Healthcare startups are on the rise..

An exclusive interview with clinician turned tech entrepreneur, Dr Jeremy Lim, Co-founder and CEO of AMILI, Southeast Asia’s first and only stool bank for gut microbiome innovation and therapy.

“Having done many things in my life, I can assure you that running a startup is by far the hardest thing one could possibly do. There are easier ways to earn a living. To me, healthcare is very mission driven.”

Since the beginning of time, man has sought to find ways to extend their lives. In the past, it came largely in the form of finding cures and treatments for diseases.

We got so good at treating sick people that previously deadly diseases such tuberculosis and hepatitis C can now be treated. In fact, medical science has progressed so much that many patients with incurable diseases such HIV, diabetes, Parkinson’s Disease and even cancer have good prognoses.

Between 1950 and 2022, global life expectancy increased from 46.5 years to 71.7 years. Singapore has one of the highest life expectancies in the world – 84 years in 2023.

Having progressed thus far, “we have probably come to the end of the road in the utility of a sick care dominant system,” says Associate Professor Jeremy Lim, co-founder and CEO of AMILI, Southeast Asia’s first and only stool bank for gut microbiome innovation and therapy.

The next big healthcare breakthrough may not come in the form of a new discovery or drug, but rather how game-changing tech can take what we already know and make it more accessible, affordable, personal and effective for more. Indeed, even if we were to find a complete cure for cancer and heart disease, American’s lifespan might only increase by three years. Moreover, it is very expensive to treat people in our current sick care system, noted Associate Professor Lim.

That said, the biggest frontier in healthcare may no longer be the treatment of sick people or the development of new drugs per se. The biggest breakthroughs may come in the form of tech, as well as new systems that support it to increase access, reduce costs, and prevent diseases for a larger population that has been previously underserved.

In that light, a wave of clinicians in the US, Europe, Asia and Singapore are exploring the exciting intersection between healthcare and tech. Among them is Associate Professor Lim, who founded AMILI in 2019. He shared the insights from his entrepreneurship journey.

Breaking The Iron Triangle of Healthcare

“The healthcare system is broken,” said Associate Professor Lim. And one of the fundamental problems is best described as the “Iron Triangle” of healthcare, with the three corners of the triangle being cost, quality and access.

The premise is simple. As any two corners of triangle move closer, the other will be compromised. For example if you build a really good hospital in a capital city that is more cost effective, it will not be accessible to a patient in rural areas. These are trade-offs in healthcare that have been long accepted as inevitable, he explained.

Technology offers us the opportunity to break out of this iron triangle in a multitude of ways. AI chatbots are becoming more sophisticated in doing a first-line diagnosis, even if patients need it at 2am in the morning. A virtual setup with remote monitoring devices may also be an adequate substitute for 80 to 90 per cent of cases in rural areas. And if the metaverse pans out, a lot of the tactic sensors worn as gloves may be a good enough substitute for in-person diagnosis in the near future as well, he said.

Shifting To Preventative Healthcare

“Our entire system is built around sick care. But the time has come to emphasise health and well-being, rather than sick care.”

With increased life expectancy, our view of ageing has shifted too.

“The view of longevity is a very vibrant one. We have come to the realisation that ageing may be a natural process, but that does not mean you will inexorably charge towards it. You cannot slow down chronological age – time stops for no one – but physiological age can be slowed down,” said Associate Professor Lim.

“If we can be chronologically 70, but physiologically 45, then we can escape the ravages of a lot of chronic diseases or push them back until much later,” he added.

For instance, Associate Professor Lim pointed out that we could dramatically reduce the incidence and severity of diabetes, one of the leading causes of death globally, if patients lost 10 to 15 per cent of their body weight, switched to plant based diets and walked 10,000 to 12,000 steps daily.

“Our entire system is built around sick care. But the time has come to emphasise health and well-being, rather than sick care. So we need to almost tear down the old system and rebuild one that emphasises preventive healthcare,” he said.

The Power Of Data

This is the main reason Associate Professor Lim and his co-founders are building the world's largest multi-ethnic Asia microbiome database.

“Gut microbiome is so important to not just digestive health, but also brain health and immune function,” he said.

Although humans are 99.9 per cent genetically identical and most human genomic research done in Boston or London would be arguably relevant to Singaporeans, gut microbiome is probably only 10 per cent or less driven by human genetics.

So the other 90 per cent is locally and regionally specific and very much driven by local factors like diet, lifestyle and the environment, he explained. This database could uncover vital information necessary for holistic health specific to Singapore and Southeast Asia.

Indeed, data excites Associate Professor Lim, and he feels there is no better time to harness its power. “Data collection, analytics and application are exploding,” he said.

Many of us may remember a time when a doctor will ask a dozen questions and diagnose patients based on a couple of symptoms. “But in today’s age, even a standard wearable device probably gives you close to a million data points a day,” he noted.

“There is no human being that can take this amount of data and make sense of it. Technology allows us to ingest amounts of data, make sense of it in real-time, give us deeper insights into patients for more precise health care, and act on the information in real-time,” he said.

Challenges Of A Healthcare Tech Startup

“The current healthcare system is also not built for tech disruptions and efficiencies in mind.”

That is just the tip of the iceberg. The power of tech to transform healthcare is immense.

However, Associate Professor Lim noted that since doctors and nurses have been taught for 200 years that healthcare is a very in-person, high-touch and service-driven, there are relatively few clinicians venturing into the tech space at the moment.

The current healthcare system is also not built for tech disruptions and efficiencies in mind. “For example, if a national regulation is that the nurse-to-patient ratio must be one in six, or one in 10, there is no incentive for the hospital operator or owner to invest in technology. Because even if they invest in remote monitoring, smart cameras or other technology, they will still need the same staffing ratio. So there are no cost savings,” he noted.

“Healthcare regulations have to keep pace with advances in technology, otherwise, the full potential of tech cannot be unlocked. For technologies like AI, we also need an environment or use-case that is purpose-fit for it. So the entire system needs to evolve with technology, and that takes time,” he added.

Other challenges include the complex regulations involved in healthcare, making a healthcare tech startup expensive and needing long runways.

Moreover, Associate Professor Lim shared that the mindset shift required for doctors is tremendous.  “By the time a doctor is 45, if they have been reasonably diligent, they would be comfortable at what they do and financially. Typically, they are also seen to be reasonably successful, from a societal status point of view,” he pointed out.

“Having done many things in my life, I can assure you that running a startup is by far the hardest thing one could possibly do,” he said. “Being a startup founder also means you're at the bottom of the food chain, especially when reaching out to investors for fundraising. For people who are used to being in charge, it's very humbling. So that entire cognitive shift is emotionally difficult,” he said.

“I didn’t found a healthcare tech startup to become a gazillionaire. There are easier ways to earn a living. Healthcare is very mission driven.”

Speaking of what made him take the leap, he said: “I didn’t found a healthcare tech startup to become a gazillionaire. There are easier ways to earn a living. Healthcare is very mission driven. It’s really about the vision of a better way to caring for patients and to enable healthier populations. You're building something that has impact, and you're in the driver's seat.”