Stephen Critchlow, founder and CEO of Evergreen, is a one of a kind personality. In 1989, with a vision to ensure all health decisions were informed at the point of care, he founded Ascribe, a business that grew to serve more than 75% of UK hospitals as well as hospitals overseas. Since then, he’s been an entrepreneur in health and sustainability and has invested over £2m supporting UK-based start-ups and social enterprises. In this eye-opening interview, Stephen reveals his somewhat revolutionary approach towards DNA testing and explains how his app, Evergreen life, can contribute to science without ever needing a hypothesis.
Please give us a bit of background on who you are and what you do.
I started off in the NHS (the UK’s National Health Service), where I noticed that a lot of accidents and lost opportunities happened because data wasn’t available at the point of care. So I wrote the initial software and gave it away to my colleagues, but it needed maintenance and upgrades. I didn’t really have enough time to do that on my own, so I started something which would become one of those “started in your bedroom” companies, where either my MSC students at the time, the doctors I met on the ward, or other interested people would start working with me on it. It was never intended to be a commercial venture, but something that would change things.
Years later, that evolved from a side project into a company that now serves 75% of NHS hospitals in the UK, as well as Australia, New Zealand, Hong Kong and Malaysia, and has become the largest supplier of IT to hospitals in clinical facing areas.
Twelve years ago, I had a kind of existential moment, asking myself what my purpose was? Why am I here? I realized that the main thing that drove me was changing things and making a difference, and that aligned directly to business, in that if you provide something of real value, people will be prepared to pay for it. That was basically the route by which Ascribe, that first company, was formed, and it ended up very successful because of that simple drive to make a difference and do something meaningful.
In 2008, I started working in renewables and saving as much carbon as I could with the money I had, and that has become a company called Evergreen Energy, which in itself makes a difference, but I’m also investing in around a dozen health tech companies that do everything from bionic arms to social care.
And then there’s Evergreen Life, our healthcare app. That was me thinking where will this all go next? The company that I sold became a PLC and was floated. I was its chairman for five years, whilst on the stock market, serving its original plan. But clearly, in the 25 years that it’s been traded, a lot has changed.
My belief is that empowering people to own their own health is the goal, but organizations don’t really allow you to do that. They generally tend to meet their own needs first.
My MSC was about pharmacokinetics. In those days, you needed to uncover people’s DNA by testing marker drugs and the way that they were handled, but you couldn’t actually do a DNA test.
I got to learn how actually, we’re all different, yet normal medical treatments are uniform. Many drug trials, for example, prescribe the same dose to everyone, regardless of their size, genetics, or any other factor, and just work out whether that population improves or not. If that gets applied to lifestyle and diet studies, they establish, for example, whether saturated fats are good for you or not.
In my opinion, the reason we have contradictory research is that no two people are the same. We’re all made up of our own DNA fingerprint. That means that our metabolism is different, our reaction to exercise is different, and the way that we absorb vitamins is different.
So how can we make a difference? How can we help people be as healthy as they can be? by understanding themselves and taking control of their own health.
What I’ve seen in my journey with healthcare organizations is they diligently recorded things about us, but didn’t necessarily give it back to us. So, therefore, we couldn’t learn from it and, just as importantly, we couldn’t take it to the next place we were being cared at.
One of my very first priorities was to allow people to get hold of their health records instead of just leaving it in the control of the healthcare organization.
Then, the very next initiative was the DNA tests, which can give people information about themselves that will allow them to personalize their diet and lifestyle.
Clearly, it can’t be right that one day we’re told eggs are good and the next day we’re told they’re bad. The true fact is that for some people they are very good and for others, they are bad, because of the way they metabolize fat.
The same health program can’t be right for everyone. What we were told ages ago does not apply the next day. We tell people to do exercise in order to lose weight, yet we know that some people who go walking don’t lose weight, and others do. Why? Look into that, we realize all of these things are genetically determined.
So we do the test that unlocks why we are all different. Let’s look at vitamins, carbohydrates, and fat metabolism. Those things answer the question we’re all begging for, which is, are fats bad for us? For most of us, no, but there are certain people who need to be a bit careful, based on their genetic makeup. So our role is to let people know.
I eat monosaturates in my diet because that’s a healthy thing to do. But when I do that I find I do lose weight. And now, after taking my genetic test, I know there’s only so many unsaturated fats I can actually metabolize because I have a limit to that. I actually found out that if I wanted to lose body fat, the right thing to do would be intensive weight lifting, not walking.
I have now watched a number of people do the test and uncover their own genetic makeup in a way that they can target their own exercise regimen and their own dietary supplements.
People may feel they are likely to be short of vitamins, and then when they do the test, they find out that it’s true, so they feel confident with the maximum supplementary dose rather than just taking a lower supplementary dose.
All those things that people would not be scared of if they found out are actionable. Other things that we test are things that will help you pick the right lifestyle, and to be healthy for as long as you can be.
What are some of the projects that Evergreen has invested in?
We see ourselves as being social impact investors, so we invest on the basis of the change that we can make. For example, the bionic arms. That industry is relatively well-served in wealthy Western societies, but the cost of a bionic arm is very high. So, I met a guy who started a company called Open Bionics, and he wanted to build something which could be scanned via mobile phones to get a 3d printed bionic arm that can be made in a fraction of the cost of the current ones, but being as functional and as capable. I’m really proud of this project.
Currently, he is still doing it in the UK, but I know he has ambitions to go overseas once the prototype phase is out the way. Meanwhile, he’s got as far as it being an NHS-recommended arm. So that’s one of the companies.
Another company, called SuperCarers, connects families with experienced and qualified carers who provide a wide range of medical, home care and support for loved ones. The online service connects families with local carers directly, saving families money, and providing job opportunities for care workers.
This company has created a brand new model for social care, and recently, in the last two weeks, they’ve been acquired by one of the large social care providers in the UK. I invested in them about five years ago, when they were a startup.
How are ethical investments different from traditional, money-driven investments?
The way that we monitor our businesses is not to do with financial return. We expect financial returns will come if they do the right thing, but it will be more to do with, for example, how many people were being cared for by the organization.
I believe the very best investors already look at the value of an organization to the people it serves. Most of the time, if you’re the type of investor that looks at the fundamentals of the business, you’ll be looking for the impact a business has on the population. So, allowing yourself to be free to say that and not have to look like a businessman who’s only into making money is the entry point.
Clearly, there are some people, the types of people who would run hedge funds, who are just looking for patterns in economics to buy in and sell, using the financial swings to make money, but they are the opposite of what I’m talking about.
Of course, we invest our reserve funds in the general stock market as anybody else would do, but even there, I follow the same principles. I don’t invest in oil, I don’t invest in any carbon-based fuel, and I don’t invest in drug companies. I’m proud to say that my investments are less than 10% down at the moment, when everybody else’s are far further down.
I’m following what you described as an ethical standpoint. I certainly don’t believe anybody should be investing in carbon fuels anymore, and clearly they tanked in the last few months, so there may be other people who were not quite disappointed. You could argue it’s just a feature of the current environment that has ended up right, but I’m certainly not worse off by following proper ethical and socially-impactful motives to do my investments.
How has COVID-19 affected your business and industry?
We’ve seen a massive increase in the use of the app, both in the number of people that are using it and in the time they spend on it. In the last three weeks, we’ve risen by 50,000 people, so we now have around 800,000 users, and their engagement with the app has gone up as well, as in the number of times that people use it in a month. But more importantly, the amount of time they use it when they go into it has risen by more than 100%. The question is why? Why would people do that?
You could argue that they’re all sitting at home and we just happen to be an entertainment for them, but it seems that people are much more interested in their wellbeing and I suppose it makes sense whilst it’s highlighted every day that those with health issues are at greater risk.
As all of the facts coming out of COVID-19, it’s clear that those people who haven’t looked after their health are much more likely to die. The impact of obesity on your outcome from COVID is massive, and that particularly relates to the DNA test.
Studies that have been done on hundreds of people who knew their DNA results showed that roughly 2-3 percent of the population who had normal vitamin D levels died. Those are people admitted to hospital, so they were already quite sick, but if you then take the ones with a suboptimal level, maybe 50 percent of them died, and those with a therapeutically low level of vitamin D, a hundred percent of them died.
So vitamin D is one of the genetically determined factors that you can see in the test. At the moment, I think everyone should be taking vitamin D tests and certainly start taking supplements. That being said, any parameter that has to do with diet and lifestyle will protect you from being badly affected by COVID-19, if you happen to catch it.
I think our users realize that, and we help by bringing them well-researched information that they can compare with their own data. We’re seeing more and more people who are making themselves well during this period. We’re finding people are drinking less, exercising more, and using the app more to get advice. So we believe that the users of the app and the information they’re getting from the app are helping them be well at a time when it’s more important than ever.
Which trends and technologies do you find to be particularly intriguing these days?
I’d like to think that the application of AI and machine learning to healthcare will allow us to learn more clearly about one’s overall profile and what’s right for them to do. Pragmatic research is where health is going.
We can already tell, from traditional trials, whether a certain genetics net will show if you’re short of vitamin D, for example, but we only really know properly about a very small number of DNA traits. The reason for that is the time-consuming and costly research that has to be done to prove it.
What we are working on is a model that tells you what the correlations are, rather than you asking it, to allow you to do trials on causation. We call that pragmatic research, whereby instead of designing a trial to achieve an objective, the trial gets done just by the fact that people are using the app and recording what they’re doing.
This is being used at the moment to help decide which drugs may work to treat or reduce the symptoms of COVID-19 that are already licensed. We’re working with universities at the moment on that one where we have 2,100 people on a particular drug which may reduce symptoms. We also record whether or not they get symptoms. In effect, the trial has already been done, we didn’t know we were doing it when we did it. The drug was given for a completely different indication to a whole load of people and now, we should be able to work out whether that drug might help with COVID-19.
So I see a future where we are all recording our data. We are all putting our own health in our own hands rather than into the hands of organizations, and contributing to research in an ongoing way using AI and deep learning to understand subpopulations within us and personalize our own health care.
Given your background in health tech, what do you think policy-makers should be focusing on to improve the availability and quality of health services?
If we’re talking about DNA, my belief is that everybody should have a DNA test at birth that would be part of their health record, and that we should learn from it; both for the sake of the population, and for providing better medical advice on the individual level. It’s so cheap to do these days. You can get a full DNA test for less than £400. That’s what should be happening and I think it would make a huge difference.
There are lots of other things we should do about healthcare. The next one would be to allow people to understand their body, so they can make better health choices, and not just be part of a population where they are given average advice.