Health start-up fuckups

• Health start-ups rely on trust much more than companies in other sectors. They are very similar to security companies: A loss of trust is the fastest way to kill the business. This week, we saw two spectacular examples of how companies can break that trust with (potentially) irreparable damage. Whilst the saga around 7 Cups has been on for a while, Ahead slipped into the spotlight due to one grave marketing mistake. 
• Both cases show that mental health start-ups are just like any other company in their need to grow and earn. Whilst there is nothing fundamentally wrong with that attitude, growth in both these cases was prioritized over ethics. Regardless of how major you might deem these PR disasters, they indicate a deeper going lack of alignment and checks and balances that put the vulnerable customer at risk. They could be read as tell-tale signs of anything between bad management and outright bad intentions. Let's dive in.

Duolingo for mental health mocks Britney.

Ahead meet strong headwind after posting an ad for their emotional coach app depicting Britney Spears with a shaved head and the tag line “Imagine if Britney had the ahead app back then”. You can find a repost here, as the original has been taken down.

What worsens the issue is that the content is obviously AI-generated. Whilst the background is obviously fake, you can also tell by the lettering of the Ahead app on the phone that this was made with minimal effort. What was probably a 10-minute job from idea to going live could have ruined the company’s reputation for the foreseeable future. Would this ad have been created the traditional way, somewhere in the process someone might have reflected on that tag line for a second.

All this speaks towards an obvious lack of checks and balances. The company said the ad was made by an agency, with whom they have now ended the relationship. Start-ups are always scrappy, but you can not allow for that to happen with a product that caters to emotionally vulnerable people. How deep such issues run in the company is not clear. But looking at some other ads of theirs, it seems that Ahead gives themselves quite some leeway to get ahead:

Whilst this tag line might not be wrong, I see it rubbing people the wrong way. in my view, Ahead gives up on the idea of providing proper mental healthcare to everyone in need and uses that fear to gain paying customers.

Marketing your mental health app as addictive suggests you don’t really have a clue about mental health. Thinking of something as addictive and effective at the same time is paradoxical too.

All examples are taken from their LinkedIn Add library: https://www.linkedin.com/ad-library/search?companyIds=71293120

7 Cups – Moriarty shows no remorse

7 Cups is a platform that matches people in need of mental support with other users to listen to them. Whilst you are not connecting with a real therapist, you are supposed to get a “compassionate” listener to allow you to talk about your troubles freely and safely. The platform is open to teenagers as well and has been around since 2013. Recently, the company has gotten a sizable shitstorm over using unaffiliated therapists' contact info to get new paid users.

In case you aren’t caught up on the issue, here is a quick rundown:

• In 2019, California terminated a contract with 7 Cups after evidence arose of trolling and, more importantly, adults posing as teenagers and coercing children into sharing explicit material on the platform. The news broke only last year as the State of California seemingly tried covering the story up. It is not clear to what extent this issue has been resolved until today on the platform. 
• Ironically, the CEO Moriarty (a psychologist himself) experienced trolling and posted about it in a forum. He basically recommended positive interventions to get the bad actors back on the right path. Whilst there is a rating system to reward good listeners, the company knew for years before the incident with the State of California that those top-rated listeners sometimes had secondary troll accounts.
  Details on the rating system can be found here. According to that post, you can contact a minor outside the platform twice without being banned permanently. (This is a 4-point offense in their system, leading to a 2-week ban the first and a 3-month ban the second time. Only for 10+ points will you get permanently banned! There are further repercussions that limit access to the platform, but I think the fundamental policy issue is clear.)
• All of this is already bad practice. Surprisingly enough, it didn’t have as severe consequences for the company as you might expect. They lived on.
• Recently though, 7 Cups decided to one-up themselves again with a therapist directory, which in reality is something called a ghost network. Ghost networks are outdated directories of therapists that many argue hurt prospect patients rather than helping them. The frustrating experience of calling around only to be declined or simply not answered might lead people to give up their search for a therapist completely.
  7 Cups seems to have scraped other directories without permission. Displaying outdated contact info might also lead people to send sensitive information to dead email addresses or even ones that belong to completely different people. But this isn’t even the worst. In cases where professionals haven’t claimed their profiles (for a 30$ fee) the companies tries to sell the website visitor on a premium membership to the 7 Cups platform.
  The result is a lose-lose-win situation: vulnerable people get mislead and squeezed for a premium membership, professionals take a hit to their reputation, and 7 Cups earns off of that. For further background information, look into this excellent article by Mashable.

Thus far, 7 Cups has not really given in to the criticism. They stand by their product and their way of doing business. It seems that they either genuinely don't see the issue or are willing to ignore the negative consequences in exchange for a few extra subscriptions. As the company itself justified not taking down the therapist directory as it was expensive to build, they probably had an economic interest in making in the first place. My guess: a badly thought through SEO strategy that went for better rankings and higher visibility with content that was easily scrapable from other directories and repackaged using AI. I would definitely steer clear of this kind of business.

On the bright side: failing the right way

Enough for the bad news this week. Many companies fail even when fighting for the right cause with ethical business practices. In this blog post, Caitlin Ner details learnings from her failed company Scion Health. Whilst this is not only a good resource for those trying to currently build in the mental health tech space, it is also an encouraging example of how this failure didn’t kill but rather enriched her career. 

Spotlight: Examining One Mind’s portfolio. Does domain expertise really accelerate ideas?

One Mind is a mental health non-profit that runs an accelerator (OMA) specific to that sub-industry. (For some reason they also host a music festival? Whatever, let’s not get distracted here.)

They are now on their third cohort, with 37 portfolio companies in total (roughly 15 per batch). At first sight, they have a rather basic offering:

Regardless, I would argue that especially in this niche, expert knowledge can massively accelerate ideas towards working products. Bootstrapping completely is basically a no-go. Also, as a non-profit, One Mind is more strongly aligned with the goals of social good companies. The organization is well funded by corporates and trusts.

Soo, what makes their companies special?

Several OMA portfolio companies operate in the digital therapeutics and virtual care delivery space, including Amae Health, Options MD, and Soulside. These companies face competition from well-established players like Lyra Health, Headspace, and Cerebral.

One key difference in growth trajectory appears to be OMA companies' focus on specific underserved populations or treatment-resistant conditions. For example, Options MD addresses treatment-resistant depression specifically, whereas many competitors take a more generalized approach to mental healthcare.

They go all in on aggressive innovation. OMA's portfolio includes various companies developing cutting-edge neurotherapeutic approaches that represent potential paradigm shifts in treatment and diagnostics.

Ampa Health, for instance, has developed a brain stimulation technology claiming a 70% remission rate from depression and anxiety with a single-day treatment.

Ceretype's fMRI-based "biomarker engine" and Dionysus Health's epigenetic tests for hormonal depressions represent advanced diagnostic technologies that have few direct comparables in the market.

Slingshot AI is probably the most prominent member of the accelerator program so far. Their massive success in securing following rounds speaks to the effectiveness of their leadership team, the gap in the market, and the quality of the accelerator.

That's it for the week,

Friederich