Andrew Botham, Chief Scientific Officer at TestCard

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Saul Marquez:
Hey, everyone, Saul Marquez here. Have you launched your podcast already and discovered what a pain it can be to keep up with editing, production, show notes, transcripts and operations? What if you could turn over the keys to your podcast busywork while you do the fun stuff like expanding your network and taking the industry stage? Let us edit your first episode for free so you can experience the freedom visit smooth podcasting.com to learn more. That’s smoothoodcasting.com to learn more.

Saul Marquez:
Welcome back to the Outcomes Rocket. Saul Marquez is here and today I have the privilege of hosting the outstanding Dr Andrew, both them. He is the Chief Scientific Officer and co-founder at TestCard. Andrew was formerly Head of Research and Development for ACM Global Laboratory, later moving to become the Laboratory manager for blood sciences in a large NHS trust. In today’s market with all of the challenges we’ve had with the pandemic, the front door to health care is changing and how we access care and how we administer care. The delivery of care is also changing. We have a lot of innovation happening and more willingness to accept that innovation. And at the spearhead of some of the diagnostic innovation, Andrew and his team are doing some extraordinary work at TestCard. And so today I’m privileged to have them here on the podcast with us. And I think you’re going to enjoy our conversation, Andrew, such a such a privilege to have you here.

Dr. Andrew Botham:
Wow. What an amazing introduction. Thank you very much.

Saul Marquez:
Well, I know you guys are doing some really neat things. And so before we dive into TestCard and how you guys are making a difference with diagnostics and ease of access, tell us a little bit about you and what inspires your work in health care.

Dr. Andrew Botham:
Oh, well, I mean, I started out working in the National Health Service in the UK in the laboratory. So I was a bench scientist. I was handling large amounts of blood and well, to be honest, all the fluids as well and doing testing all the time and the really all the unsung heroes of health service because the nurses and the doctors are up front and they do an amazing job and they’re caring for people Right. as the rubber meets the road right on the front lines. But the people who are working in those labs, the ability they have to affect large amounts of people is much, much higher. So a doctor will see a few thousand people over a year, whereas a health care worker, health care scientist in my laboratory that I thought was running not that long ago now supported one percent of the UK population that would have between six and seven hundred thousand blood samples per year. That’s a huge amount of people. And to be able to make a change, even if what is a relatively small change makes a massive difference to those people’s access to health care and their lives ultimately, but also the clinicians. So the doctors and nurses ability to treat them, look after them. And I don’t think there’s anything that you could have such a huge impact with. And I think that there’s a huge amount of opportunities there to be able to help people.

Saul Marquez:
That’s outstanding. And, you know, it’s so great you come from this, I guess, the the legacy system, the way of doing things. And you’re like, there’s just got to be a better way Right. you do so many of these every single year and you start seeing insights. You know, it’s those it’s those distinctions that help us make advances. And so talk to us a little bit about what you guys are doing at TestCard and how you’re adding value to the health care ecosystem.

Dr. Andrew Botham:
Sure. So, you know, one of the things we see is some pathology and the ability to do tests become a little bit of a victim of our own success. We need more and more tests every day. And relatively speaking, a test is quick. It’s cheap, it’s easy to do. And what that means is that clinicians and health care ecosystems are using it more prospectively, so less diagnostically a more sort of as a as a mining expert to just just find out what might be wrong. So we found ourselves testing more and more healthy people. So we’re getting more and more normal’s every single day, which is diluting how much you’re able to see and pick out on how much time you’ve got to spend on the abnormals. I think if you look at health systems really other than very recently because of the crisis, they have really changed very much. We’ve got more people, more tests, more treatments than ever before. But the way health is delivered, how you access health care, you’ve got to get off your couch and you’ve got to go to the emergency room where your primary care doctor and ask them to open the door for you. Really? And yeah, that’s I don’t think that’s scalable. It’s just not the technology in health care is so high, but actually getting us there isn’t. So you can’t keep adding to that system, adding more and more people and expecting it to work. It will continue to work and be the right thing for some people, but it’s not for everyone. So, you know, in the UK, what we’re seeing is that people are putting off going to the doctors. They’re unwilling to take the time off work. They’re trying to convince themselves there’s nothing wrong. They don’t want to hand over a lot of power to someone else and put something in someone else’s hands. And some of them just don’t want to admit that something’s wrong. And we think the best way to overcome that is to actually take a step. Back into people’s homes and offer them the opportunity to start the process there, to take some of the work and weight off the shoulders of clinicians and clinics and give the hand the first step well, to use it to the individual, to the person in their own home.

Saul Marquez:
I think it’s great. And, you know, we we touch on a lot of the the difficulties of taking a day off work or how far is the hospital from your home, urban care or rural care. And so a lot of these things are very real.

Dr. Andrew Botham:
I mean, so many people are isolated from health care generally, and that can be geographically, like you say, they could be out the way it could be economically. I mean, we’re really fortunate in the UL. We don’t get a lot of people economically or geographically isolated from health care, but we still do have a huge amount of people who are socially isolated and social isolation, although we’ve seen a new type with covid that we always had social isolation in the sense that people who are elderly and frail, those with mental health conditions, it isn’t the right thing to be dragging them out of the safety and security of their own home and put them into a health care setting. If anything, you’re putting them in danger by doing that for anything and everything. But then you’ve got the social isolation around the fact that people like you say they don’t want to make that decision. They don’t want to take that step. They don’t want to admit something wrong to offer this as a tool to people to overcome those mental barriers that they put this put up and or offer it to a tool to carers who are looking after people in their homes so they can better advocate for them when they go into and engage with doctors. It just completely changes the power dynamic. And I don’t mean it takes power away from clinicians. I think it empowers an individual or a carer to actually take the steps that they need to take anyway.

Saul Marquez:
Yeah, that’s great. And so, Andrew, just to level set with the with the listener, so TestCard is in at home testing solution. Tell us a little bit about it. And I’d love to to just level set with the listeners on what it is and how you guys are utilizing digital tech to get the answers.

Dr. Andrew Botham:
Sure. So test card is it’s flatpack a urine test kit. So we start starting off in urine testing because one of the big things about health care is it’s quite intimidating. It’s scary. Medical things worry people. They build anxiety. And the more anxious you are, the less confident. Well, so we start off with urine testing because it’s not not as scary as blood testing. People give urine away for free every day. So it’s not really a problem for them. And we’ve put it into a flatpack postcard, which is cheap to manufacture, cheap to deliver, but also it’s a familiar format. So, again, it’s not intimidating. There’s no box that you have to unpack lots of elements to and then line them up on the side and then follow complex instructions. The way we’ve designed it is to create a user journey to build confidence through the whole process. So, I mean, it’s not enough that they have confidence in our product. They need to have confidence in their ability to use our product. Now, I learned very early on in running large laboratories that you’ve got tens of millions of pounds worth of equipment in the laboratory. But the biggest driver of the quality and integrity of a result was actually what happened before the sample ever reached the lab. So it was how that was handled, how it was taken, how it was labeled. All of these things are much bigger drivers than the minor changes in performance you get sometimes within the laboratory analyses. So we wanted to extract or remove as much of those variations and opportunities to do central as possible whilst also bolstering their confidence in their ability to do it.

Saul Marquez:
It’s super interesting. And with the sample, so you get the urine sample on this card and you actually use your mobile phone and you take a picture. So you turn this right. Yeah. You turn this phone into what you guys call a clinical grade scanner.

Dr. Andrew Botham:
Absolutely. Yeah. And we use that term because it kind of encompasses or explains to people the level of quality that we’re able to get on these devices. Now, we’re very lucky that mobile phones, thanks to people’s desire to share pictures of their lunches with one another on Instagram, has has reached the point where the quality of the optics in there is so much better than a lot of the incredible laboratories. So the biggest issues we have around to control of the engineering aspects now we’ve put our tech up alongside a large, large diagnostic company. We are asked to sort of effectively put them side by side with one another. And we looked at 13 different concentrations of urine over ten different replicates in nine different light levels. And we actually outperformed the benchtop readers that I used to read dipsticks in hospitals. And we have the same accuracy. We’re not saying the ones in the hospital weren’t accurate. They were we had the same level of accuracy, but our reliability was higher. So we said the same result more more often.

Saul Marquez:
Wow. So in a way, the innovation here is not only accessibility through, it’s in home and and the prices lower, but you’re also shortening the supply chain to get the results.

Dr. Andrew Botham:
Absolutely. And this means, from my point of view, what this means is sometimes the first time someone sees a doctor, the doctor has something to work with. They already have skipped the step. They already have a piece of empirical data to work on. So they have the same interactions they’ve always had. They’re able to talk to them. They’re able to ask about symptoms. But they’ve also got something to start is they haven’t got to say, OK. That’s great. Now we’re going to do this test and we’ll talk to you again afterwards. So in some cases, we’re going to skip to oh,

Saul Marquez:
OK. Yeah, I didn’t even think about that. It could be a just in time mechanism because how long does it take from when the urine sample gets placed on the car in the picture? Like, how long is that?

Dr. Andrew Botham:
Two minutes.

Saul Marquez:
Two minutes.

Dr. Andrew Botham:
So it’s really quick.

Saul Marquez:
I mean, how long are you waiting in the doctor’s office?

Dr. Andrew Botham:
Well, absolutely.

Saul Marquez:
.

I’ll be back in ten minutes, OK? Yeah, pretty standard.

Dr. Andrew Botham:
But also these these results can be shared securely over electronic systems. So if you do have excellent access to electronic doctor on demand service, these results can be shared directly with the doctor. You may never have to go to the doctor’s office. You can stay at home and have a cup of tea and and wait for them to get back to you.

Saul Marquez:
I mean, it’s clear Right.. I mean, the way it’s different and the way it’s better is clear. Talk to us about how you’ve improved outcomes or made business processes better with this.

Dr. Andrew Botham:
Well, I think there’s there’s two parts to the outcomes, really. Firstly, these give us the opportunity to get people in earlier. So all those excuses they had for not doing things, for not getting to the doctors just go away. They’ve got a low cost solution that could be arrived on their doorstep or they can pick it up at the pharmacy and they can do the tests right away. And that sort of stops them putting things off, which means they get to treatment much earlier, which means that their outcomes are improved, but also the length of treatment has got to be low. So most of these sort of infections that we’re talking about might be treated with antibiotics. We’re going to be able to do lower dose antibiotics for shorter periods of time, which improve antibiotic guardianship, but also mean, in some cases, people that would otherwise have been treated with antibiotics now because we’re removing them from it. So it improves things all the way through, but it also improves the patient’s experience. And that really isn’t, to be honest, the fact that your experience of passing through health care and coming out the other end, you are so much more confident and so much more empowered in what you’re doing if you think the test has been around longer than anything else.

Dr. Andrew Botham:
So the urine pregnancy test, people are so used to seeing them in people in their homes and the amount of people who use them, I think every everyone who gets pregnant uses them or is trying to get pregnant. So they’re really well established. They’re really invented. But still, the first thing a woman does, having done a pregnancy test, is to another pregnancy test. And the next thing they do is go to their doctor and have them do a pregnancy test. Yeah. And that that isn’t because the test the doctor’s doing is any better than they would have done and put money on the table and say the one that woman did at home was she probably did it better because she read those instructions and followed them to the letter because she’s 100 percent invested in the outcome of that result. The difference is she doesn’t have confidence in her ability to produce such an important piece of information. So our entire system really is about driving that confidence and changing how they feel about their party things so they no longer feel that stuff’s happening to them, that it’s happening with.

Saul Marquez:
That’s really neat. And that’s and that’s the paradigm shift.

Dr. Andrew Botham:
Absolutely.

Saul Marquez:
Super interesting, Andrew. And and so it is that confidence in the results. And you guys are doing a great job of building that. And the shift to home care and self care is one that’s very real. And a lot of large companies and innovators, new companies coming into space are are certainly placing their bets and doing the work to get it to where it needs to be. What would you say, as you guys have been building, Andrew, has been one of the biggest setbacks that you learn so much from. What is the key learning?

Dr. Andrew Botham:
Oh, I think our biggest setback was just convincing people it was the right thing to do. What’s happened with the current crisis, as awful as it’s been, has changed the risk to gain ratio of home testing. And people can now see much more readily the value of allowing people to be able to do many of these things in their own homes when there isn’t another option for them. It’s just it took us a very long while. We’ve been sort of shouting from the rooftops for years. This is the right thing to do that we need to be moving to prevent preemptive preventative models of health care, giving people the ability to do first steps in homes. And now and now we’re starting to see that. And that that is great. That that’s happening is so sad that this has had to happen for that to be the case. And the other side of it, I’d say, is probably the setbacks on the regulatory side of things which no one is ever surprised to hear. I have to say, you always expect things are going to be fast. So the regulatory agencies, they are very slow to work with. And also they’re not quite ready for a lot of the digital solutions out there. So they’re nearly there. They’re getting there is just they’re all sort of flexing their muscles when it comes to digital health a little bit and understanding what it means and what it’s going to mean for them. But you’re you’re effectively having standards of rules being applied to you, which are made for much older systems. Some of those things need to be looked at just to ensure that we’re not holding people back for the wrong reasons. Let’s put it that way.

Saul Marquez:
Yeah, that makes a lot of sense. And and and think about the the difference that you guys can make and that you’re making. And it’s exciting and a good reason to. Stay in the game, so I’m glad you guys have. Now let’s talk about availability. You guys I know you guys are UK based and is this thing available in the UK? Is it available in the US? tell us where it’s available for use?

Dr. Andrew Botham:
So we just launched in the U.K. That’s going to follow very closely by several other launches in Europe because I see which is required for Europe, covers for the whole of Europe. We’re going to go U.K. than Scandinavia, but we do have our FDA finding. And so that’s all we need to effectively to be a medical device within the US. That is a step we’re open. That’s going to be in January that we’re going to be going there. But as I said, these things are often move a lot slower than you expect, even if you build in possible delays. So we’re expecting to be the, let’s say, first quarter next year of it.

Saul Marquez:
Super exciting. So if you’re listening in Europe and you’re looking for some some interesting partnerships, ways to do things better, certainly consider the work being done at TestCard and then in the US. Well, it’s coming, so sometimes it’s easier to get ahead of it, understand it. And you see a potential partnership here, an opportunity to to drive better outcomes, lower costs. Certainly a dynamic team over there at TestCard that I would encourage you guys connect with. So, Andrew, what are you most excited about today?

Dr. Andrew Botham:
Oh, I’m I’m just bouncing around like a puppy at the moment. Everything seems to be exciting. Me, just as it’s been a long time, seems to be a long gestation for this particular project. And to see it just coming to life now and seeing know recruiting more staff and expanding and growing and scaling is just amazing. But I think probably the most exciting thing that’s happening at the moment is the conversations we’re having to help deal with the COVID response. So people are saying the covid response is really just about COVID. It’s not the amount of people that aren’t accessing health care when they need to it because they’re so afraid of going into health care settings because of COVID they’re staying at home and they’re just getting sicker.

So the partnerships that we’re starting to put together with other fantastic companies, such as 14 medical solutions that do a incredibly high quality system to be able to take urine samples, to be able to provide people the opportunity and ability to still manage their own health in their own home. So one of the ones we’re doing at the moment is round up is around pregnancy, actually. So pregnant women who have to come in for their regular checkups, we’re putting together effectively sort of a little love in a box style set up that can be sent to pregnant women so they can stay within their own home so they don’t have to come into health care settings. They can do all the assessments they need to do. They can access the health care they need and the advice they need. I think that’s probably the single most exciting thing we’re doing that is exciting and and something that we need.

Saul Marquez:
So kudos to you and your team, Andrew, for for the work being done here. And so getting here toward the end of the podcast, I love if you could just leave us with the closing thought and the best place that listeners that are intrigued or want to learn more can engage with you and your team.

Dr. Andrew Botham:
You can access any information that’s coming through our website, TestCard.com. We also have a Twitter feed where we give a lot of advice to people who might have different health conditions related to Tesco. But I’m pretty accessible. I’m happy to answer people’s emails. They might get a bit fed up from hearing from me if they start emailing me and asking me advice, because I will always give it a yes. By all means, just get directly in touch with. We’ve got an amazing team here and we’re extremely lucky. And I think TestCard is a really good idea, definitely. But there are a lot of really good ideas out there that never make it anywhere. And I think the reason TestCard has got to market is because we’ve been extremely fortunate to not just have a good idea, but to have some amazing people involved. Our designers, our programmers, our everyone is just they they get it. They’ve not just bought into it from a point of view of a job and salary. They’ve bought into it because they really believe this is the right thing to do and we’re really blessed to have them.

Saul Marquez:
That’s awesome. That’s a great message and testament to to the why behind what you guys are doing. Andrew, I can’t thank you enough for spending time with us today. Listeners TestCard.com or go to OutcomesRocket.com type in TestCard in the search bar for the full transcript and links to everything we talked about today. Andrew, thanks again.

Dr. Andrew Botham:
Thank you. Saul.

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