340 karma · joined June 23, 2009
Totally agree that the electronics is not the difficult part (battery management, and power consumption aside). Our most loved features are the industrial design and materials science around our electrodes and ways of attaching them to the scalp.
It's quite a contrast to their previous interview with the creator of LTSpice: https://theamphour.com/196-an-interview-with-mike-engelhardt...
Happy to answer questions about anything seizures, epilepsy, or med-tech related.
For a device to be approved as a Class 1 medical device for blood pressure measurement, the FDA wants +/- 3mmHg to an established BP measuring method.
Smartwatches and similar devices use photoplethysmography (PPG) to measure blood oxygen saturation. The heme units in blood have different reflectance/absorbance spectra depending on their level of oxygen saturation. The only difference between the fingertip pulse oxygen sensors used in clinical settings and those used in smartphones is that the clinical ones use transmission, whereas the watches use reflection. While the methods are different, they arrive at very similar numbers (+/- skin color & racial biases).
Unlike pulse oximeters of yore, smart watches can take many thousands of readings per second. And if you offset your photodiodes by a known distance, you can calculate pulse transit time, and a variety of other measures beyond just your spo2.
The challenge has been in translating these measures back into systolic and diastolic blood pressure. To be accepted by the FDA you need to be able to show that your device is +/- 3mmHg. That's just not doable right now for the reasons mentioned in the article.
That said, the measures that you can get from high-speed PPG are probably not useless. But these measures aren't backed up ~200 years of medical practice. It is a very long road to introduce new measures into the medical system. Not only do you need to get FDA clearance to sell your device, but you need to navigate the reimbursement system to find someone who will pay for your device. Doing this in a 5 year time span would be unheard of. While cardiologists would like a better system than cuff based BP measurement, the upside of a better system is limited by the current medical system. And there's a significant cost and downside risk to anyone pushing for something different.
One company that I spoke to and is still working on the problem comes with an impressive biomedical pedigree, and they're starting in the non-diagnostic "wellness" space.
Another company is using mm-wave radar to measure pulse waves in a different way, but it appears that they've pivoted from being directly challenging the BP status quo into now selling their hardware sensors to more well established medical device companies.
Long story short, I'd be impressed to see blood pressure cuffs retired in my lifetime.
I use engenius WAPs, a 100Ah battery, 2 100W solar panels, a $15 solar charge controller, various buck/boost converters for other power requirements. The system also powers an LTE repeater and LTE modem, to provide the farm with internet access.
You're right on the prior to 2008 comment, but it was indicative that any bum and their mortgage broker could get a charter. But tech companies who are (hopefully?) less shady, can't.
If you're a payments business and cash passes through your balance sheet, then transmission regs apply.
If you're moving bits, but not money, they don't.
And if you have a bank charter, or bank sponsorship, you're mostly exempt from them.
The problem with acquiring an existing bank is that for any tech company, you are likely to be changing the business purpose of the acquired bank, so you'll need to basically go through the de novo process again.
Either way, you're looking at 5+ years to get a charter that you can use to run any new digital banking business.
And then there are the capital requirements. The capital required to launch a Bank is tremendous. You need to have sufficient capital against your projected future deposits. Way out of the range of VCs. And only a limited number of PE firms play in that space.
And even if VC's did have the financial resources, the returns are dismal. Chartered banks, particularly new charters (either de novo, or acquired for a new business purpose) are limited in their growth. A very fast growing bank might grow 50-100% yoy. The return on capital equation just doesn't work out for VC capital.
It doesn't make much sense either for PE firms, given the limitations imposed by the Bank Holding Company Act.
tl;dr, this shit be hard.
In Kenya, M-Pesa is by far, the #1 payments service, with nearly half the country using it. It grew acceptance as a replacement for the other way of remitting money from the cities to villages - busses. Prior to M-Pesa, bus drivers would act, for a fee, as money carriers, bringing income back from the cities to families back home.
The competent hackers were, literally, brute-forcing the old system. Bus drivers are easier to compromise than mobile handsets and infrastructure.
Not sure if I quite follow.
We don't let our customers write checks directly. They can send checks from our apps, but they don't get a checkbook. Even if someone produced checks with one of our customer's account numbers, our systems are set up to reject them.
We are working on a way to let our customers write their own checks, but we're taking our time on this feature as we want to shut down that fraud path with a special type of check. More details to come in the future.
The feature we released today is for check deposit. Yes, you could suffer if someone gave you a fraudulent check, but the risk is no different than depositing that same check at a teller.
You've nailed it. We can't outcompete banks with gimmicks. We can't afford to lure people in with teaser rates or rewards programs that look great in an ad, but never work as well in reality.
Instead, we're competing on experience. Crafting that experience, especially given the cruft of banking, is a schlep. And its a huge competitive advantage for us.
To the grandparent poster, yes, switching banks is hard, but $30bn of revenue switches retail banks each year because of negative experiences. Thats a tiny amount for the top 4 banks, but a large market for a startup. If you can deal with the schlep.
[0]: I work there.