HN Explorer

Launch HN: Caelum Health (YC S17) – Digital Therapeutic for Stomach Problems

56 points by laurenkc ↗ HN
We’re Luke and Lauren, the founders of Caelum Health (http://caelumhealth.com). Caelum is a digital therapeutic for Irritable Bowel Syndrome. We optimize your diet and figure out which foods are driving your stomach problems.

Lauren is an MD from UPenn who saw how patients with stomach problems (IBS alone affects 15-20% of people) couldn’t get the care they need. The best treatments - diet and lifestyle changes - work in clinical trials, but are extremely hard to execute in the real world without continuous expert guidance. Very few patients have the resources to afford this type of guidance.

Our app fixes this by providing 1-on-1 digital coaching (via messaging). We guide patients through the leading IBS diet (the Low-FODMAP Diet) with turn-by-turn directions and daily lessons/exercises.

Currently, the diet requires several stages of eliminating food groups and then adding them back in to see whether symptoms change - forcing each patient to “start from scratch” even though many other patients have gone through the same process. We leverage user data to personalize each patient’s program based on their eating habits, past food trials, and demographics (age, gender, ethnicity, etc).

We’re launching our consumer-facing product and will be starting our clinical trial soon.

We’re a sibling team and have wanted to start a company together since we were kids. When Luke went into tech and then business school, and Lauren into healthcare investing and then medical school, we thought it probably wouldn’t happen. We were obviously wrong. We became pretty obsessed with bringing data to medicine and applying it to the treatments right in front of us: food, exercise, sleep, stress-reduction.

44 comments

[ 4.6 ms ] story [ 84.1 ms ] thread
glitcher
Cool project and great idea! Unfortunately your website falls a bit short on selling me though. And at $29/week after the free trial I don't even want to find out if I love your app, because then I would know exactly what I was missing out on after having to cancel based on price.
laurenkc
Glad you like the idea! Thanks for the feedback about the website. Would love to learn more - is there a particular part that especially falls short (or something that, if included, would have sold you)?
rzr999
One example which is as simple as possible as complicated as necessary would be great.
laurenkc
Gotcha, that makes a lot of sense - appreciate it
rzr999
I have a long lasting gastritis and would love to try you guys out. I am wondering if I should wait for the lactose/fructose/sorbit tests or not.

Another question is I already have a huge list of things I tried, can I just feed those in?

laurenkc
Getting started isn't dependent on any particular lab testing - the low-FODMAP diet includes elimination of lactose/fructose/sorbitol, so as you follow your plan you'll figure out if those are triggers for you.

For the things you've already done, you can tell your coach it'll be incorporated into your plan.

hhw3h
Do you all have plans to support ulcerative colitis or the SCD diet?
laurenkc
We're building the platform so that it can support any diet, and UC/Crohn's are on our short list. (Some folks with those conditions have benefited from the Low-Fodmap diet too, although it wasn't designed for that purpose.)
hhw3h
thanks lauren. good luck with your company.
bvod
I feel like your pricing is off. $29/week is too expensive for consumers, yet far too cheap if you plan to get reimbursed from insurers. Especially considering you'll need a lot of people and show improvements for them if you want insurers to pay - this pricepoint won't let that happen.
rzr999
Same thoughts here. I don't have too much time to chit chat with the trainer there, I know it's required but for example I would keep exchanges to a minimum.
lukekc
We've actually toyed with having a version without the coach that's quite a bit cheaper (~9/month) - is that something you'd find more compelling?
jpmw
What would it do? I looked (probably too) briefly...and thought the the main value was mostly the coach. Or at least, the value I saw that I was "OMG, we need this in French _now_".
lukekc
It would have some expanded functionality to take the place of the coach - it would give turn-by-turn directions each day on what to eat, and educate the user on how to avoid FODMAPs / other eating options. But it would have less customization (at least at first), and the user obviously wouldn't be able to get questions answered in the same way
jpmw
Gotcha. So that could make sense. Someone could start with the coaching, then downgrade to this option instead of just cancelling due to price once they don't use the coaching services enough.

i.e., it would help you with churn a bit, I think.

jordancampbell
My gf has lots of problems with various foods and manages to keep on top of it fairly well - although she has very little concrete evidence about what it actually is that is causing the problems.

I could see her trialling a comprehensive ($30 a week) package for a few weeks, then dropping to a less intensive (~$10 a week) package that kept her on the right track.

I personally don't think she would pay $30 a week unless the service gave her a significant material difference in lifestyle (which I certainly imagine it could have the potential to do).

jpmw
If you compare that to paying for a dietitian, it's actually not TOO bad. BUT, I think churn will be high due to price.

I could see a declining fee model. Just a thought.

We are trying a low FODMAP for my wife. I could see her paying for it for 2-3 months, then we would probably find that expensive at $29/w...but, if after 3 months, it went down to say $29 per month, then it would totally make sense as we would use it a lot less, I think.

At least if we compare to when she stopped gluten, lactose and a few other things 6 years ago...the worst was the first 2-3 months.

lukekc
Also good thought on a pricing model that declines after the first several months - definitely something we're considering introducing.
barbegal
A dietitian is a different service though. Registered dietitians are trained, accredited professionals that can legally give you medical advice. This service will not give you medical advice.
sdrothrock
> If you compare that to paying for a dietitian, it's actually not TOO bad. BUT, I think churn will be high due to price.

Could the high pricing be because this is really a guide to a solution -- once customers have need for a guide, they'll stop using the service; that is, churn is naturally built in due to the nature of the service.

notlob
Can you speak a bit about how this is regulated? Are you working with the FDA Digital Health group?
laurenkc
The FDA is currently selectively regulating mobile apps, primarily based on risk categorization. We haven't been subject to regulation so far, but will of course work with any regulatory bodies if/when that time comes (and, of course, regulation of digital health products is continuously evolving).
notlob
I would suggest taking a more proactive approach in your relationship with the FDA, perhaps hiring an experienced consultant to either help you work with the FDA (the new "Pre-Cert" program might be worthwhile) or dial back your marketing claims to a safer position.

Right here on this Show HN you've said "Caelum is a digital therapeutic for Irritable Bowel Syndrome." This statement makes clear that you're intending for this to be used in the treatment of a specific disease (so this is a medical device and is subject to FD&C Act).

You're also said you're providing "1-on-1 digital coaching" and more specifically you "personalize each patient’s program based on their eating habits, past food trials, and demographics (age, gender, ethnicity, etc)" (so specific treatment regimens). "Minimal risk" for the FDA generally excludes individualized treatment regimens. There may be sufficient grounds to support oversight.

laurenkc
Thanks, will bring up these points with our advisers in this area
jpmw
Oh god, love it! This is not that expensive if you compare to having someone helping you that you pay for, and need to get a meeting with.

On the business side, I would assume churn will be pretty high after a few months.

lukekc
Yup, this is the comparison we see - alternative is going to a dietitian, which is very expensive. Re: your other post on people potentially churning after 2-3 months - we've actually seen strong retention, but leaving after 2-3 months is certainly a use case we've seen as well. Those users tend to have gotten a lot of value from the product, and are also profitable for us - overall not a bad outcome
djstein
just sent to one of my best friends who has been suffering for years. I hope it can help
laurenkc
Thanks for sending along! Hope we can help.
barbegal
Your terms state that "The services are not medical advice or treatment". If that is the case then this service is operating in a legal grey area where customers could be under the impression that medical advice is being given out and could sue Caelum Health if the diet does have a negative impact on their health. And if the customer knows it isn't medical advice, then they should run the advice past a medical professional on a regular basis which kind of defeats the purpose of the service.
lukekc
That language is intended to indicate that we’re not a physician, hospital, drug company, etc. - pretty standard for companies in our space.

But you’re right that, similar to drugs, dieticians, or physical therapy, we’re not a substitute for a doctor - in fact, one of the ways our users find is through referrals from their doctor.

barbegal
But unlike FDA approved drugs, registered dietitians and licensed physical therapists your service is not accredited and can't legally give the advice that it claims to give. As an example Ohio state law says that "only licensed dietitians can practice dietetics".

Practising dietetics is defined as including "Nutritional assessment to determine nutritional needs and to recommend appropriate nutritional intake" and "Nutritional counseling or education as components of preventive, curative, and restorative health care"

Either your service isn't doing those things (and outwardly it seems it is) or the service must be provided by a licensed dietitian to customers in Ohio or it is breaking Ohio state law.

[1] http://codes.ohio.gov/orc/4759

lukekc
We've worked with our lawyers on this topic and so far we're in good shape. But it's definitely something we need to keep an eye on as we introduce new functionality / try out different marketing.
rokhayakebe
Cost? It is not showing me the cost when I click on free trial. Could be a bug, using Chrome.
lukekc
The cost ($29/month) should be displayed both on our homepage and when the user gets to the payment screen in the sign up flow.

If this is a bug obviously want to track it down - where exactly did you click?

pg_bot
Do you consider yourself a covered entity? If not, what kind of data are you collecting about your users?
trowway21
What they are offering is actually very simple, and systematic.

While the list of foods containing fodmaps has changed a lot lately, there are several sources that are up to date. University of Michigan has a lot of reliable resources.

The system is described in full here: http://www.myginutrition.com/diet.html (U of M)

They also have a pinterest that has tons of ideas and specific brands they've tested... Which is here: https://www.pinterest.com/UMGIdietitians/

Full list of foods here: http://www.myginutrition.com/downloads/Low_FODMAP_foods.pdf

The warning my dietitian has given me, is that many of the websites out there are using out of date information pertaining to foods; and that I should only trust their lists.

welder
You just put this startup out of business. The Michigan Uni website and video tutorials are more complete than Caelum's mvp. Couldn't figure out how to get Caelum's website to work, it just dumped me into a food log todo-style app with no info how to use it.
lukekc
Our core value currently is the 1-on-1 coaching, so the MVP app is meant to support the coaching service (and currently working on building out the content). Michigan has some great content, but it’s a different experience than having a coach or dietitian. It could be supplemental to a dietitian - sounds like this is the use case for trowway21. There are definitely people out there who want to do the diet with content/info only, and our service wouldn’t be a good fit for them.

Thanks for your feedback on finding the app disorienting - that’s helpful for us to know as we improve it moving forwards.

[dead] aviv
Simply unbelievable. Yet another way to productize a set of diseases that are highly curable. Modern medicine is a great enabler of lifelong, expensive, disease management, and here we have another prime example. Turning a patient's disease into a subscription play.

I repeat the following in many HN health related threads and I will continue to do so:

Prolonged (10 to 40 days) water fasting is a highly effective method for permanently reversing and curing most IBS (incl. Crohn's) and gut related diseases that are considered incurable by modern medicine.

Anyone interested - do your research. Literature is out there. Don't let lack of "scientific evidence" discourage you. No one benefits from researching and proving that not eating cures diseases that are currently multi-billion dollar industries. Open your eyes and enjoy your path to healing.

glitcher
> Anyone interested - do your research

Any advice on sources you believe are credible?

Otherwise your advice to "do your research" on a topic that you admit is lacking in scientific evidence is not very helpful.

aviv
This is the standard HN trap, where I provide links and a dozen commenters respond saying how unreliable these "non scientific" sources are.

There is no point. I'm not trying to convince anyone to do anything. I plant seeds that hopefully will encourage people to take their health in their own hands and reconsider their blind faith and reliance on modern medicine that is strongly incentivized against finding a cure for them. They make money when they keep you breathing, not when you walk away cured.

cm2012
When we get back from vacation my wife is absolutely subscribing. Its a step up from dieticians (who guve worksheets and meet in person) since the app looks like it will make everything much more streamlined.
lukekc
That's great! Look forward to having your wife on board
fabiandesimone
As any new project that pops up in here, I wish you well and hope you guys make it.

However, as a IBS sufferer, I'm not sure I get it.

Yes identifying the foods that make you ill is a top priority for IBS patients like me, but I downloaded this app:

https://www.monashfodmap.com/i-have-ibs/get-the-app/

And within a week or two I identified the culprits, took them out of my diet and I'm back in business all for I think it was a one time payment of $6.99 and some willingness to make some changes. The app is fantastic.

I guess what you are really selling is the coaching and I'm sure some people do need it. Good luck guys