Smart Shoes for "Parkys" - who funds Health Innovation?

Over the past couple of years writing this newsletter has brought me into contact with dozens of people with bright ideas for improving healthcare. It has also made me ask myself a couple of questions - how do we get innovation into our health service and how is it going to be funded? This post is the first in an occasional series in which I aim to explore how innovative healthtech ideas progress to become profitable products - or, far more likely, fail to make it.

NuShu X - charging up

A fascinating meeting this week told me that funding can come from all manner of unlikely sources but getting a product adopted by the NHS is still a lengthy and challenging process. I arrived at the Putney home of David Streule having been introduced by my cousin who had told me that he was an investor in a company which made an interesting product connected to Parkinson’s - shoes that could monitor and perhaps improve how you walked.

David turned out to be younger than I had expected. A career as a commodities trader and then working for a couple of large mining companies had left him in his mid-forties well off but uncomfortable with the ethical standards in those industries and determined to invest in an area he was passionate about. Aha, I thought he wants to improve healthcare.

But no, he flung open a door to reveal a room where his pride and joy, something like half a dozen top of the range racing bikes, were locked on racks against the walls. David revealed that his real passion was cycling and when he had exited corporate life and returned to the UK from Switzerland he had decided to put many of his investments into cycling-related companies. He had bought stakes in one company making clothing for cyclists, another organising cycling holidays and he was in the process of setting up a racing team to promote a new bike store.

David Streule with his bikes

But what on earth had Magnes, the Swiss firm behind the Parkinson’s shoes, got to do with cycling? It turned out that their original aim had been to build a power meter, a product I had never heard of but which is apparently extremely popular with serious cyclists as it helps them train to pedal with greater efficiency. They are installed on the pedals and can cost over £1,000 each so if you have a number of bikes the cost can really mount up.

Magnes, a company spun out of Switzerland’s top technical university, had a brainwave - why not put the power meter in the cleat which connects the cyclist’s shoe to the pedal? This would mean you would only need one of these gadgets which would work on any of your bikes.

The trouble was that this did not work well enough to give accurate enough data and the company started working out how to put its power meters into pedals, which meant it had lost the USP which had been the motive for David’s investment.

But along the way Magnes had done some experiments which involved using their device and the algorithms they had developed on the static exercise bikes used by doctors during rehab sessions. “They could connect these pedals up to an iPad,” David explains “and they could make the patients play games on the iPad, which are controlled by how much force they're putting through each pedal. And so, for example, they looked at patients recovering from a stroke which had affected one side of the body, not the other.”

From there it was a short step to embedding their device in a pair of trainers and building a phone app which would connect to the shoes and collect data from them.And so the product I had come to see, the NuShu X, was born.

At this point I delicately tried to suggest to David that he was now investing in a company entering a market of which he knew nothing.

“I don’t deny it,” he replied with a smile. “I know a lot about cycling, I know a lot about trading metals, I know very little about health tech.” But luckily over in Switzerland there is someone extremely knowledgable about both technology and healthcare and within moments David had summoned him up via a Zoom call.

George Chatzipirpiridis is one of the founders of Magnes, a scientist who got a PhD from Zurich’s technical university. The title of his thesis “Magnetic Technologies for Small-Scale Robotics” tells you something about his level of expertise which has played a big part in developing what he describes as the miniature iPhone installed in each NuShu. He explained that he and his cofounder Olgaç Ergeneman had taken the research they had been doing at the university into tracking microrobots inside the human body and ended up with a way of tracking movement of the human body with extraodrinary accuracy.

By now I had seen the shoes and tried them on - David had arranged for a pair in my size to be shipped over from Switzerland - and I had all sorts of questions about how they worked and above all what was the business model for Magnes to turn all of this complex research into a profitable product.

George explained that the company was targeting two audiences - clinicians and individuals with Parkinson’s. Doctors would buy the shoes so that the traditional “please walk up and down the corridor outside my office” that happens at every annual appointment could be recorded more accurately. Then rather than just having an impression of how the patient walked, the doctor would have some hard data and be able to compare it with last year’s appointment.

“Every neurologist all over the world is looking at how patients are walking - only a little fraction is actually collecting data,” George tells me. He says that after three years, the NuShu is pretty well established in Switzerland, with a typical clinic buying a dozen pairs and the cost now being covered by health insurance.

The other model is selling direct to patients, with marketing to them focusing on the vibration function in the shoes which is said to improve your gait, particularly for people who suffer from freezing. George gave me a brief explanation of how it works: “It measures in real time the movement, and based on the movement, calculates when to vibrate. And the more you use the shoes, the more they get personalised to your gait patterns.”

The shoes are an expensive investment for an individual or a hospital - but George is confident that it will pay off in the long run:

“The biggest benefit we see is not that the patients walk better and that they don't freeze. The biggest benefit is that they have less falls.”

Falls are devastating not just for the individual but for the finances of the hospitals where they often end up, so anything which can prevent them will be looked at with interest. But while the shoes are being marketed in the United States and major European countries, George is not expecting to make fast progress in the UK - even the NHS “fast track” system for introducing new medical devices takes five years he says. What he hopes is that what happened in Switzerland, where more than 200 individuals bought the shoes increasing the pressure on insurers and medical regulators to take a closer look, will be repeated here.

The trouble is Magnes is still a small company and has nobody based in the UK to market its product. So David Streule, cycling enthusiast and former commodities trader, has been asked to step into the breach: He says they told. him“as an investor, David, if you want to try and do a few things, be our guest. we're not going to stop you.“

I am going to write more about how the shoes work in a few weeks when I have had time to test the pair I have been lent. In the longer term, I will also keep up to date with how Magnes fares on the long journey towards getting its technology accepted.