Oh, it's like a workout thing.
But what was maybe interesting and I can't claim any credit for this, but it is something that really interested me is the founders of the company had always seen sleep and health as like the end game of where they were going.
And I don't just mean health, like more than fitness or – more than something else, a broader surface of value for someone.
They were thinking about, like how do we change the way health is actually practiced and how healthcare works?
Big, big vision.
And that was actually really interesting, because if you came at it and you said well, what's the properties of fitness?
Well, fitness is actually weirdly a churny use case.
People get excited in January.
They stop going to the gym in March.
You know people come and go from fitness because it turns out to maintain a really good fitness regime is kind of hard.
Got to take some discipline or have some time and have some focus and you might get busy or have kids or whatever.
And then maybe, the third thing was, their belief was that sleep was this incredibly powerful foundation.
And the reason why sleep is powerful is because if you sleep well the next day, you know what you're going to feel.
Better.
No matter what.
And then that's like a really powerful kind of behavioral reinforcement.
And the fact that you are going to do it once in every 24-hour period, or if you're not, you know like it's a real problem for you.
But most people are going to do that making an impact on someone's sleep and seeing that change the next day and they feel better.
Like that's actually a really great value proposition.
Actually, I think it's a little bit why, you know, there's so much activity in the space right now.
So they really believe that sleep was this incredibly powerful thing.
It also was a Trojan horse and the Trojan horse is this, When you sleep, your body's at rest.
It's more or less usually in the same place or at least in the same condition.
And therefore, all of the noise of other kinds of inputs into your body are actually removed.
And so therefore, you can make a really clean comparison night over night, about what is normal, and is there some deviation from normal that might be indicative of something going on?
Or let me just tell you a score about, you know, you had a half a glass of tequila.
Let me tell you what's different.
And the thing is, most humans can't perceive those differences very well.
Maybe they're.
If some people are trained or they spend a lot of time thinking about it, they can, but most people don't.
And that's a real revelation is this idea that we can give your body a voice and you just need to listen to it.
Powerful.
And so this idea of sleep as this way to both measure people and this clean, you know, low signal to noise, high signal to noise ratio, control variables like that.
That's actually one of the key insights that the founders had.
And, you know, when I came to it, I think, you know, people were like, oh, it's a fitness thing.
I was like, I don't know.
That's not what we're talking about.
It's really different.
And so to communicate to that, the market turns out that was one of the big challenges we had.
Yeah, ironically for me, I actually don't use it for fitness, because when I'm doing weights and stuff, I don't, like you know, I take rings off when I just because I- You lift heavy.
Yeah, I lift heavy.
Yeah, that's right.
That's right.
Those large barbells just really- Dost thou even hoist, my brethren?
That's right.
That's right.
So we talked about a few of the different things that you have done at a personal level.
And I want to, at some point, jump to the company's journey and what that evolution looked like.
And I'm curious, a lot of the people I talk to are entrepreneurs.
More software people than not, probably.
It's what I invest in.
It's where a lot of value has been created over the last couple of years.
And so talking about brand and all that stuff, I think would be an interesting thread to go down.
But yeah.
So as you started using the product more and more and you pulled out sort of the things that were specific to you versus the commonalities that were true across the board we talked about alcohol.
So you've gone to basically occasional wine, but not anything beyond that.
Um, yeah, pretty much.
I don't, I don't really drink hard alcohol anymore.
And you did prior.
Yeah.
I mean, I I don't think I was like a heavy drinker or anything like that, but but you know I enjoyed it.
And honestly, going back to that fall of, of, uh, uh, I guess it was 2021.
Um, the reality is is that like I was going through a cycle of caffeine in the morning to get wired and get going?
Um and a glass of wine at night to sort of unwind, and that was sort of.
You know, that was a habit and and there had been times in my life where, like it was more than that and um, You know those sort of.
The first advice was like hey, if you want to get high quality sleep and I had lost sleep, so I wanted to.
You know, I did a bunch of really basic things.
I stopped drinking alcohol first and then I didn't feel like I needed the caffeine.
So I walked back my caffeine.
I slept in a cooler room, which turns out weirdly, as you know, because you're a sleep customer, I guess.
Like, you know the temperature actually is really important to the quality of your sleep.
Okay, that's interesting.
Obviously stop staring at Netflix and my phone at 11 pm to sort of take my brain, which is going a million miles an hour.
Like how am I going to get this problem solved, to sort of be able to turn that off a little bit more effectively?
And then thinking about how to stay asleep.
I use magnesium as a supplement to try and stay asleep, because I kept on waking up at 3 am and then not being able to get back to sleep.
And the realization I had in that moment that was amazing was oh my God.
First of all, I've been sleep deprived since I had kids in my 30s.
Because the combination of kids, we have three kids, and a demanding job, guess what?
That's a recipe for sleep deprivation.
And it wasn't like I was going psychotic with sleep deprivation.
I was just mildly sleep deprived which, by the way, like three out of four people in the United States, probably would fit that description.
And so making those changes and then seeing, in a short order, a week, two weeks, like my sleep pattern change and my – how I felt every day changed, my ability to manage the crises that I was currently you know had been handled, my ability to, like you know, think clearly.
It was like walking out of a black and white movie into a 4k technicolor movie.
I was just like, Oh my God, what I've been missing this for 30 years.
Like this is what life is like.
I'd forgotten because when you're 20, that's how you feel all the time.
It was amazing.
So that's really what, what drove it.
And I think changing alcohol is probably the the, the one that is maybe most surprising to people, because most people don't I mean some, a lot of people don't drink and that's an increasing trend.
You look at the demographics like near beer, all the stuff mocktails.
It's definitely a thing, but there's so many other factors of the amount of sugar you consume or the quality of your sleep that go into that as well.
And so so did you go all in on all of these at once, or did you start pulling them out kind of one by one?
As you know, I wasn't very scientific about it.
I was just like, this is a problem.
I need to solve it.
So I'd sort of put all, all the bets on the table and didn't really parse, but they were related.
I mean, coffee and alcohol was clearly related.
Um, you know the um, You know, using the device to kind of numb your brain as you fall asleep, or using the television.
Like, those were clearly related.
And now, I guess, I mean, I know you guys are prideful of the data sovereignty that you have.
But you have enough aggregate data to know that there's probably through lines and commonalities across the board.
I was not unique.
Yes, all of these things.
I think these are consistently.
Do you on the screen side of things?
I mean, did you go as far as using like blue light glasses and some of that stuff?
I did for a while, and the reality is that blue light glasses are kind of good because they kind of make you sleepy if you use them at the right time.
And it's partially because you are cuing your body and your system to say, like, it's time for bed.
And that's the function.
I guess all of these things are great and I guess they're all leading you to a point of why sleep is important.
I think we know a lot of the elements around that.
But maybe why is sleep this canonical thing that we should be pursuing the highest quality we possibly can?
Yeah, I mean we could go pretty deep on this, but the first thing to recognize is that your body works on a circadian rhythm.
And all of these processes that are happening in your body on a 24-hour cycle are really important.
And one of them is the wake and sleep cycle.
Sleep is really important for both physical health because you're rebuilding your body.
It's also really a part of the cognition cycle.
You know, the sort of working theory is that during the day you have all these experiences and you learn all sorts of things.
And then at night, during REM sleep, your brain is both committing things to long-term memory and kind of rewiring the circuitry of your brain to support the tasks that your brain has deemed is the most important thing for you to do.
We see this in studies of like piano players who practice a really hard thing all day and they can't get it at the end and they have a good night's sleep.
And the next day they're like, I can do this really hard, you know, rec mon enough, whatever.
Um, That actually is like the cognitive relationship between sleep and cognition is really profound.
And that's what I experienced.
Right was all of a sudden, I really felt like the world was a brighter place because of my cognition changing.
So sleep is this kind of foundational element for people.
When you pull it apart and you say, well, okay, so –
What happens if you don't sleep?
What are the things?
Well, I think we all know what that looks like, but there was a study, except I wrote the data down, so I don't get it right.
There was a study in the NBA and they divided the players into two cohorts seven-hour sleepers and more than eight-hour sleepers.
So-
When they looked at the two cohorts the ones who had more than eight hours sleep they had 12 more minutes of play, 29 more points per minute, 2 better three-pointer percentage, 9 increase in their free throw percentage.
And then, of course conversely, they had a 37.
The other side, the people who didn't sleep they had a 37 increase in turnovers and a 45 increase in fouls, which anybody who has small kids obviously knows, because when your kids are not slept, they're going to be committing fouls and turnovers all day long in your house.
I mean, yeah, okay, that's super intuitive and like it makes perfect sense.
But the reality is as adults, you actually don't think that way.
You think I have agency.
I can choose when to go to bed and I adjust this and I do all these things.
Your performance is really directly tied to sleep.
Now you take it to the other extreme, which is when you're sleep deprived.
Like they've done, studies of drivers and traffic accidents and then try to sort them between alcohol and sleep.
And in many ways it's confounded because sometimes you'll be sleepy when you're alcohol.
It turns out when you are sleep deprived, like you are worse. and more prone to having an accident and worse accidents than when you're drunk, which is shocking because I think we've all grown up to think like you can't drink and drive because that's the worst thing you do.
Worst thing you do actually is be underslept and drive.
Because when you go out, your body shuts your brain down.
You're not even pretending to control the device.
You're driving a missile and you're not giving any input to the person and you're not giving input to the vehicle.
So those are kind of the acute things the next day.
There's obviously elements of longevity as well.
And I assume there's a lot of data.
There's a ton of data.
So for example, Parkinson's and Alzheimer's heavily correlated to short sleepers.
In fact, people who have short sleeping genes because not everybody's sleep patterns are the same much higher incidence of Parkinson's and Alzheimer's.
There's a lot of evidence that actually heart disease.
One of the things that's a confounding factor that helps people get heart disease is the fact that they don't sleep well.
It's correlated with a lot of other factors as well.
The American Heart Association made sleep just recently, like I think in the last four years, they made sleep one of the eight essential habits for heart health.
And there's lots of reasons for why that is.
But the truth is, is that, yeah, your body needs to recover.
I think athletes have learned and maybe corporate athletes to your kind of like knowledge worker thing they've learned that if you sleep better, you perform better.
We just talked about the NBA.
From other health perspectives, the one that surprised me the most is metabolic.
So type 2 diabetes, that's the diabetes that you get from not eating well, not the one that you're born with, affects a lot of people.
In the United States, there's probably 50 million pre-diabetics.
Turns out, sleep is really a mechanism that controls these two hormones, the same mechanism that GLP-1s use.
And the GLP-1s are like the ozempics and the –
We Gobi's of the world.
If you sleep well, the two hormones that regulate whether you feel satisfied and whether you feel hunger, they're actually released in different amounts.
If you're better slept.
This whole thing of midnight snacking is a thing, because your body, the way we evolved over, you know, whatever 150000 generations of human life, is that If you don't sleep, your body's going to make you eat.
This is why midnight snacking is a thing.
And so if you're not slept, you're going to eat.
And the reality is that that's going to lead to all these sort of cardio metabolic issues down the line.
So if you think about those kind of health states turns out those ones Alzheimer's Parkinson's, heart health, cardiovascular disease, that accounts for, like you know, most of the reasons why people either get sick or die.
Now, it's not cancer, it's not.
You know, I got Ebola or something else, but maybe 60 of the illnesses that are ultimately going to get you are related to your behaviors.
And so the last thing that sleep provides is actually a fair amount of willpower.
It increases your ability to have agency and decision making about the choices that you make.
Should I eat the chocolate shake or should I maybe, you know, forego?
If you have, if you're better slept, you'll make that choice more frequently, more you know the right choice, more frequently over time.
And so I guess, as you came into the business, how big of a fundamental element of the branding was fitness versus sleep.
So I think it was, you know, rough justice, something like 60-40.
And it was 60% sleep and 40% fitness.
And the fitness stuff was largely a function that we were paying very expensive, sort of hospitalization, high visibility, high value athletes to sort of rep aura across a wide range of sports, which was really interesting.
It's fascinating thing to kind of like learn about that, that business.
And.
But ultimately, what we started to realize was that, being pigeonholed as fitness was one not great to the point that, like you know, this is something that you have in your hand while you're working out and, by the way, lots of people wear their aura ring to work out and lift weights.
But you know there's lots of reasons probably not as heavy as it's, not as heavy as you do obviously um, but but.
But the point was more, if you are, you know, going to be thinking about what this thing does for you.
Fitness was certainly interesting, but there are lots of really great fitness solutions out there.
And, by the way, because we're not competing for your wrist real estate, we can add that you know people can wear their garment and their ring.
And in fact, our positioning became about recovery.
You know, workout really hard, track your workout, but then understand how you're recovering and how your body's adapting over time or during a training regime.
And that was really useful because it was like a good complimentary positioning.
But the real genius was health. start to position around health.
And, you know, one of the lessons actually I learned in my career and a little bit at Redpoint was when you're choosing an investment, think about TAM, right?
Think about the opportunity size, because that's probably going to be the most weighted variable in the calculus of whether or not your company is hugely successful.
So health is a bigger town.
Well, okay, why?
Well, certainly there's lots of people care about, you know, going to the gym and go to the gym all the time, but most people don't have ripped abs and most people don't get to the gym twice a day like you do to lift heavy.
Um, but you know, some people do, but, but most people don't.
And then by the way, there's a whole cohort of people who going to the gym is just not a thing.
They either don't have time.
They don't have money.
Maybe they're sick.
I mean, we see a big cohort of aura users who are managing chronic illness.
They're not going to the gym.
They, you know, for them, they're trying to say like, how many steps can I take today?
Not, did I get my 10,000 steps?
Hmm.
And what is unique about the finger?
I mean, you said this versus a compliment to the other stuff.
What is unique about the ability to have a ring versus other parts of the body?
Well, one is the comfort.
One is the wear time.
One is because it doesn't have a screen and an operating system that's consuming batteries the battery life.
Battery life on an Apple Watch, maybe if it's an Ultra, maybe it's two days.
And depending on how you use it, maybe it's less.
Battery life on a Garmin depends on which one you buy, but pretty good.
But a Ring, by and large, five to seven days between charges.
But the difference in battery size is really telling.
The battery size on this might be, you know, eight to 10 times larger than the battery size of the ring, which means we're way more efficient in terms of our use of compute and energy.
That's really powerful.
Really goes a long way because it just fits into your life.
You don't have to think about it too hard.
It's not something you need to manage.
You don't have to be like, oh, I forgot to charge it so I'm not getting my score tomorrow.
You get habituated to getting your data on a regular basis without too much effort.
That turns out to be really important.
The other thing that's important structurally is that if you think about this site on the human body, it is the place that is the most accurate for these kinds of sensors to get data.
When you go to a hospital they put the sensor for your blood pressure.
I'm sorry your heartbeat.
They put it right here in your finger.
Why do they put it there?
They put it there because you have an artery that flows right up your finger.
It's the first stop on blood coming from your heart straight down your arm.
So you're on the leading edge of the pulse.
And maybe most importantly, you're working through very uniform tissue.
It's pretty thin.
That blood flow is very close to the surface of the fin.
When you consider it to the wrist, you're on return blood flow.
It's capillary action.
You're dealing with confounding factors like skin bone hair tattoo, discoloration from sun.
All these factors even race because generally your palms are lighter than the dark side of your skin, which is the backside of your body, the dorsal part of your body.
So really interesting.
We get a signal for PPG that's something like 15 to 100 times stronger than it is at the wrist.
And so that's really powerful, because that gives us the ability to see and analyze things using machine intelligence that just aren't – the data's not in the signal.
We get signals that are really, really fine-grained and we can – make assessments of things like your pulse wave velocity, which is, you know, a measure of arterial stiffness.
These are kind of more health metrics as opposed to like hey, what was your heart rate after you finished your run?
Or, you know, hey, how many steps did you take?
Which is important, not playing that down at all.
We see this in practice because people wear, you know, two devices.
66% of our customers have a second device, usually a watch.
We get another set of people who are like I like nice watches and I want a wearable, and I'm not going to wear two watches.
And we had a lot of women who are like I like this because it's a cute ring and it's not, you know, a big iPhone on my wrist.
To each their own.
The point is that there is a structural advantage to being a ring.
I notice it.
100% I notice it.
Your accuracy versus the Garmin that I wear is demonstrably different.
It catches... I mean, even as far as...
My Garmin.
For the most time I have to alert when I'm done sleeping, versus if I roll back over at five in the morning.
I'm not ready to get up.
Like you catch all the way, all the way through.
This was a wake period that you were hanging out uh, messing around on your phone, versus.
You fell back asleep for another 45 minutes, and all that.
It's just the precision of getting up in the middle of the night, all that stuff.
It's far, far more accurate.
Yep.
And if you think about the benefits of that, the benefits are like it feels like it knows you better.
One of the canonical aura experiences is the first time.
It sort of detects that you're getting sick, but you don't feel sick.
And then two days later you're on the couch surrounded by Kleenex and you're like wow, this thing really knows me.
You know, the, the, these kinds of experiences are enabled by the accuracy.
You know when it's when, When it understands you and you feel like it knows something you don't, then you're like wow, this is really something I should pay attention to.
I should pay attention to something that's telling me something I don't know.
And that's powerful.
And the reality is that I think if you think about sort of wearables 10, you kind of learn some things and then you're kind of like oh, I learned that thing.
I know what 10,000 steps look like.
Don't drink before bed.
Don't drink before bed.
And the thing is, great, you should have those.
And I think our strategy on that front is to kind of Take health journeys and string them together, because you might go through a sleep journey, like I did, where you lose sleep and then maybe you figure it out or maybe you don't.
I'm sorry for you if that's the case.
But you go through that journey and then maybe it's like, whoa.
I'm aging and I need like health.
I need to make sure I understand what's going on with my health.
Or maybe I'm a woman.
I'm trying to get pregnant or maybe I'm trying to not get pregnant.
And if we can string those journeys together.
We think about this as a personal health companion for your life.
Whoa, think about that.
Our big, broad, bold vision is that everyone has a phone.
That's a supercomputer.
Everyone should have devices on their body that's measuring their health, that's feeding information to that supercomputer.
And there's machine intelligence that's monitoring over you and helping you make both healthy choices preventatively, but also monitoring you like a check engine light for your body.
About where things are going.
And maybe you should either change your behaviors or see a doctor.
And that kind of idea is really powerful, considering the state of healthcare today where, geez you know, we got maybe 500 million hours of primary care available to people in the US.
That is about a million, you know, one and a half hours per person per year.
That is not enough.
And if you were going to really service people, maybe you need a couple billion hours.
Not happening.
Where are we going to get the doctors from?
Not enough doctors.
So something like this, I think, is transformative to the way people practice healthcare.
Okay, well, that's interesting.
But what's really happening is people are also taking agency.
COVID taught us that COVID's like, Hey, like world's going up in flames.
You got to take care of your health.
Like make these choices are like, that was a huge moment of education.
The advent of the internet.
Information's available.
People now know more about the world of health and are reading more scientific papers and are signing up for clinical trials.
That sort of agency in health, we're riding a tailwind right now.
And that's really powerful, because I think the way technology does things is disrupts it completely slowly slowly, slowly and then all at once.
And I think we're part of that.
And so, if you accelerate that vision past where we are today, we're already seeing the world in which you're able to enable personalized information.
Hey, this is a deviation from standard.
You might be getting sick or you might be pregnant or whatever it is.
You can see that, which maybe we'll talk about some of the data implications or the things that you guys feel a moral and a business obligation towards, but let's put that on the side for now.
As you try to, as you extrapolate that through?
Are we nearing the point from moving away from sick care and some of the preventative care that we might want to go to?
Not at a personal level.
Obviously, there's a lot of people that are doing this, but...
Are the incentives moving in the right direction between the big payers and the health plans and all of that to really incent this kind of behavior in some way, shape or form?
If you wear an aura ring, you have lower deductibles or whatever it is.
Incent?
No.
I don't think the incentives are changed or will change quickly.
But I do believe that the market power of consumers actually is what actually moves things.
When people move money from...
In Ora's case, health savings account and instead of spending money on some elective procedure or going to their FSA account and buying first aid kits that they're going to give to their family to get rid of their FSA funds,
When they change that mode to be thinking like no, I'm going to buy this thing and they're voting with their dollars and they're voting with their behaviors.
I think that's what changes.
Maybe explain HSA and FSA in simple terms.
Sorry, yeah.
If you work at a company.
A lot of companies provide a benefit, which is a health savings account or a flexible spending account.
These are pre-tax dollars that you set aside.
In the FSA case, usually it's use it or lose it.
In the HSA, it's kind of use it until you need it.
And the idea is that you're looking at things that you might pay out of pocket.
And, as most people know, the insurance kind of world of healthcare is that You get good healthcare and you don't really pay, other than you pay your insurance premium, and maybe somebody who's really sick uses more of it and maybe someone who's less sick funds more of it, and it all sort of balances out and hopefully –
You know, it all, it all works.
And that, that's a, that's a practical kind of solution to the problem.
But the incentive is, well, you get paid if you get sick, if you're a provider.
And if you're a pharmaceutical company, you get paid if you get people to take drugs, because those drugs are making them better.
And if they get better than, you know, they should pay, the insurers should pay.
And the insurers have an incentive, which is like we want to charge the right amount of premium, but we don't want to lose our shirts in case too many people get sick.
So we have to charge the right amount of premium.
So the incentives haven't changed.
And that's structural, and I'm not sure that's going to change.
Sorry, finish.
No, but what has changed is that there's a certain amount of care which is basically disposable income out of pocket.
And that market, whether it's for preventative care or for people who are going to different kinds of doctors or elective surgeries or medical tourism, like that.
Number is growing.
And that's a real trend that's happening in the world.
And I think what's happening is consumer choice is leading that trend.
And that, I think, again, I believe that that's what causes real disruptions.
Is there any stat that you're comfortable sharing or any data point around people spending using HSA or FSA?
Is that demonstrably growing within the business for you guys?
Oh, my God.
Last year when we introduced it, we were the first ring company, and maybe the first wearable company, to really crack the code on HSA FSA.
We were blown away.
We were blown away because basically there were these captive dollars.
And we thought, actually ironically, those captive dollars would come from people who are price sensitive, and so therefore, they would buy the cheapest form of, or a ring.
They would sort of – be taking advantage of their pre-tax dollars.
Interestingly enough, the ASP through HSA FSA, was higher because they were upping.
They were buying up to the fancier finishes.
They wanted gold or rose gold and they use those pre-tax dollars to get that.
And so it wasn't about price sensitivity.
It was about like, This is money that I've already set aside for this purpose.
I've already decided it's for my health.
And here's something I want that's going to help my health.
I'm going to spend my money on.
There's probably a legal reason that'll make it sound really dumb for me to ask this question.
But I'm curious if I'm a big self-insured employer, why wouldn't I want to incent the behavior within my organization to hey, I have root insurance on my phone a portfolio company.
I use it for my car insurance.
Yeah.
It monitors by driving.
I thought you didn't do paid placement.
Yeah, yeah.
Well, actually, I think we're totally out of that position at this point.
So how the public stock trades, I'm very happy for them, but it doesn't impact me.
But I'm curious, they can track how however, I'm driving, if I'm speeding, if I'm not, all that stuff.
It packs my premiums.
Yeah.
We seem to be OK with that.
Is there?
Are there reasons legally that self-insured employers can't say hey, you know our employees that wear the aura ring and track their sleep and all that?
I think it's going to be inevitable that the same kind of what you know I think that's called telematics, right.
This sort of idea, that sort of your behavior is revealed by data, might indicate your risk and therefore will stratify you based according to your risk.
And maybe that takes the form of a lower or higher premium.
And by the way, that's actually the business that they're in, right?
Is stratifying risk and understanding what their exposure is.
That's an insurance company.
So I don't think there's like a structural impediment.
I think there's no law inhibiting.
No, there's no law inhibiting it, other than the fact that your data you need to be okay with sharing your data.
And so our posture on this is that, like we don't share your data unless you want to share your data,
If you think it's going to help you and the insurance company, then we're happy to do that.
And if you sign up for it, then we're happy to do that.
But we're not going to do that on your behalf or to our own advantage.
That's just not the case.
That that is going to be ultimately a really interesting going back to this.
There's a vision of everybody has a phone and everybody has a device and, like it will change the dynamic because you won't be using you know actuarial tables to determine it.
You'll be using live data to determine it.
And I think insurance companies see this.
We have conversations with them and they're like, yeah, we see this coming.
And it could be an opt-in thing, much in the same way, Clear, TSA Pre, those are opt-in systems.
And if you want to give the incremental information or pay the incremental service, you get something along with it.
You get an incremental benefit.
And hey, if you want to track my, I'll give you access to my data on some basis, some cadence, some amount of information.
And in exchange for that, I get lower premiums or a lower deductible or whatever it is.
The reality is they already know.
And the reason why they already know is because they see your treatment history and because they pay for your treatment history.
And so therefore, like they have a pretty good sense of when you're going to die, because the numbers are there.
The actual actuarial exercise is actually quite good.
There's a lot of data.
There's 50 billion people or whatever, 60 billion people that have been born.
That's right.
And there are machines who can process it.
The one about self-insured employers is really interesting.
I figure that's the smallest pool that you could start with.
And there's different risk associated with a Redpoint employee versus, you know, whatever.
Yeah.
Somebody's driving trucks or something like that.
Yeah.
So absolutely.
And I think that goes again to like they want to understand that and they want to understand those risks across the board.
I think what's interesting about self-insured employers is that the incentive to care for someone preventatively plays out over the long term.
Meaning that if you're on average an employee of a company for five to eight years, I don't know what the actual average is, but it's generally people, they change jobs.
The incentive actually is to not pay for the preventative care because it's not your problem.
And no one's ever said anything quite like that, but I think that's probably true.
Just to play that out for people that aren't totally following.
So if I'm only going to be at a company for five years and I can spend – if in eight years' time I'm going to have to spend 500000 but I can spend – two thousand dollars a year uh, for the next five years or whatever it is to prevent that 500k, you might keep the can.
It's gonna be someone else, someone else's problem.
Someone else can pay the eighty thousand dollars to.
You know, have your your, your heart surgery or whatever?
And the thing is obviously the person bears that expense and the pain of it, but also the society.
You think about our society today where 20% of the expenditures in the country are healthcare.
I don't think that's healthy.
Because we should be spending more money on things like education or innovation or whatever it is, to sort of move the society forward.
But healthcare is actually weirdly a tax.
And I think if you can change that landscape by incenting large groups of people to be healthier for longer –
And you can reduce the burden, most of which, by the way of that.
Whatever, it is 4 trillion to get spent on healthcare in a year.
Most of that happens end of life.
Like the majority of that is critical end of life care in acute places where you're trying to keep someone alive, man.
That's actually bad for the society.
Now i think that's changing and we're seeing the winds of that change, and aura is, you know, a small flag in that wind.
Um, but that's that's really what i'm talking about consumer choice, people becoming aware of their choices and the implications and outcomes that they can affect and taking those actions.
I think if you do that at a countrywide scale or even a global scale, the impact is massive.
Hopefully our international audience listened along with us on some of these nuances of the US healthcare system.
It's not good.
Newsflash.
Yeah, exactly.
I'm curious, I guess, as you sort of zoom out and maybe this is a question that is applicable to both international, but maybe also US if there was something that you wish people knew, or if you could wave your magic wand and have people- do some behavior, is there anything that immediately comes to mind that you're like yes, i really need to impart this information to people.
Or i wish behavior change happened.
Yeah, to sort of have a positive impact yeah yeah, i mean, i think it's.
It's the importance of small choices that add up over time, and the example is like i mean i would, i would use sugar consumption or processed food consumption.
There's all these huge environmental and structural incentives to get you to consume foods that actually aren't great for you in the long run.
I mean we're learning more and more about the impacts of processed foods and the impacts of sugar consumption on your diet.
And you look at the rates of diabetes, type 2 diabetes, and in some countries it's far worse.
I mean, you go to the Middle East or you go to the Indonesian or South Pacific Islander nations.
And you see the impact of the global food system on those people.
And you can see it because everybody is 250 pounds.
That's a broad overstatement and no offense meant to anybody who lives in those areas.
But that's a factor that the public health systems in those parts of the world are thinking about is to think about the power of your diet.
And think about the choices that you're making.
And maybe to agitate for – you should be educated.
You should understand what the impact of the foods that you eat and the things that you consume are.
Because the truth is you might go to the gym, what, twice a week, three times a week?
Maybe.
And probably you get some – depending on what kind of job you do, you might get some movement in.
Well, that's good.
You're definitely going to sleep seven times a week.
You're going to eat 21 times.
And so the impact of those 21 meals that you eat, massive.
I guess maybe putting a pin in the data and the trends and all of that as you envision this world.
There's this big thing.
People are talking about artificial intelligence.
And as you start thinking about... Heard of it.
Yeah, it seems like a thing.
And, as you think about what that could look like, in all of the stuff that we've just touched on, is there anything that feels particularly exciting about the potential?
I mean, we've been doing artificial intelligence for decades.
Day one, and that's because the algorithms that we develop are basically formed by neural networks over a large set of data, and that's what trains them and therefore, that informs the algorithm, and the algorithm is what tells you what the score is, what the value is.
Okay, so that's great.
Uh, most people are excited about gen ai and and the ability for you know, sort of simulated intelligence that can be presented to you and is um, And I think there's a tremendous amount of power and we're seeing amazing things happen in healthcare around that.
But they're kind of what I would call like automation.
So you know, a lot of the healthcare industry's inefficiencies are about tracking down.
You know insurance and who pays and all this kind of stuff.
I think that automation is really powerful for clinicians who don't have time the ability to create patient notes or a follow-up or a patient record.
That's being aided by some machine intelligence that can both categorize and maybe report on what's going on.
You look at radiology.
So now it's well demonstrated that you take, you know, 100 scans and you feed them to the AI and the AI comes back with 78.
You know, these people are healthy and 22 are not.
And that's as good or better than doc.
Okay, great.
All amazing things are going to happen.
And so I think it's going to be profound.
We're at the beginning of, whatever you want to call it, the fourth technological revolution.
Whatever it is, it's happening.
It will take time.
It's not going to happen all overnight, but the technologies are evolving at a rapid pace.
It's going to be pretty impressive.
For Aura.
I think the way we think about it is that idea of the doctor in your pocket, that is with you.
You know the 23 hours and 45 minutes that you're not seeing the doctor for 15 minutes every year.
And that that intelligence is going to affect one it'll make predictions about.
Hey you, it looks like something might be going on.
You might really want to seek care.
You've had three ectopic heartbeats out of the last, you know, million heartbeats.
You might want to do something about that or at least get it checked out.
Okay, that's interesting.
Checking, you know, check engine light for your body.
But the hard part of health, particularly preventative health, is behavior.
And the thing is that if you have a relationship with something that's maybe holding you a little bit accountable, maybe giving you some education so you understand the why you shouldn't eat the food that's bad for you, maybe giving you some motivation to say hey, here's something you could do, or maybe even some ideation.
Take a walk with your dog, and it's giving you an idea.
You're like, oh, Yeah, what a great idea.
I should go do that.
That power of small changes writ large, personalized to someone, decentralized meaning it doesn't have to happen and be filtered through the lens of a doctor who's talking to you.
It's like, no, you know that you've been educated.
This is what you do to be healthy.
I think that's going to be profound.
And we're seeing early – like inklings of that.
We have a thing in the product called the aura advisor, which And the aura advisor basically remembers things about you and it doesn't give medical advice, but it does have lots of advice and education.
And it says, what are you interested in learning about?
Let me teach you about your body.
And then we'll point you at metrics in your records or say, hey, you should pay attention to this.
Or, oh, you're interested in that?
Let me tell you about that.
And that – is really profound.
And the reason why it's profound is because like, we're seeing people who really use it and they use it almost like as a advisor, as a friend.
I love this story.
We had a focus group and we were talking to some early users of the advisor and we said what is your number one feature request?
And they said, well, we love it.
We love how supportive it is.
We love the information it gives.
We love how it helps us find things in the app that we wouldn't have discovered otherwise.
And we actually also just kind of like hanging out and talking to it.
And we're like, well, that's interesting.
Tell us more.
What would you want to see as a feature?
I said, well, we'd really like to be able to name it.
Can we name it?
Can we give it a personal names?
Cause it's like I feel better talking to someone who has a name and we're just like you know, our minds being blown because I think you know the way we're wired something seems like a human and then behaves in a way that cares about us.
Our natural reaction is like, okay, that, that thing, that person cares about me.
I'm going to invest in it.
Oh my God, mind blowing.
I think we're at the beginning.
I mean, there's so much to talk about there.
Yeah, it's fascinating.
It's fascinating.
I'm looking through this one sort of very small lens of like people having quasi-human relationships.
And so that's coaching and advisory and doctors and stuff like that.
But I think it's much bigger than that, obviously.
Is today the ring is the principal hardware product?
Yeah.
Only?
It is our only product.
Yeah.
Only product with all the subscription service.
Yeah.
I don't have a name for my coach, but all the software stuff around it.
Yeah.
You mentioned CGM earlier, and you have a partnership or a new relationship with a CGM provider?
Yeah, yeah.
So if you don't know what a CGM is, it's a continuous glucose monitor.
It's basically a patch that has a filament that goes underneath your skin that senses the amount of blood sugar in your interstitial fluid not in your blood.
It doesn't actually penetrate your vascular system, But it gives you a sense of that.
What happens is you eat something and you look at your blood sugar spike.
And the general theory is that there's a healthy range of blood sugar for a healthy adult if they're not pre-diabetic and you want to be in that range.
And if you spike above that range, maybe you should eat less of that food, or maybe you should go for a walk after you eat that food, or maybe you should – change the order.
You should eat something that's more like fiber, which absorbs a lot of the blood sugar before it gets, you know, sort of distributed to your blood as glycogen.
Okay, great.
Awesome, awesome, awesome.
And these were historically mostly centered around diabetics?
100% for diabetics.
They were used to dose insulin.
And in the last...
Five years?
Yeah, I think it's been yeah, maybe four years or so, where people suddenly became aware that they could use this.
Actually athletes performance athletes would use it to understand fueling Um, and people who are going on weight loss journeys that were sometimes um, you know, medicated weight loss or serious intervention would use it.
They would use it to understand how their blood sugar spike.
It's become more popular among venture athletes.
It's definitely, it's definitely become, it's become more of a thing.
Actually, somebody told me once that they you know they were going to a CGM party and I was like wow, it sounds like a fun party.
Yeah.
That is a cult.
That is.
Do not drink what they give you there.
That's right.
That's right.
So the point is that this is just yet another data point.
And for us, we partnered with Dexcom.
And Dexcom is a major provider of this technology, primarily to diabetics, but is expanding and providing it to the general populace who are diabetic, paying for it out of pocket.
The price has come down.
Uh, it used to be about, you know, 100 bucks a sensor.
Now it's about 49 bucks a sensor, or 99 for two and, most importantly, you don't need a prescription.
You used to need a prescription to get them, now you don't, and so people are learning that your genotype and your phenotype and how, who you are, and your medical history means the way you react to food is totally different.
You know, you talk about your microbiome in your stomach and like the way it processes the things that you eat, is really, really variegated.
It's not the same for everybody.
And so understanding that's really important.
And so for me again, it came down to learning the things that i thought were actually healthy foods.
They were things that you know i've been brought up to think that this was healthy and i had done some research and i thought that was healthy.
And it turns out for me they were not healthy foods and so i've cut those foods out of my diet and it's made a real impact on how i feel and how i look and my weight and all the things.
So I think our vision in Aura is that this is a great device for measuring a lot of things.
It's probably not going to be a great device for measuring blood sugar.
Never say never.
People talk about the watch doing this someday, but I think that's very far in the future.
But you know what?
If this is the thing you're caring about and it has the most current and the best data well, let's leaven that data with other sources of data and you'll get a more complete picture of your health.
Um, you know what?
What illness you have, or a very specific intervention?
Uh, you know what?
I'm putting a new knee in you, and so it's all about that new knee and it's not about anything else.
Not about your other knee, it's not about your shoulder, it's about your knee, and that kind of like rifle shot view actually misses a big part of the picture, which is that, over the long span of your life and the long span of all the things that you might possibly do to affect your health, Like you're going to be missing a lot.
It's the sick care paradigm.
And so what's really interesting is and customers tell us this all the time is that they are making these connections between behaviors that they have and choices that they make and outcomes that they see either in their application or in their life.
And making those connections reinforces those behaviors.
And it goes back to healthy habits.
And so at some point, I guess, as you zoom out or you paint the story long term, it sounds like other ways of getting data or other integration points for you as a part of the vision, and the means of doing that are TBD.
You have this partnership in place currently, but...
Dexcom is a really practical thing.
That'll be in market within a matter of months.
Will that integrate into the app?
Yeah, it shows up in the app and we make correlations and the AI understands it.
There's a great demo I do.
You take a picture of the food using your Aura app.
And it sort of records that for you and sort of decomposes it.
This is a salad with cabbage and arugula and onions and whatever.
And it sort of decomposes that.
And then it sort of says, that's good.
Lots of fiber.
Good job, Tom.
But it also feeds that to the AI.
And then you might say to the AI, like, well, what should I change about my diet?
It says, actually –
Keep eating those salads.
Those salads are great for you.
In fact, the one you had today, and you're like, what?
And that connection between even that small choice and that bigger idea and that bigger behavior.
Sure, that's the magic.
Changing behavior is hard.
It takes reinforcement.
It takes time of doing it.
And it takes some motivation.
And sometimes it takes extrinsic motivation or accountability.
And I think an AI can kind of play that role.
I'm curious.
When you came into the business, we talked about the 60-40 split of fitness and sleep and what that looked like.
I guess 60 was sleep, 40 was fitness at the time.
And I've read it was majority male at that point in time, but I don't know to what extent.
As you sort of looked at that and you start thinking about hey, how do we reposition around this sleep thing?
And start thinking about new avenues of growth.
How do you go about actually doing that?
Well, first you have to have a really clear intent.
And we had a pretty clear intent, which was we liked sleep and we wanted to keep that as a foundation, but we wanted to expand into other need states.
And the other need states were women's health, cardiovascular health and basically longevity, healthy aging and stress.
And so once we had that really clear and we had set our roadmap in that direction, then the point was well, how do we educate the market about that?
And I'm a big believer in using all the resources of the company and putting it behind one idea to sort of break through the noise.
There's a book.
It's called Play Bigger.
If you've ever heard of it or read it, it's a great book.
It's about category design.
And how market winners accumulate a disproportionate amount of value.
Exactly, exactly, exactly.
Um, and, and that, and then in order to do that, you actually have to rise above the noise.
You can't kind of be like everybody else, but be a little bit better.
You actually have to be really different and you have to be like different at one thing and that's it.
Yeah.
The incrementality causes comparison, which you don't necessarily want.
You want to define your own category, be on your own playing field.
So it's a powerful idea.
One of the ideas in that book is this idea of the lightning strike.
And the lightning strike is.
You put all the energy of the company behind that one idea and you compress it in time so it all happens in the same time frame so that it can break through the noise.
Anybody who's ever launched a product knows what this idea is, but being really call it company-wide about it, as opposed to saying oh, that's that function's job to launch the products.
Like, no, the company's launching the product.
And how can we use every resource in the company to break through?
It's a very powerful idea.
So that was kind of the paradigm that we approached was like, how can we generate lightning strikes?
And one was women's health.
That was sort of the first one that really landed.
And so we thought very hard about like, how can we break through?
And we had been working with a company who had used the Oura Ring for their clinical trial of a digital contraceptive.
And that company is called Natural Cycles.
It's something that you can use to determine whether or not, based on where you are in your cycle, which is a derivative of your temperature, whether or not today's a day to have sex and not worry about it, or to not have sex because you might get pregnant.
And a really, really interesting product.
So we had been working with them and we're like this woman's health thing.
It is like it's really interesting because there's a couple of things going on.
Young women, don't want hormonal birth control.
Why not?
Well, lots of reasons, but one of the reasons is that it messes with their physiology.
Great benefit, not getting pregnant.
Actually, you don't get your period.
That's a great benefit, but also messes with your physiology and maybe when you come off it you might have a hard time getting pregnant.
Okay.
So interesting that that was sort of happening.
There was also this kind of like almost quasi identity politics thing which is Hey, we want to be have agency over.
We don't want to be told what to do.
Like we want to be in charge of our own lives.
You remember there was a woman who ran the London marathon, you know, and was like it was her, she was having her period and she just decided to run and like said screw it.
I'm not going to let anybody tell me what to do.
Really interesting kind of coming together.
So we sort of steered right into that.
And we launched with Natural Cycles.
And we made a big deal about positioning the company around women's health.
And we delivered a great product for women.
And it was like, it was a rocket ship.
And delivering a great product around women, were there style design considerations or sizing?
You know, honestly, I think that it was really more in the software presentation.
I think the fact that it's a ring. was actually the thing that made a difference.
Because, as a wearable like if you're going to be a continuous wear wearable and, by the way, if you're going to make predictions about someone's cycle you kind of need to be on their body all the time.
If you miss even a few days of data, your period, prediction about when your period is going to come it's going to be could be off.
You know, missing this in the data is a real problem.
You want consistent, crisp data.
Okay, so that was really the product feature was that it was a ring, right?
And that it was cute and it looked good and it was, you know, stylish.
And what we saw was when we pulled that together with HSA, FSA, those things came together in time. and that that broke through because all of a sudden you had you know young women on tick tock and instagram telling each other that this is what they needed to do and that was really powerful for us to see and we kind of got behind that and fanned the flames of a little bit not by buying influencers but by amplifying people who were these authentic voices that this was something that a young woman ought to consider Today, 18 to 24 women is the fastest growing demographic for us.
And not to say we're, you know, men grew 50%, but women grew 250%.
And that's product market fit and catching a moment.
It's a lightning strike.
So going back to like, what did we do?
First of all, we found something that was really compelling.
It's way easy to market something that's super compelling.
We found that.
And then we had the science to support it.
So it was credible and, you know, we had a great partner and then we took that to market.
And there's obviously this other element of luxury and price point and all of that.
And it sounds like that was another... It was an experiment.
It was an experiment.
Maybe speak to that.
And I guess, I mean, how you even think about brand design and price points and all of that.
I mean, you know, we have a really strong kind of cultural impulse towards the mission of improving people's health.
And so there's a really strong strain in the company of like.
We need to figure out how to make this accessible to everybody.
We're not successful until we've affected the lives of a billion people.
At the same time, We stand for accuracy and credibility and the rigor of science and the world-class product development and excellent fit and finish.
And that's premium.
And so reconciling those two things, that's an interesting challenge.
But on the whole...
A premium price point, or what is perceived as a premium price point, actually signifies something, signifies quality and it signifies value.
And the calculus on this was thinking about health.
What would you pay for health?
Well, it turns out more or less it's priceless, because without your health you have, you know, very little to live for.
And I mean that in the most like practical and down to earth way.
And it shows up in data, by the way, like higher, richer nations spend more on healthcare.
And so it's one of those things that YA always when we show our spend versus other nations and all the data is always a little skewed on that for a bunch of reasons related to health and service costs and all that.
But it's a luxury good, similar to travel or similar to education.
You spend more on And, by the way, you know if you're well off, you know you're going to spend more on like out of pocket.
You know you're going to find the specialty doctor or the best person who does this particular procedure because you can afford it.
So as we thought through that, we're like, well, it's pretty important to have that.
And we toyed with this idea of like, should we really be a luxury good?
And we did a partnership with Gucci where we did a run of Gucci design rings.
And when it came time to price it, you know they suggested a price point and everybody's jaws fell to the floor because we're like you can't charge that.
No one's going to pay that.
That's crazy.
Was this just a small scale kind of experimentation?
Hey, let's go work with.
It was a partnership with Gucci.
I think we had, you know, we'd seen Apple with Hermes and.
There's sort of a tradition actually in wearables and technology of sort of collabs with luxury brands.
If you remember the Virtus phone 10000 for a bejeweled cell phone that didn't work very well.
Um, pretty interesting uh, for us was um one that there was very little price elasticity.
That was surprising to me.
I would have thought it was, you know, much harder to sell.
What did it end up getting priced at a thousand thousand euros?
Basically, thousand euro, yeah and uh.
And what was the run, the initial run?
I can't remember the number exactly, but we sold out in two weeks.
Oh, wow.
We thought this was going to be a nice supply, and it went really quickly, so much so that we had to do a second run and launch it again about six months later, for a larger audience.
And what was, I think, compelling for us was like –
I don't think we want to position as like the Gucci of healthcare.
That's probably not right for us.
We do want to be accessible and we want to do that.
But it's certainly interesting to note that this has the properties of jewelry, which is that it's expression.
And if you happen to align with the expression of Gucci or whatever luxury brand, you will pay for that.
And that's an intangible that people are willing to pay for.
And so we came down sort of to the idea that what we should do is we should have a range of offerings from an entry-level price to a premium price, and sort of allow people to self-sort based on either utility or fashion.
And that that range from, you know, utility plus fashion being the highest price and utility with a little bit of fashion, maybe in comfort, being the lowest price.
And that seemed to work really well, because the people who were like look I just – I want to track my sleep and I don't care what it looks like.
They would buy the cheapest one.
And the people are like, this says a lot about me and I wanted to batch my other jewelry.
We'd buy the different finish.
And that was – that was an unlock for us because that not, that's not how wearable people think.
And technologists don't think that way, because technology is like what are the features, and which features do you put in which which skew, and you should price more for more features.
I'm curious these decisions.
There was the scaffolding of a very successful product and there was a business that was already in place with a lot of mission-driven employees in there.
That's right.
And you're coming in not as the founder, where you don't have the same moral authority that a founder kind of has.
But you're making these decisions changes, broadening the mission, changing elements of how you go to market, and all that.
I'm curious... how you go about making those decisions.
And ultimately, there's probably a balance between collaborative decisioning and also, at the end of the day, you're the one whose job's on the line and you're the one that got hired to come in and try to do this stuff.
And so I'm curious, like how does you know?
There's this whole founder mode thing that popped up in the.
I guess I'm just curious broad strokes your perspective on that?
Well, I think there's so many things to pull out there.
So many threads.
I think, you know, one thread might be What does it mean to be a founder?
And what permission does that give you?
And what license does that give you?
And what power do you have?
And, by the way, what does it mean that if you're a founder and you're working 80 hours and everyone needs to work 80 hours, how does that fit?
You're setting the culture through your own example.
I think that's powerful.
I don't think it's the most interesting thing um here, because in many ways i kind of operate like a founder.
I feel like a founder.
I'm as committed to the company as any founder is.
You know, i work harder than some founders.
Maybe you know the less successful ones, who knows.
But but the point is, is that like, If you're committed to the mission of the company, I think that's the moral equivalent of being a founder.
And I am very much committed to the mission of this company.
It's part of the reason why I chose to work for it, because I felt like here's a company that's going to actually make a difference in people's lives.
I want to be a part of that.
And that's so powerful.
By the way, as a leadership tactic or a cultural element having a really strong and tangible and – authentic mission.
It's gold.
You know people are.
They work, you know, with more intent.
They collaborate better.
They will stretch further they will.
You know you'll get a higher level of performance in a mission driven company than a non mission driven company.
And I guess interject.
I mean that was part of your consideration or what you communicated to the board through the process.
Yeah, I understand this.
I understand.
I understand this because actually SurveyMonkey had a large degree of actually, you know, based on Dave Goldberg's kind of like personality, it had a large sense of mission and its mission was to allow anybody to their voice to be heard and to give the powers that were making decisions the mechanism to hear that voice.
Wow, what a novel and interesting idea and a way to approach the idea of like survey software.
So for people that know David, Dave Goldberg was the CEO, tragically passed away.
Sheryl Sandberg's husband passed away probably five, seven years ago.
Yeah.
Something like that.
Yeah.
I guess maybe a little bit longer.
So that was a really powerful part of it.
And that maybe goes to founder and mission driven.
I think the other side of it and the story of Aura is that it was founded in Finland.
It was founded in Oulu, which is the fifth largest city in Finland and maybe 100 miles from the Arctic Circle.
So it's pretty isolated.
But it was one of the outposts of Nokia.
Nokia was a big maker of mobile phones back in the day, number one market share for many years.
And so there was this real interesting skill set there.
There was also a real focus on health and a particular metric called heart rate variability.
So there was some real sort of physiological scientists there who had real understanding of it.
And there were some people who were working on data science.
And that was kind of the founding matrix of the company.
And the thing is, is that like...
One of the things that I know about any office anywhere is that they have a culture.
And at the heart of that culture is some either set of values, or set of beliefs, or an understanding of themselves.
And if you ignore that, you cannot lead them effectively.
And when I joined the company, the first thing I thought was like, okay, so –
Here's this Finnish-founded company.
The last couple of years has been led by an American CEO and has an American investor base.
And those two things are somewhat in tension, and I need to resolve that tension.
So the first thing I did is I went to Finland and was like, you guys make this product.
You guys built this product.
You guys are the founders, whether you're the – cap table founders or the founders who built this thing.
You are the people who did this.
And I have so much respect for you.
And I have so much, I honor you.
And by the way, I'm your servant.
I'm your servant leader.
That's, you know, I'm sure you've read Tom Collins book, but like, that is a powerful idea.
I do not.
It's not me.
I am here for us.
I'm here for you.
So, so motivating.
And so that was a really fundamental thing because they had not heard that before.
Even though they were the people creating the product, they did not feel that or hear that.
And that was really transformative, I think, for the company, because it opened the door for us to grow around the world, primarily for the next couple of years in the US, but to add more employees and to propagate that culture.
Today.
If you ask people, they would say there are lots of elements of Finnish culture and aura today, but I'm from California or wherever you grew up.
It's not Finland, but there are Finnish values.
There's the value of sisu, which is like grit and determination.
There's Finnish culture, which is typically blunt and direct in terms of communication.
And all these elements have carried through and they're part of what make Aura both distinct and inform the product that we make.
And so I guess you come in and you go over there and you found out you don't change things initially along the way.
Did you have an intuition of where you thought this would go from a product standpoint?
I did.
I mean, I had a thesis.
I had a thesis that like, really what needed to happen was that the software needed to really evolve and that the surface of value that we were painting on needed to evolve, and that we needed to think about these need states.
And that was sort of the strategy part of it.
Of course, as always, you know, you lay the best made plans.
Like you know, we were staring down the barrel of.
Like you know, we were going to have to raise money and it was the worst fundraising environment in you know a decade.
And you know, the go-go years of 20 and 21 were over and the bloom had come off the rose for health, investments and everything you know.
We were staring down the barrel of that and i said, like i can tell you right now, we got to change and and so in some sense uh, that forces you to make decisions.
Never let a good crisis go to waste.
Never let a good crisis go to waste or else that crisis will eat you.
And so it was a pretty tough... It was like six months, maybe less, five months into the job.
And, you know, we had to do some tough stuff.
And we had to make some tough decisions.
And we had to, you know...
We had to change the trajectory of the company.
We stopped spending, you know, buckets of money on marketing and everyone was screaming that you can't do that.
It's going to kill the business.
And ironically, you know, we've ramped down spend.
And at the end of the fourth month, we've cut spend altogether on, on demand generation.
We had the best sales month we've ever had.
Hmm.
And that's the power of a product with a good market fit and a customer base who loves it.
What a great asset to have.
And that really carried us through.
And we re-articulated the mission away from.
We're here to be a glossy consumer product goods kind of company with a glossy brand and everything was about the brand and the brand is this and let's make the brand that.
It's like, no, no, no, let's return to the basics here.
Let's make a great product.
Let's make a product that draws on the power of this thing to change people's lives and to help them with their health.
Like, let's steer into that.
And that was really, you know, we've had a great couple of years.
The company has half a billion dollars in 2024 of revenue.
That's a big performance from where we were.
Yeah, it's amazing.
I guess you talked about this tension of product and brand, or maybe they're not at odds and there's an inherent tension.
They're tied together.
They're actually the same thing.
They're the same thing, but...
Which master you're serving at different points in time could be a little different in all of that.
I guess do you feel like your software kind of background where really for the most part there's elements of brand and software, for sure, but the product inevitably will speak for itself.
Was that...
Were you drawing on some of those experiences?
For sure.
I mean, I think somebody much smarter than me once told me that strategy is the allocation of resources.
And so determining where you're going to spend your resources actually is where your strategy is.
You might say your strategy is this.
But if everybody's working on that, that's what your strategy is, not this.
And so for me, it was about like making sure that we were doubling down on the product investment, and our software team was sort of a great team, super strong, but sort of underpowered for the task that we wanted to set in front of them.
And you know, the upper hand of the business had been building the brand and building awareness and positioning the company a certain way luxury, all the things we've just been talking about.
And I was like, I think we should get back to the basics here.
Let's get back to the benefits that this product can confer to people, not what it means to wear one.
And do you recalibrate?
I guess as you actually operationalize that, do you recalibrate around different...
OKRs and North Star stuff, or is it values-based things?
Is it sort of all of the above?
It's all of the above, but at the end of the day and I think you probably know this intuitively as an investor it comes down to the people.
We basically got a brand new team.
I hired a whole new set of executives and it was much easier to sort of set them at the course that we wanted to go after.
Because they didn't have any history to sort of protect or any – they didn't have a dog in the hunt other than like let's make this thing go.
And you know, there's a moment, I think, in every company where you sort of go oh, it's really clear what we need to do.
We just need to do it.
And as we built the team, it became very clear that that sort of health was this place that we really needed to anchor and we really need to push on and we really need to drive towards and women's health in particular.
And that was both motivating and clarifying.
Hmm.
As you look out now, are there new areas that you're excited to go into, either from a demographic standpoint or a customer type.
Whatever,
Yeah.
I mean, I think about international.
We're largely a US business with a small kind of outside of the US business, and I think that's a –.
This is, we're early days.
You know, the ring's having a moment.
A lot of people know about Oura Ring and we've gotten awareness.
But really, at the end of the day, most people actually haven't heard of it.
Or if they have, they don't really understand the benefits of it.
They think of it as like a Fitbit for your finger or something like that.
We've got that opportunity in front of us from international expansion.
And are all the trends that we sort of talked about in the U.S.
Global.
Yeah, I was actually sitting with someone from Tencent earlier this week and they were just like yeah, let me tell you what's going on right now in China.
It's all about health and wellness.
Let me introduce you to the influencers there.
So I think those are global trends.
Weirdly, I think COVID had something to do with that.
It sort of put everybody on the globe that their health is not something they can take for granted.
So global is one.
I think the other that's really compelling to me is this idea that we can ingest or source data that enrich what we're doing, and whether that's environmental sensing or other kinds of devices or even other sources of data, whether it's electronic health records or
And and and, and and sort of this.
One of the premises of artificial intelligence is the best data and the most data wins.
And I think we have a really interesting role to play because we can be the scaffold, that is, the data, and then other people can be the context and sometimes can be the core data.
And like that's a really interesting thing that we're expanding towards.
Um, i'm really interested to see how this ai advisor thing plays out.
Um, and then there are certain things that are like new kinds of sensing.
Um, you know, i'm i'm I'm wearing a CGM continuous glucose monitor now, but I've taken at-home blood tests.
I think that's really interesting.
We're seeing people who are doing a quarterly blood test to track some biomarker or another, and that's become way more accessible, right.
Logistics and the mechanisms for doing analysis of dried blood or...
Sending a phlebotomist to your house to do a blood draw because you're too busy.
There are things that are structurally changing there.
I'm really interested in other kinds of analytes.
So your urine is an analyte.
Your sweat is an analyte.
There are electrical signals that are mediated from your body which are really powerful for measuring what happens with your heart.
There's all sorts of things that I think are in front of the company in terms of new sorts of sensing.
And then I think there's the whole healthcare opportunity of sort of being the foundation, both as a piece of hardware but also as a data layer, for change in healthcare and how healthcare gets delivered.
And I think, if you think about the TAM there going back to the lesson being like have a big TAM, that's a big TAM.
And the conversations that we have with either practitioners or insurers or providers, everyone can kind of see that this future is coming.
It's sometimes a little hazy, sometimes a little more clear, but this idea that the way people are going to practice health driven by the patient, not by the doctor, that's happening.
And you can see it.
And it's not happening.
You know change overnight, but it's happening in the way that you will see that it's going to be an overnight massive change at some point.
If That I'm excited for because- A lot of exciting stuff.
Could be interesting to have a real impact in the world once.
Yeah, I don't know.
It's good.
Yeah.
Not implying that software doesn't do that.
Well, software ate the world.
Software ate the world.
Software ate the world.
And so now and that's the famous you know One of their like seminal articles on their site is they think the biggest you know consumer company in the next 20 years is going to be the combination of a technology company and a healthcare company.
And, you know, if UnitedHealth and Apple had a baby, it would look a lot like Aura.
Yeah.
Well, no one's going to hear this because I cut any plugs to Andreessen Horowitz.
Oh, sorry.
Oh, I'm sorry.
Am I at Andreessen Horowitz?
I'm sorry.
Your mic's already cut out.
Oh, yeah.
Your mic's cut out, and no one heard that anyway.
You're welcome to cut it out.
Yeah.
Tom, thank you for doing this.
It was a pleasure.
Thank you for joining this episode of The Logan Bartlett Show with CEO of Aura, Tom Hale.
If you enjoyed this discussion, we really appreciate it.
If you subscribe to whatever podcast platform you're listening to us on, as well as share with anyone else that you think might find it interesting.
We look forward to seeing you back here with another great guest on The Logan Bartlett Show.
Have a good weekend, everyone.
