Dr Andrew Greenland: 0:00

So welcome back to another episode of Voices in Health and Wellness. This is the podcast where we speak with founders, clinicians, and innovators shaping the future of care connection and client outcomes in health and wellness. Today's guest is Dr. John Oberg, founder of Pristina Health, a company that's redefining what longevity and preventative care can look like when powered by data, science, and deep clinical insight. John, welcome to the show. Thank you so much for giving up your time this afternoon. A very warm welcome to you.

Dr John Oberg: 0:26

Well, and thank you so much for having me. I'm really looking forward to the conversation.

Dr Andrew Greenland: 0:30

Wonderful. So maybe you could start at the top. Could you perhaps share a little about your role and perhaps how you ended up doing what you do? Because I think it's always interesting to hear about the journey of the guest.

Dr John Oberg: 0:39

You know, it's I tell people I think I got here by accident. Uh I did not start out to do this in the beginning of my career. Uh, but in 2014, I started a company called Sidera Health that dealt with medical cost sharing. So on the payer side, we were trying to solve the problem that payers experience and the cost of healthcare in America. And so we had some really interesting solutions. And that was my first kind of broad experience to chronic disease and all the problems people were facing, the expense of health care. And then a few years later, my mother-in-law, who had been diagnosed with type 2 diabetes quite some time ago, had um a diabetic event and she ended up in the hospital. And the problem with that was that it was totally avoidable. Had she had a couple of shots of insulin that were timed correctly, she could have avoided a cost of $100,000 here in the US that was paid for by the taxpayer. So she's on Medicare. And so, so all the taxpayers in the United States paid for this $100,000 medical visit that could have been solved with, you know, two shots of insulin, significantly less than $100, right? And so I got really frustrated. And so I went back to the University of Southern California and I said, hey, I had some friends there. I said, I want to get my doctorate and I want to solve type 2 diabetes. And they kind of looked at me like I was cute, like, oh, that's that's nice. We've been trying to solve type 2 diabetes for decades. Uh and so we'll take your money. You can come study with us. Probably not going to solve type 2 diabetes. And so we went out. Um, I have a partner who's a medical doctor who I was working with, and we wrote some medical protocols. And in our first pilot study, we took 50 patients that were in rural locations that had low income and low access to care. They had an average hemoglobin A1C of 9.6, which I think you measure a little bit differently, maybe in the UK. Uh, and so 6.5 is when you hit the diabetic threshold for most people. And we reduced that a hemoglobin A1C to 6.4 in 12 weeks for the 49 out of 50 patients. We had one patient who had an autoimmune issue that was far more complicated. And then we kept that group, 83% of them in control for the next two years, and everyone stayed out of the hospital for the next two years, like not a single hospital event for anything diabetes or diabetes related. And so the advisors in the program, when they saw this data, were of course stunned. And so uh since then, we just finished the study that we're uh about to send out for publishing. We, you know, instant institutional review board came through, looked at everything we've done, and it we took patients from uh 79 patients at this time from a hemoglobin A1C of 11.06 down to 7.2 in 60 days, and sorry, in six months, and 30% of the patients we were able to discontinue insulin use after six months. And so we've had some radically um different results than the rest of the industry. We're doing things very, very differently, but we've had to restructure the entire way that we look at the field of medicine and mental health and how they work together and how we get patients involved in the being an agent for themselves in the process. I could geek out about this for hours.

Dr Andrew Greenland: 3:39

Fascinating. Can you give us a little bit of insight into what you actually did for these people just to give us a little bit of clinical background?

Dr John Oberg: 3:47

So the first thing we do is look at all of the medical conditions that a patient is dealing with because rarely is it just one thing. And so we've met patients that are taking 20 medicines over five time frames every day. And you're quite familiar with this, I'm sure. And so it's a very complicated medical situation. And so we take in all the information about all those medical situations, hospitalizations, pharmacy, you know, all of the disease, uh, you know, all the diseases. And then we look at all of the mental health conditions they may be facing. And we split those into two buckets. There's mental health conditions like anxiety, stress, and depression that are a result of those medical conditions. And then there's all of the mental health issues that are a result of something else. And we split those out because you handle them differently in terms of how you intervene. Then we look at a number of non-clinical measures, things like some of the social determinants of health and some other non-clinical variables, and we normalize those with a severity scoring so we can see what's most severe. And then we push that against the patient's readiness for change for any single variable. And by doing all of that, we figure out where the patient is ready to change and what's most urgent, and we focus the entire care team on that one thing at a time, and then we make a radically incremental plan so that people are changing only the smallest things one at a time to build momentum so they can move from getting on the right medication to medical adherence to then getting lifestyle interventions at the right time. But generally speaking, there's too many changes that are trying to happen. The changes are too big, there's conflicting information, there's too much science, the patient's overwhelmed and confused. And it leads to the problem we've had, which is we know what to do and no one's doing it. And then you get doctors saying things like, the patients are lazy, or I've educated them, they won't do it, or they're non-adherent. And those are just bad labels for we've failed the patient. The truth is we haven't given the patient a plan that can work. The patient needs to have an expert plan where the patient is a part of the planning so they can tell people what they're willing to do. Like if they're eating Captain Crunch for breakfast every morning, they're probably not going to move to kale and carrots tomorrow. It may take some time to get there. And so you've got to give people very small interventions. For us, change your coffee creamer. Just move from one brand to another brand or one flavor to another flavor. Just take tiny, tiny little steps. Don't go run a mile, walk to your mailbox. This is the type of really tiny intervention we start with.

Dr Andrew Greenland: 6:09

Amazing. So from a patient's perspective, what does the journey look like from their perspective in terms of who are they interfacing with and how does this actually all pan out practically?

Dr John Oberg: 6:18

Yeah, so in our practice, we have physicians and then we have um nurse practitioners and physicians' associates, and then we have uh therapists, clinical therapists. And so, and they operate in a pod so that whoever the patient needs to talk to, they can talk to. They have a relationship with a physician and a nurse practitioner or a physician's associate and a mental health uh clinician. And so that whole team of people all intervenes in a kind of a uniform way. Uh, obviously, the mental health clinicians dealing with mental health issues and the doctors and physics, you know, are dealing with the prescription issues, but we're all working together to make sure that the patient gets the one correct next step. Generally speaking, we bring someone to the practice, we get all of their medical charts from a whole bunch of different places. It might be a couple of thousand pages of documentation that we bring into the practice. And then we do something crazy. Our physicians read the patient's chart before they meet with the patient. We actually want to know what people have said so that we come prepared for the conversation. Now we use um AI to kind of flag the most important things to know and to get through all that information in a time-sensitive way. But the reality is we walk into that first visit knowing something about the patient. The patient, of course, loves that. And then we help the patient make a plan. Generally speaking, we start with medications to make sure that they're on the right medication, they're able to adhere to the medication plan, which is often a much bigger problem than people recognize. And then we start talking about lifestyle interventions when the patient's ready for that. And sometimes that's in the first week, but sometimes that's 90 days later. Sometimes the patient just needs confidence that what we're doing is going to work.

Dr Andrew Greenland: 7:57

So you mentioned you've done a lot of work around diabetes and improving the metrics on diabetes. Does your work extend beyond that single condition, or is that your kind of flagship thing that you're working with at the moment? How's this going to kind of expand?

Dr John Oberg: 8:09

Yeah, it's I'd say both. So it's the thing we talk about publicly because it's the easiest thing to understand. But we also work with people that have cardiovascular disease. Our particular protocols work extraordinarily well with patients we have today that have hypertension, that have uh CHF. And then we also, of course, uh are working with patients that have different pathology of the disease but same treatment modality. So COPD, asthma are also very treatable with this particular modality. And so uh I think those are the places where you see the best outcomes for what we're doing.

Dr Andrew Greenland: 8:44

Brilliant. So obviously, Prosena Health is a brand. What do you hope that people will immediately associate when they hear the word proscena health?

Dr John Oberg: 8:53

Right now, I think we've solved the chronic metabolic disease problem. Like we have an actual protocol, and our hope is this turns into a new sub-specialty of medicine that can inform endocrinologists and cardiologists and primary care physicians and integrative medicine and functional medicine about behavior change and how you actually get it done. Because all of those different fields of medicine are doing more and different work than what we're doing. And so we support all those types of medicine. Like we do not replace a primary care physician or a functional medicine doctor or an integrated medicine doctor. We don't do what they do. What we do is help people get from a high acuity situation into a place where longevity becomes a real conversation. And we help people understand how to become an agent in their own healthcare, but that takes talking to a patient sometimes twice a day for the first month. Not every time, but sometimes. And so if they need help injecting insulin for the first three injections in a day, and they want to get onto a video chat to do so, we'll do that with them. Like we have trained professionals who are ready to take those steps. And then we work with functional medicine practices where they just say, hey, we have somebody who's stuck, help them get unstuck.

Dr Andrew Greenland: 10:01

Amazing. So I mean, there's probably a lot of um health practitioners, clinicians that will be listening to this call. And there are two or three very simple things that they can take away from this in terms of the things you've learned about why things go wrong for patients with these complex illnesses that they could perhaps do tomorrow and actually make a real difference in their practice.

Dr John Oberg: 10:20

Yeah, I think the the there's two there's two really important answers to that question. The thing I would say to do differently is immediately make the changes you're asking a patient to make smaller. Like what because a small change that is executed is better than a big change that is not executed. And so I hear physicians sometimes say, well, they have to do XYZ. It's like, well, that's great. But if they're not going to do it, then wouldn't you have them just do X? And even if that's not enough now, isn't that better than nothing? So so make the change smaller. And then recognize that that some of the work that has to be done, just like a primary care physician shouldn't be treating patients who need to be treated by a cardiologist. Like bring in someone who's an expert in behavior change and help with the medicine. Like that's that's a really important part of what we do. And and we hope that's not going to be just us over time. We hope that other physicians raise their hand and say, hey, I want to do that as a field of medicine.

Dr Andrew Greenland: 11:20

Thank you. Really interesting. But that's sort of chunking the information down. I have a little bit guilty of this myself. So I do um quite a complex protocol for patients with Alzheimer's called the Breuderson Protocol. And we do tend to um uh give the patients a lot of things to do, change everything. So maybe I can take away something from this myself.

Dr John Oberg: 11:38

And uh, and and the and the answer is not to not change everything, it's just to not change everything all at once.

Dr Andrew Greenland: 11:44

Yeah, got it.

Dr John Oberg: 11:45

Right. So so I think the plan is still an excellent plan, probably. I don't know it. I don't know much about Alzheimer's. But what I would say is there's probably a smaller plan that works at least for a couple of days. And so I think sometimes doctors talk to a patient and say, here's what you do for the next 90 days, and we're saying here's what you do for the next three days. You know, and so and so like insulin is a great example. If we get three days of blood glucose data, there are times, not every time, but there are times where we're titrating medicine every 72 hours to dial it in for a patient so their body feels good enough to have confidence that the process is working.

Dr Andrew Greenland: 12:19

What are the um major shifts that you're seeing in health and wellness right now? Because you've you've come into this from a sort of behavioral angle when you're plunged into clinical medicine and the role that you have. But what are you seeing more widely in health and wellness? And is that informing where you want to go next with your work?

Dr John Oberg: 12:35

Yeah, I think there's uh several answers to that as well. I think that I'm I'm really encouraged by the um engagement of people trying to fix the healthcare system. Like there's a lot of people who recognize there's a problem globally and they really truly want to fix it. And I think I have a lot of hope. Uh, when I stepped into clinical medicine, uh, I have a lot of hope because the way my grandfather was a surgeon and my mom worked in the healthcare. And so I was around a lot of physicians growing up, and I saw them care about patients and really care about the health and wellness of patients, and that hasn't changed. You know, the vast, vast majority of physicians that I meet today really do care about patients. And so I think that's been really great. And I think there's a lot of people that are saying, what do we do better? How do we fix things? How do we move forward? And I think that's good. So, like we use artificial intelligence in a lot of different ways inside of our practice. Um, and I think we're we're finding lots of ways to hopefully wring some of the costs out of healthcare by doing that. Um, and then I think um really I'm I'm encouraged by technology, I'm encouraged by the people, I'm encouraged that there are people trying to kind of move within the system and fix it within the system. I think it's harder to change the system from outside the system from like a revolutionary perspective because the system is so ingrained today. So those things all give me hope.

Dr Andrew Greenland: 13:57

Fantastic. And what about um client expectations? How have they changed in the years that you've been doing this work?

Dr John Oberg: 14:03

You know, I think we have a more consumer society outside of medicine, and we encourage our patients to take that expertise and consumerism and try and apply that to agency in their own healthcare so they can become a good partner. The problem is that it takes an expert to also guide the plan. You need a physician to actually say this plan is actually clinically appropriate. Otherwise, you have people that are using, you know, WebMD or AI, and they're bringing things forward that just aren't clinically appropriate and frankly a little bit dangerous. I'll give you one example. Um, we saw a patient recently who had a set a series of blood panels that were done, and it was a very large series of panels for wellness, not because they were sick, and they had one number that was considered out of range, which really didn't matter unless it was out of range along with six other numbers, but they weren't. And so we this caused a lot of anxiety for this particular patient unnecessarily. And so we call that treatment burden, right? So if you're spending time, money, or emotional energy, those things all create treatment burden. And so this person had days of anxiety about how do I fix this? And the answer is you don't need to fix it. Well, but it's out of range. It's like, but that doesn't matter. Like that matter numbers when it's out of range, and six other things are happening too, none of which are happening. And so people, by and large, don't understand the scientific method and shouldn't have to. They should have enough trust with their physician that the physician can say, look, these are markers that matter, these are markers that don't matter, and here's the reasons why. And so we still want to measure them, we still want to watch them, but we don't want to create unnecessary anxiety. And I think sometimes physicians don't recognize because they're moving so quickly, some of the unintended anxiety they're causing by telling people to take on too big a plan, too many things. Uh, you we the way we talk about it internally is we have to meet patients where they are. And just because we left a patient last week at a place doesn't mean we're picking them up in the same place this week. They may have gone backwards, they may have gone forwards, they may have gone sideways. So every time we talk to the patient, we've got to first figure out where they are and then go meet them where they are on the journey and walk with them for that next couple of steps.

Dr Andrew Greenland: 16:08

Are there any wellness trends that you're skeptical of or feel a bit overhyped at the moment?

Dr John Oberg: 16:12

Uh you know, I think there's a lot of um, I think supplements are a place where you see a lot of this, right? Like I think that, and so the way that we view this in our practice is there are things that are scientifically proven for the moment, which is the way science works. Like nothing is ever proven definitively, but there's, and so we would put that over here. It's like that there's the science that's proven. Then there's like the things that are generally accepted as this is the best practice for medicine. And then there's a whole bunch of things that, you know, aren't proven but seem to work. You know, Eastern medicine has a lot of concepts that are foreign to Western medicine, but they've been rules of thumb for the last 3,000 years. There's probably something to them. And so, and there's a whole spectrum of like, you know, works really well to not really sure. And then there's a bunch of things that do harm. And so what we tell patients is like, we're gonna work with you all the way up to to where it does harm, we're not gonna help with anything that does harm. And we just want you to be really educated about where you are on the spectrum. And so, some supplements we think are gonna probably provide you with some benefit, but it might just be more expensive urine. And so, if you have the time, the energy, and the money to do that, and it and it feels better to you than not doing it, then you should do that. But if you're concerned about your budget and whether or not that's gonna work, there's things over here that might be better for you. So we just want patients to have all of that data in a really informed way. And I'll use myself as an example. There are supplements that I take that aren't hard science proven, but I want to live to be 100. And so I want to do things that may not have a benefit, definitely aren't bad for me, right? But it's questionable about whether or not they're beneficial or they're just going through my system, but that's worth it to me.

Dr Andrew Greenland: 17:58

Brilliant.

Dr John Oberg: 17:59

Does that make sense? I mean, you're working for medicine, this is your world.

Dr Andrew Greenland: 18:02

Oh, absolutely. And um, you know, we try to be as evidence-based as we can, but you know, I've I've studied terrible medicine and I fully appreciate the eastern aspects of um Chinese medicine that you've referenced. It's quite hard to explain on a Chinese medicine paradigm, but at the end of the day, they are botanicals, they have you know medicinal effects on people and often very, very helpful. So um, I'm very, very open-minded. Like you said, if it's safe, it might help or it might just not be any good. But as long as it's safe, some things are just worth trying.

Dr John Oberg: 18:34

And I think personalized medicine, you know, we talk about our medicine as personalized medicine, making a very, very hyper-personalized plan. And the truth is, everyone's got their own genetics, everyone's got their own system, everyone's got their own environment. So there is some bit of trial and error inside a clinical, clinically kind of guided methodology that makes a ton of sense. You know, it for me, I use intermittent fasting at points of the year because it's really impactful for me. For my wife, there's no way it's good for her. Like we've tried that. And it's like, you know, she turns into a monster and she's the nicest, sweetest person you'll ever meet. Like intermittent fasting, not a good call for her, right? And so recognizing those differences, like I don't think there's a one size fits all for most things. There are some things in medicine where you know antibiotics are you know clearly the right path. And like, so I think there's some easy ones, but but I think that people need to, if they should be agents for their own health, they should pay attention and and then they have to meet their own goals. Like I know people that want to be bodybuilders, and that's one set of goals. To me, that's a very different goal than living to 100. And so I don't want to project my desires onto somebody else. I want to help them meet their healthy goals.

Dr Andrew Greenland: 19:45

Thank you. How do you think um Pristina Health's approach to retention or care stands apart from others in your space? Now, I don't know how crowded the space is for you, but I'm just curious to know how you see yourself with uh amongst your competition in terms of what you do and how you stand out.

Dr John Oberg: 20:01

Yeah, I think for us, there's a lot of substitutes rather than exact direct competitors because we we really think that we have kind of a new sub-specialty of internal medicine. And we try to take a very collaborative approach. Like we want to hand somebody off to the lowest cost, lowest treatment burden scenario as quickly as is reasonable. Like that's that's the way we approach the world. And so we try to be very, very collaborative. And um we have patients that stay with us for years for sure. Like that happens, and we'll monitor them. And um, but we try to keep that monitoring burden very, very low, and then we just jump right in before there's kind of a major event. So we I'll give you an example. We had a woman who was her blood sugar was in control for, you know, I think it was 15 or 18 months, and blood sugar out of nowhere spiked to, you know, two or three times what the normal was for her. And we had her on the phone and we said, Hey, is everything okay? What's what's happened? And she said, Yeah, I'm in Miami, away from home. I'm with my in-laws. I ate half a pizza. And we said, Okay, stress, got it, stress eating. Do you need help? And she said, No, I've got it. Well, do you need to review any of our coping tools? No, I've got it. It's like, great. She's like, just watch my sugars. By Monday, they'll be back on track. You said, Hey, that's it, got it. We just want you to know we saw. And she was back on track by Monday, like, no big deal. But like, so I think, you know, but we we want to stay ahead of the big, big problems. And you know, we we can head off really big problems like amputation, blindness, death, like those are organ failure, like those are we can get way ahead of that and do it in a way that's really thoughtful about how the patient's being interacted with.

Dr Andrew Greenland: 21:35

Brilliant. So you obviously made some big clinical strides with your work on the diabetes. What else is working well for you at Pristina Health, whether it be a business operational or some other aspect of um client experience that you're happy with?

Dr John Oberg: 21:49

I would say we've been really happy with our provider experience. You know, we're using technology in a very advanced way. Um, I'm asked to speak on AI in lots of different forms with lots of different leaders technically. And um, I have an advanced degree in management of technology, so I've really leaned into this myself as a personal interest. And so we're using, you know, artificial intelligence when it comes to like ambient scribing, which I would say is kind of vanilla AI utilization at this point. Um, we're using it to reduce burden for our providers in the billing cycle, um, but we're also using it to reduce provider burden in the um in the kind of patient cycle. And I'll give you one quick example of that. Um, where before we'd have to make a plan with a patient that included meal planning that was overwhelming because you would try to get down to that granular level. And it's very hard to go from initial meal plan down to the granular level. Now we can take a patient in just a couple of minutes from what do you want the meal plan to be for the week? How many times do you want to have leftovers? How do you have to change the recipes for your size of family for the types of leftovers you want to have? How do we factor in what you're comfortable cooking, what you're not comfortable cooking? How do we factor in what's already in your pantry so you don't have to buy it again? How do we turn that into a set of recipes that you can cook in the time that you want to cook it in on the day you want to cook it? And how do we create a shopping list for you that makes it really easy? And soon we're gonna have it so the shopping list shows up into an online cart where they can just push the button and have it waiting for them at the store when they get there if they want to. And that now takes us less than 10 minutes where it used to take 90.

Dr Andrew Greenland: 23:18

Amazing. Amazing. That's such such um advancement. And on the flip side, um, what's frustrating or perhaps harder to crack or challenges you're trying to kind of solve at the moment?

Dr John Oberg: 23:30

Right now, the biggest one is the amount of noise that we have in marketing inside of healthcare. You know, diabetes is a, you know, they say one in seven dollars globally is spent on diabetes. It's a four and a half trillion dollar problem in the US. And so you're talking about, you know, over a half a billion dollars in the US being spent, I'm sorry, half a trillion dollars being spent on diabetes in the US, which means lots of marketers have lots of things they want to sell into this space. And so where we have clinical results that are, you know, markedly different than anybody else, the amount of marketing noise has been overwhelming to me. And I've had several of the people that I've worked with for you know 20 years of my career in marketing who've said this is by far the hardest, noisiest space you'll ever get into. And I was ready for that when I walked into it. But man, experiencing it for the last you know several years, it's been daunting just how noisy the space is to let people know like we actually have clinical results that are cost effective, that work. And so, but but the answer from a lot of people is yeah, yeah, I've heard that five times before. I've spent millions of dollars on it, I've tried five times and failed. We're just gonna keep doing what we do. That's disappointing.

Dr Andrew Greenland: 24:40

Yeah, no, got it. Um now you come from a management background and you leverage technology and AI quite heavily in your business. Yeah. Which um KPIs or metrics are you most focused on? And are there any that you're actively trying to improve on in the business?

Dr John Oberg: 24:57

Yeah, I think for us right now, um, we want to understand a lot around the marketing metrics on the front end and how people are engaging with our message. And so we're really trying to understand that part of how do we get through that noise and break through it? And so we're we're using a lot of our energy to focus on that problem right now. On the clinical side, we've got a very strong set of KPIs that go very granular, that obviously start with hemoglobin A1C and work backward all the way through to the activity channel. So it's like, do we have a goal for somebody? Are they following that goal daily? Is the plan working for them? How fast do we need to intervene to change that plan to make it smaller, smaller, smaller, smaller, smaller until it works? Um, and then we have all types of exceptions reporting, right? So anytime there's an exception to some of the KPIs or process, somebody gets alerted to something so we can decide whether or not we want to intervene in that exception. So someone's not taking their medicine, you know, if it's if they're 90 days in with, you know, great habits, it might be less important than someone in the first 24 hours working with us. That might be really, really important. And so if that type of exceptions reporting, we really pay close attention to so that we can intervene faster and faster. And so we're constantly thinking about ways we can get more data with less effort from the patient so that we can give them smaller, easier-to-do things and less to do over time to reduce that burden in terms of clinical burden. So how many medicines they take, how many times they have to talk to a doctor, in terms of emotional burden, how stressed they are, uh, how much anxiety or depression they're facing, and in terms of financial burden. So those are all things we're trying to reduce, you know, um deliberately every day.

Dr Andrew Greenland: 26:34

And with all that data and feedback that you get, are there any sort of patterns that signal that clients are about to drop off or disengage that you've picked up on?

Dr John Oberg: 26:42

Absolutely. It's and I think the number one thing is just the habit that, you know, are they continuing their habits or not is the easiest one, right? And so, and depending on where they are in the cycle, medication adherence, um, improved diet, improved exercise, like those are the things that are the easiest, the easiest things to see. The other thing that we love to see that is a really good signal that someone's getting ready to leave is long-term disease control. Like one of the one of the challenges we faced is that sometimes we're getting disease under control so quickly that someone's behavior change has not stabilized enough to keep them into control when they leave our practice. And so we're having some boomerang problems coming back. So someone gets their disease in control super fast, thinks they don't need to work about it anymore, and then they come back a few months later, it's like I'm I'm in trouble again because that we haven't stabilized the new behaviors.

Dr Andrew Greenland: 27:31

What would you say is one of the biggest bottlenecks to growth at the moment? I mean, is it that whole thing about the marketing noise, or are there any other things that are bottlenecks for you in your growth?

Dr John Oberg: 27:41

That's the big one for us. Like we, we, it, yeah, that's and and so we're we're going to market a number of different ways. We talk to hospitals that have high acuity patients coming out and being discharged. We talk to specialists who are having trouble with patients who are adherent. And now we're talking to employer groups about cost containment and the way that they can contain costs for major events by getting ahead of it with the work that we do. And we're having some big, I'd say, initial success in those conversations, although we haven't had our first case study yet. And so our goal is to go do more real research around this. And then, you know, I think we're also looking for, you know, family offices that want to solve this problem. We have a research nonprofit that we're, you know, we we just stood it up so that we can start raising money for more and more research so we can go faster and deploy these to other practices globally instead of just trying to build our business. We really want to build um a solution for the world. You know, I talked to our team, our goal for our team is that everyone on our team becomes a billionaire. We just don't, we don't measure that in dollars. We measure that in the number of lives we've improved because of the work we're doing. Like that's the thing we care about. And so we've set up a research institute to start putting all the thought leadership out there. And so that's the those are the big challenges, getting through the noise and finding the people that kind of want to come alongside of us and partner with us to take this out to the world versus trying to hold it tight for financial gain. That's the I'm a doctor of social work.

Dr Andrew Greenland: 29:02

I know I love the billionaire, I love the billionaire analogy. I think it's fantastic. And I like the way you measure it. I think that's really empowering for your team to take some ownership of you know, helping as many people on the planet as possible with their health problems. It's amazing.

Dr John Oberg: 29:15

Three and a half billion people have problems that we can impact. And so if we can get to a billion of them in the next 50 years, that's the goal.

Dr Andrew Greenland: 29:21

Amazing. So if you had a magic wand and you could fix one thing in the business tomorrow, what would that be?

Dr John Oberg: 29:27

We would we would know exactly the right messaging for us to cut through all the noise. If we could figure out our marketing messaging, to have it. Oh, it's funny. I I came up with like three different sets of marketing messaging and took it to a mentor of mine who's really smart in this space. And I said, Hey, I think messaging number one is kind of like a steaming pile of poop, and I don't think it's very good. And he said, Well, that's accurate, it's horrible. I said, Well, check out number two. He's like, Okay, that's not as bad, but still terrible. I was like, Okay, my best one's number three. Here's number three. I told number three, he's like, Um, we have some work to do. So I tell people, like, we're as bad at marketing evidently as we are good at clinical medicine. Like we so we've got a real like if I had a magic wand, that's the place I'd point it right at that problem. And we've got smart marketers we're working with, but we're we need to really figure out um we need to be as innovative in our marketing message as we have been in our clinical science, and that's not our background. And so we're gonna we're gonna lean heavily into finding the experts in that space to help us with that problem in the way we help um clinicians.

Dr Andrew Greenland: 30:28

You said you want to try and reach three and a half billion people on the planet in the next X number of years.

Dr John Oberg: 30:33

We'll take we'll take a billion. Just take a billion, just one billion.

Dr Andrew Greenland: 30:37

So if you if your business suddenly experienced a new surge of clients or leads in the next two weeks, not to maybe not to the level of a billion, but what will be the first thing that would break or stretch your system?

Dr John Oberg: 30:49

Yeah, we're we're we're working on a contract right now that would actually make us 10x the size next year, and we're pretty confident that that contract will be uh inked quickly. Uh and then we have a couple other contracts that we're in the early stages of that would have us then doubling again and doubling again. And so I have a background in scaling businesses. So I think the um we all of our systems and all those things are in place. Um, what's gonna break is the marketing.

Dr Andrew Greenland: 31:18

And if you are starting the business again tomorrow with everything that you know and your entire experience that you've had, would you do anything differently?

Dr John Oberg: 31:25

Not do it. No, I've started a lot of businesses over the years, and I think that um for me, gosh, what would I do differently? I um I I think I think I asked that question before we started this business. I've done some things right. Some of the things we really liked, we built reporting in very early so that we had a lot more data for a small business than I've had previously in small businesses. There's a lot more data-driven small business than before. That's something we've done really well. Um, and then we've we've really in a small startup business, we've been much more focused on cash flow. And so I think what I would do is I would, even though I think we started in a fairly disciplined way, if I did it again tomorrow, I would probably ratchet up that discipline even one step more. I'd be even more disciplined about cash flow.

Dr Andrew Greenland: 32:18

Was there a moment or decision in the journey that really changed the growth trajectory for Piscina?

Dr John Oberg: 32:26

Um, I I would say that we're in we're at that inflection point right now. If we if we can execute on the couple of contracts that we have in flight today, uh which I feel good about at least one of them, then I think that's going to be a story we can tell that'll be a really exciting story. I don't think we're there yet.

Dr Andrew Greenland: 32:43

And finally, where would you like Priscilla to be in the next six to 12 months? You've talked to some about the in initiatives and innovations you're working on, but where would you like to be in 2026, October?

Dr John Oberg: 32:53

Yeah, I think I think I'd like to be, you know, 10 to 20 times the size that we are right now. And we're small right now, so that won't be a hard number to hit. And then I'd like to have a marketing message that resonates with people where they truly understand that the that they they can see the hope that I can see. They can see that even though we've been trying to solve this problem, we've been banging our head into a wall as a society for a long period of time, like there's a real solution that we have, particularly for the sickest patients who are the most vulnerable. Like we have a real solution for them and it works, and we can show them the data.

Dr Andrew Greenland: 33:26

On that note, John, thank you so much for your time this afternoon. It's been really fascinating hearing about you and your mission at Priscina Health, what you're trying to do for the health of the world. Um, really, really enjoyed talking to you and thank you for giving us uh some very detailed insights, some very personal insights into the business and how it's all working out. Really appreciate it. Thank you very much. Thank you. Great questions.