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  Tyler Suiters                      

  This special edition of CES Tech Talk is brought to you by DnaNudge. DnaNudge is the world's first service to use your own DNA, plus your lifestyle, to nudge you toward healthier choices each time you shop.

  Tyler Suiters                      

  Hey, everybody. With the Consumer Technology Association, I'm Tyler Suiters. We are the owners and the producers of CES, the world's largest, most influential tech event. And we are here to help you get CES Ready. The show is January 7th through the 10th, 2020, in Las Vegas, and today a deep dive into one aspect of digital health. All the ways that tech is helping us be healthier and better informed about our wellness. And really it's that second outcome we're focusing on today.

  Tyler Suiters                      

  We are talking with a UK company called DnaNudge, and this is a company that can use your own DNA to help you make healthier choices when you're shopping for groceries, so knowing what is best for you based on exactly who you are and, I think you can say, what you are. We can't help but sometimes make poor dietary choices, some of us more frequently than others. But is that the result of us not really caring about what we're eating or the choices we're making, or is it more because we honestly just don't know and aren't well enough informed about what the right choices are? Well this is a topic that DnaNudge is taking on head on, and it's a very personal story as we'll hear from their founders. So today, what a startup, a research university and a supermarket chain in the UK are doing to drive forward one aspect of digital health. That's this edition of CES Tech Talk.

  Tyler Suiters                      

  Joining us today from London, England, are Professor Chris Toumazou, who is CEO and co-founder of DnaNudge, and also Dr. Jonathan Pearson-Stuttard, who is the Wellcome Trust Clinical Research Fellow at the School of Public Health at the Imperial College of London. Gentlemen, good morning/good afternoon to you both, and thank you for being here.

  Chris Toumazou               

  Yes, good afternoon to you.

  Dr. Jonathan Pearson-Stuttard  

  Good afternoon.

  Tyler Suiters                      

  So somewhat diverse backgrounds between the two of you. Can we begin by hearing how you both came together and why your backgrounds mesh so well for the DnaNudge project? And, Chris, why don't we start with you?

  Chris Toumazou               

  Yes, so I think the linkage is Imperial College London. I'm a professor there, as well as the CEO of DnaNudge, and Johnny is a Doctor of Public Health in Imperial College, and I guess very much we come from a background of engineering and science effectively. I'm an engineer, and I enjoy the sort of gadgetry of technology, and I've moved for many years towards personalized healthcare and seen how we can apply technology to healthcare, [inaudible 00 03 28] consumer health, and Johnny comes from a public health background. So our paths were meant to meet some time—

  Tyler Suiters                      

  [laughing].

  Chris Toumazou               

  —and now's the time they've met [inaudible 00:03:39] brought to the public with this technology.

  Tyler Suiters

  [laughing] Well, Jonathan, coming from your background in public health, did you imagine yourself being in a tech startup space at some point?

  Dr. Jonathan Pearson-Stuttard  

  No, this is extremely exciting. One of the... many of the biggest challenges that we face in public health are diet related. And I spend lots of my time looking at what different policies we should be looking at to improve diet-related health and also the academic side, specifically around diabetes and other conditions. And so, when I met Chris, and he introduced me to DnaNudge, we really saw the potential of "what can we do with such innovative technology when applied to specific populations or groups susceptible to certain diseases?" and it's really exciting.

  Tyler Suiters                      

  Where did the inspiration come from? Speaking from a more American perspective, I would say, there are various elements of growing health challenges that we have certainly, and I think that related to the problems DnaNudge solves, Type 2 diabetes is one that that comes to mind where the diet that you are following, or not following, is so closely linked to the status of your health or that condition particularly. So is it the same case in England or the EU, and what exactly was it that drove you all to try and reach the marketplace with this?

  Dr. Jonathan Pearson-Stuttard

  I can begin, I guess, with a personal reason. Many years ago, my son lost his kidneys through renal genetic predisposition. He was 8 years old, and it just demonstrated how primitive chronic disease management was. As parents or [caretakers] looking after a sick child, particularly out of the hospital than in the sort of home environment, it's very, very difficult. And there's sort of a paranoia about whether the blood pressure is correct, whether the heart rate's correct, whether the glucose levels are correct, really, really did demonstrate that unless something's done and technology is demystified and brought to the consumer in a very friendly way, we're going to lose kids like Marcus as years go by.

  Dr. Jonathan Pearson-Stuttard  

  Now, I'm not saying that the source of inspiration was to sort of save life necessarily by inventing prophetic technology, but if we'd known early enough, we could have managed his lifestyle very differently and therefore avoided almost a mini engine growing in the Rolls-Royce car. You know? So, prevention is really the key to me. And I thought, well, we've got these wonderful consumer technologies out there. We've invested billions in sort of the semiconductor industry, all of these gadgets. If we just apply a fraction of this to healthcare, maybe we can make major innovation and bring what the consumer understands, but use it for prevention and to sort of, therefore, help with reducing chronic disease. That was really the starting point, I guess, of a lot of this work on personalized health.

  Tyler Suiters                      

  Well, before we go too deeply into the inspiration and the potential outcomes, Chris, I think this is a great time to give your personal view on what exactly DnaNudge does and the practical uses for consumers who are looking at it right now because you are now in the marketplace.

  Chris Toumazou

  Yes, so I think really the most important aspect of DnaNudge is really enabling consumers to make very, very small changes in their diet initially without them realizing it. It's almost, sort of, saying the best diet is a diet you don't know you're having. I think this is where we've gone wrong before. You know, trying to change behavior just doesn't work. And a lot of the technologies out there are quite aggressive with that. They're really thinking that by giving people information, they can go and just act on their own. And we know that compliance like that just doesn't work. That's why we've got an obese population.

  Chris Toumazou               

  Even with national guidelines, you know, people aren't complying. So, really, DnaNudge is a service, a retail service, where we're trying to nudge people towards healthier food choices predominately based upon their DNA. And it's not radically changing behavior. It's actually giving people more choices within their natural behavior. So we're not saying eat a banana instead of a biscuit. They can still eat a biscuit, but this is the better biscuit based upon their DNA. So the DNA almost becomes their authority now, and they're guided by their DNA. And that really was the key to this, and we're finding it really [inaudible 00:08:45] seems to be working.

  Tyler Suiters                      

  [laughing] ...which is wonderful news for company and consumer alike.

  Tyler Suiters                      

  Jonathan, walk us through, if you would, how the technology works once you set foot in a grocery store, in a supermarket, and you're using the DnaNudge product as you walk down the aisles, and, as Chris said, you are making choices.

  Dr. Jonathan Pearson-Stuttard  

  Yes, absolutely. And, as you say, what's so innovative about this technology is that it's at that point of decision that you're being informed as to what the better choices. So, when a person walks into the store, they use either the Apple net phone or the DnaNudge band and scan the barcode of a given food and that will give on the band a simple red or green. Is it good for you? Is it not? And then similarly, on the app, it will tell you if it's a red, why is it a red? Is that because the sugar levels are too high or the saturated fat too high or what might it be?

  Dr. Jonathan Pearson-Stuttard  

  I mean instead of just saying this is a red, it will then offer alternatives which are healthier, both combining the DNA of that person and also the dietary guidelines, as Chris said. And so that way, we're able to look... and importantly within all of these choices when substitutes are offered, they're within a given category. So as Chris said, if you scan a given chocolate bar or some cereal, for example, it won't be suggesting you go and have a banana. It will be within that food category. This is an alternative food that is better for you because of the given macronutrients being higher or lower accordingly.

  Tyler Suiters                      

  [inaudible] Jonathan, given your expertise on public health, to what extent is it true that we all, and this is a general “we,” but as consumers, we want to make good choices. We want to do what's healthy for us, but we just don't know how to go about doing so or we're poor or inefficient at making those good choices versus actively making bad choices for ourselves because we feel like it or we like the taste of this better than that.

  Dr. Jonathan Pearson-Stuttard  

  Well, no, you make a very good and important point in that nobody sets out to be unhealthy, and no one sets out to get illnesses. What we know now is that the environment around us, whether that's the environment when you're in a store or the advertising you see when you're on the public transport, is always emphasizing and nudging us towards the unhealthy rather than the healthy food. What DnaNudge is trying to do is trying to make the healthy choice the easy choice by providing that information and the actions that can go with that at the point that you're making that decision. The evidence is very good at providing information alone. We all know we should have five bits of fruit and veg a day, yet the vast majority of the population don't, but actually providing that information at the time when you're making the decision, and actionable information so that you can make a healthier substitute, is much more likely to be beneficial.

  Tyler Suiters                      

  Mm-hmm (affirmative). Chris, what about, I call it the other half of this technology and the product, but the side of monitoring, right? Lifestyle. Activity monitoring is something we're well aware of and accustomed to, I think, whether you're a tech follower or not, the idea of wearable fitness technology has been here for a number of years and so many of us are using it whether it's something as elementary as step counting or even much broader like a glucose monitor, let's say. But then DnaNudge takes into account inactivity monitoring as well. Right? How little we're acting, how few calories we're burning, how poorly we're exercising. Correct?

  Chris Toumazou               

  Correct, correct, correct, and I think this is one of the biggest, biggest lifestyle pushes today that any wearable should have. I think the issue up until now has been a lot of these wearables affect the open loop, and nobody's really related—which I think is epidemic right now—inactivity and sitting time. That's become the new smoking, you know. Half an hour of sitting, some people are saying is equivalent to smoking a cigarette. And you know, big meta studies now on millions of people are showing that even if you went to the gym following national activity guidelines, say one or two hours of full intensive exercise a day in a gym, will not compensate for the health effects of sitting for more than six hours. So sitting is really epidemic. And so what we decided to do was to relate sedentary and sitting time to nutrition and DNA, because they're the three things that like, [inaudible 00:13:37] you know, we weren't born to sit. We have to eat healthier, you have to eat healthier.

  Chris Toumazou               

  Our DNA is our makeup. So effectively combining those three things in the way we've done it, we've done it in a closed-loop way. No other wearable does this. Fitbit, Apple Watches, these are all open loop. They say walk 10,000 steps, and you walk 10,000 steps, and after a while, you get fed up with walking your 10,000 steps. But you're not getting the real feedback. Sometimes, you put on weight because you reward yourself with more food if you think you deserve it for walking 10,000 steps. So what we've done, we've introduced this concept of the green DNA bar and sedentary behavior. We believe that if your genetics is such, and these are your green traits, this is as good as it gets. Your DNA is as good as it gets. So don't pollute your DNA with lifestyle. So we've introduced an amber in the red and green, and the amber, I think yellow as far as the Americans are concerned, is our equivalent to your traffic-light yellow, okay, it's the amber.

  Chris Toumazou               

  So if you effectively sat down for more than half an hour, your green DNA bar starts to turn amber, which means that the good green product that you went to scan is no longer green. It's amber. To take it back to green, you need to move a little. So there's that reward then. So effectively, the worst of the green products, you know the gut reaction of why that chocolate bar is green to mean, it will become amber, you're not deserving of that product. It's slightly unhealthier to you because you've been sat down too long.

  Chris Toumazou               

  So we've got this bar in the app, which is the green bar as I say, and you've got to avoid that bar totally becoming amber. You can set that for the number of hours you want to sit throughout the day and then the steps come in because you can then set a number of steps to cancel half an hour of sitting. For my setting, it's five hundred steps for every half an hour of sitting. So it's closing the loop and it's related to nutrition, and that's never been done before because this way around, it becomes a dynamic continuous thing. You know your DNA is fixed, but it's your lifestyle that's polluting it, so therefore try and keep it green on a daily basis. That's the sort of emphasis—

  Tyler Suiters

  So—

  Chris Toumazou

  —very different from what anybody else is doing.

  Tyler Suiters                      

  [inaudible 00:16:09] —clearly, Chris, in terms of your point, that is all a level of engagement, right? The feedback, to some extent, a back and forth and these recommendations of what you should do or you, as in the general population, should do regarding step count or inactivity, et cetera. Let's delve into the element of DnaNudge that I think is inspiration for the name. That is the DNA aspect because this is a highly personalized engagement and interaction. This isn't just general advice and not even, you know, halfway deep toward your height, your weight, your body mass index, let's say. This is about who you are and your genetic makeup.

  Chris Toumazou               

  Exactly, exactly. And what we tried to do... there are three really important achievements I think with DnaNudge. I mean the first is that we've invented an entire laboratory on a little chip, so no puppets, no white coats and no three months waiting for results. It's all done in situ on a very, very little cartridge. And the big deal of that, by the way, is getting what we call the sample preparation on the cartridge. That's actually extracting DNA from cheek swabs or saliva on the cartridge itself. And that's all done in the retail environment, so that's one big major thing. Cause what people want ... people want to do a test, they want their results then and there. They don't want to have to wait three weeks. So there's the emotional attachment to their DNA. They get their report within an hour. Within an hour, we can process everything and on their app, they'll see their genetic trait and that really is a very emotional attachment to them.

  Chris Toumazou               

  And what we're doing, as I mentioned earlier, you know there's so much out there in the field of DNA, I was one of the inventors of semiconductor sequencing. So you know a lot of hospitals use semiconductor technology to sequence your genome. But we're not interested in sequencing your whole genome. We're just looking at particular genetic traits related to nutrition-related medical condition. We're not looking at metabolism, for example, which a number of other... several companies do, where they're looking at whether you can metabolize carbohydrates, the DNA is metabolizing sugar, the DNA is metabolizing salt. We're not doing any of that. What we're doing is we're looking purely at the key medical condition that we know diet will affect, things like Type 2 diabetes, as we mentioned, obesity and cardiovascular-type diseases, heart diseases through cholesterol, et cetera, and hypertension.

  Chris Toumazou               

  These are very, very, very well versed [inaudible 00:19:08] based upon massive populations. And clinicians will use this important information. What we do then is we know that if you've got one or two of those genetic traits, then as a clinician or a dietician, they would look at that and they'd say to the patient, for example, who might have prediabetes, they think you need to be careful of saturated fat, sugar, fat, for example. Those are the macronutrients that you should be careful of. If you've got the hypertension gene, it's salt that you should be careful of. And so what we're really doing is giving sort of real medical advice. We're guiding the consumer through macronutrients to be aware of their health rather than the other way around. Say, look, you're going to get Type 2 diabetes. You should have these macronutrients. So, in a way, we try to demystify that.

  Chris Toumazou               

  A disclaimer from DnaNudge you'll find with the activity monitoring, you know, this isn't a hundred percent precise, you know, risk isn't that precise, nor is activity monitoring that precise. But what we try and do is we try and compress it into just the differences we set between two biscuits. So as long as we can guide people to make healthier choices, then we've achieved our objective.

  Chris Toumazou               

  We're not trying to sort of look at, you know, 30, 40, 50 genes that would determine whether or not you're predisposed to a particular cancer, et cetera, et cetera. That's not what we're trying to do. And, in a way, on each cartridge or a niche, we call them primers, effectively. We're just focused in that particular area of your genome that's associated with those particular conditions. We will get another cartridge later in the year for supplements, for example, and vitamins, which will be another area of the cartridge that we'll be looking at, so that's the way we're guiding people. We're using a medical condition to macronutrients, macronutrients we know exist in all these different products. We've got a complete cloud up there with every single product in every single supermarket in the UK, and we relate all those macronutrients to those genetic predispositions. And, therefore, once you've had your test, we know what macronutrients relate to you. That's basically the personalization.

  Tyler Suiters                      

  Jonathan, is there an indication or any research in the larger public space regarding public health of our behavior for specific or even general guidelines for health versus our behavior around guidelines that are tailored specifically or explicitly to us? So say the difference between government-recommended daily allowances, which are broad, versus a personal doctor telling each one of us, here's what you need to do and what you need to eat, et cetera, et cetera.

  Dr. Jonathan Pearson-Stuttard  

  Sure. Yes, it's a really good question. Two things to be clear then. One is that within the provision of information that certainly it is more effective when given at an individual level and not contextualized around that person's life and what the purpose of this is, whether that's to reduce their risk of a given disease or otherwise, but that across the provision of information in general, we know that providing information alone often isn't enough, and the evidence is much stronger that if it's providing information and then what that person can do about it, is much more empowering because otherwise what we can find is, across the spectrum, whether that's genetics or otherwise, is actually providing information to tell somebody they're at an increased risk of X disease can be quite disempowering because the individual may ... clearly they don't understand what that might mean, but more importantly they don't know what they can do and that's basically saying to them, you're determined that your fate is etched, and that sometimes can be quite unhelpful.

  Dr. Jonathan Pearson-Stuttard  

  The flip side is clearly as well that making the environment around it more healthy is also very important. And one of the really interesting partnerships with DnaNudge that they have is actually with retailers. So as Chris mentioned, to be able to get all of the bar codes and so forth with several partnerships that DnaNudge has with retailers. Now by working with the retailers to actually see which of their products are more likely to be red, which are their products are more likely to be green according to a given population that's using the dietary guideline and as Chris says, the DNA predispositions, then what that can do actually is encourage the retailers to reformulate which foods they have in store, where they have ... so they have more green and healthy food, more accessible. And so if those actually changing the environment actually as well as empowering individuals to make those healthy choices.

  Tyler Suiters                      

  [inaudible] Chris, sorry Chris, back to you. I'm curious what comes next in terms of the marketplace. You're now in grocery stores in the UK, the initial step of getting DnaNudge to a consumer market. Do you see it crossing over into other verticals, other spaces, what lies ahead? As an innovator, you're always thinking about what's next and if not, what's next after what's next? So take us a step or two ahead of where you are now.

  Chris Toumazou               

  Yeah, so where we are now, we've got most of the supermarkets in the UK covered. We are obviously launching in the U.S., and CES is going to be a good platform for us. They're work allies there. And this is predominantly a sort of business-to-consumer business, which is where we want to be. It's affordable health. The cost is really, really significantly lower than any other sort of genetic test, and we want to make it affordable. And then we see this escalating both vertically and horizontally. You know obviously we've got the cartridge business, a bit like Nespresso, so we're going to introduce the next cartridge, which is supplements. We've also got one for skincare, which is a bit later on down the line so we're going down that route.

  Chris Toumazou               

  But the business-to-business is also very important to us because, as Johnny said, if we can now collect swaps of people that we can check through the cloud, we don't, everything's anonymized. All we're looking at is what this code is swapping in terms of this product to this product. So we can monitor the green to red swaps. And that information is really, really, really valuable. It's valuable for the manufacturers, it's valuable for the retailers.

  Tyler Suiters                      

  What about the technology itself, and Chris and Jonathan, this is for both of you. Where do you think this will go in the future? I mean, how does this develop moving forward, not just the applications of it but the technology itself, the DNA analysis, the scanning, the feedback, the engagement, et cetera?

  Chris Toumazou               

  Yeah, I can see two [inaudible 00:27:52] I mean, first of all, we're moving already away from just genomics to proteomics where you're actually looking at sort of almost epigenetics and lifestyle changes automatically, so real time sort of monitoring gene expression. That's going to be very, very important for us. So we can look at that, we can look at allergies in the future, all sorts of medical predispositions. I mean, initially, when I kicked this off, it was applied to cosmetics, and this was a few years ago, and the reason I went straight to cosmetics was really to sort of demystify the whole genetic testing thing and use vanity for health care. And if I could get people to sort of understand that actually a genetic test is not a bad thing, it's not just all about disease, it's about prevention. The number of women that gave up smoking as a result of their skin DNA, not because you show them a carotid lung on the back of a cigarette box, but you show them a mirror instead as a result of the DNA, their skin was phenomenal.

  Chris Toumazou               

  My dream has always been effectively that you could go into retail one day and have a test for the BRCA gene or for a cancer gene, and then it would be that, Oh, it's that simple technology and given in such a way that everything's translated, everything's demystified, and it's preventative, so empowering the consumer to bulldoze big pharma and healthcare rather than the other way around is the way we're trying to push this from a sort of large scale perspective. Anyway.

  Tyler Suiters                      

  [inaudible] So let's now scale back a bit to the more immediate future in the next month or so. Let's talk about what DnaNudge has planned for CES 2020. Obviously, expectations are heightened now from anyone who is attending and knows what the technology is about, the potential it has to reach business-to-consumer, business-to-business. What's the story you're going to tell? What is your strategy going into CES 2020?

  Chris Toumazou               

  I think that we'll demonstrate at the stand. We'll do tests there. People can then scan products. We've got U.S. products out there, we'll have some of the Walmart/Walgreen varieties of U.S. products on our stand. People will get that emotional attachment straight away. They'll see their results straight away. They scan products and they say, wow, I didn't realize this. They look at product labels, and they've wondered why salted peanuts that they were buying for years have got actually so much more salt than they thought that they had, and the packet next to them is a better salted peanuts for them. So, if we can get that message across, that nudging message across, and... I was presenting this a few years ago. I was planning to present this a couple of years ago and actually, the timing was quite good then when Richard Thaler won his Nobel prize in economics for nudge theory, but the big difference being that here where I want to demonstrate that we're using biology to nudge you, we're not using marketing to nudge you.

  Chris Toumazou               

  It's getting that authority across, and I think if we can just demo that and we come in the U.S., create what we're doing over here in the UK, a flagship shop somewhere either in the East coast or the West coast, one in each possibly, and then ring-fence it with the nudge stations in a few retailers arrived and use that as the sort of franchise-type business model to expand. And eventually, when we want to reach the millions, we don't necessarily... everybody doesn't need to come into the shop and have the nudge experience. We could go towards direct-to-consumer because people will realize that their test is being done in the retailer, they will see that their cartridge is being destroyed so we don't all keep genetic information at all, don't store any DNA information. We use cheek swabs, which is a one-stop shop that you can't keep any of the genetic tissue. So, effectively, if we can just incubate the similar model that we're doing over in the U.S. and then obviously Asia will be the step after that.

  Tyler Suiters                      

  I can't let either of you all go without a final question, Jonathan first, then Chris. Who's your primary league football club? We've got to realize what the situation is and where the focus is on public wellness right now in England, and I'm sure it's on football year-round.

  Dr. Jonathan Pearson-Stuttard  

  Well, but my wellness levels are always pretty grim given that my team is Newcastle United. It's been 21 or 22 years of disappointment, sadly, but I'm forever optimistic.

  Tyler Suiters                      

  [laughing] Understood. Chris?

  Chris Toumazou               

  Yeah, I'm not an avid football supporter, but I'm getting really into football right now. There's one feature actually, if I could just throw it in, I didn't mention, related to football and that is the sort of peer-to-peer and the educational aspects of Nudge. We've got this wonderful feature called Nudge Match, and this is where there's some gamification with the wearable. You can actually touch two wearables and then you can indicate how close you are with your genetic traits in terms of matching, so for the nutritional traits, I could be 70% matched with Johnny. That would be a green. I could be an amber, which would mean we're between 17 and 40%, or below 40% would be a red. I think it's great that the educational peer-to-peer aspects, for example, David Beckham's genes could be great.

  Chris Toumazou               

  Imagine him matching with an obese kid, and this obese kid sees I've got similar traits to David Beckham. All of a sudden, you've then introduced this sort of peer-to-peer angle. In sort of personalized medicine, people always talk about quantified self. Well, I believe in quantified others. I think a lot of us want to compare ourselves to others. Then you can create forums of people that have got similar DNA to you. You can have a, sort of... if I could find people my age group that had similar traits to me, we could then share information about what we're eating or what we're wearing, et cetera, et cetera. And then I think that will be a new type of social network, but based upon health and making each other healthier through this sort of network of nudge matching. So that's something we want to introduce, and we're calling it the Confidence Campaign, where we get celebrities such as football players and sportsman to match with possibly obese kids or with the general public, just to sort of then start to get forums going together.

  Tyler Suiters                      

  Hmm. The product DnaNudge is now available in some UK supermarkets and the possibilities seem almost limitless in terms of consumer applications. Jonathan Pearson-Stuttard is with the School of Public Health at Imperial College London. Professor Chris Toumazou is CEO and co-founder of DnaNudge. Gentlemen, thank you both for your time, and we look forward to seeing you in sunny Las Vegas at CES 2020.

  Chris Toumazou               

  [crosstalk 00:34:20] Thank you very much. Have a good afternoon.

  Dr. Jonathan Pearson-Stuttard

  Thank you.

  Tyler Suiters                      

  We want you to be CES Ready, so subscribe to this CES Tech Talk podcast, and that way you won't miss a single episode as you're getting ready for CES 2020. The show is January 7th through the 10th in Las Vegas. The information you need is at CES.tech. None of this would be remotely possible without the true stars of our podcast, executive producer Tina Anthony and our senior studio engineer, John Lindsey. You two are the best in the business. I'm Tyler Suiters. Let's talk tech again soon.