About this episode
Huma is about to reach a 1 billion dollar valuation, and is thriving while other digital health companies are dying. But what's their secret sauce?
Dan Vahdat is the Johns Hopkins dropout — who meticulously studied the successful business practices of big pharma, and using these, has created the 'soonicorn' digital health company that's about to take over the world of remote patient monitoring and decentralised clinical trials.
In this conversation
- The contrarian core of the whole episode: "focus on one thing" is bullsh*t in digital health, because if that one thing is wrong you've burned three years and tens of millions before you find out. Vahdat's answer was to build like a pharma company — a pipeline of assets on one configurable platform, so experiments cost a fraction and can run in parallel.
- The AWS-for-healthcare play, explained: Huma built its regulated platform for itself first, got it to 80–90% cheaper and 5–10x faster than building per-disease, then opened it up — landing the first and only configurable, disease-agnostic FDA Class II and EU MDR Class IIb clearance.
- A genuinely useful warning on the infrastructure play everyone romanticises: go upstream and you can end up with "a TV channel that has no content" — high upfront cost, no users, and death. Building for yourself first is the hedge.
- The Jony Ive lesson on focus that reframes the word: focus isn't saying no to things you didn't want to do anyway — it's saying no to the thing you want to do with every bone in your body, and know is good, and still decline.
- The candid part founders never admit: Vahdat says he never understood anxiety or stress until Huma got big — because suddenly you have something to lose, publicly, and everyone's watching how you walk and talk. Plus his real take on whether studying successful people is worth it at all.
Transcript AI-generated
Dan, over the past decade a lot of companies have had similar visions to Huma, and a lot have risen and then failed. As Huma approaches almost a billion-dollar valuation, what do you think are the two or three things you've done right that meant you survived — and thrived?
It's a really tough question to answer, because unfortunately or fortunately we only get to live one life. We don't have full visibility into the parallel lives where you could do a proper assessment of what you did right versus everyone else. For sure, we were lucky — and I'm really transparent about it, because I can pinpoint times we could easily have not made it. But for the luck of somebody believing in us more than we believed in ourselves, someone kicking us onto a different trajectory we otherwise wouldn't have taken.
The general wisdom is: focus on one thing and do only one thing. And somehow that got translated into — if you want to make digital health work, you have to be really focused on one disease or one condition, make that work, and scale from there. The challenge with the one-thing strategy is: what if that one thing is wrong? Digital health and healthcare is not an industry where you learn the bottom line in three or six months and can pivot quickly. It takes two, three, four years, and tens of millions to build the software, regulate it, collect the evidence. By the time you realise you're wrong and this isn't going to add value, you're out of time.
That's why pharma companies — which I consider successful businesses with meaningful impact in the world — always talk about a pipeline of assets. You never see a pharma company say, "you know what, I only have one asset and it's going to make it." As soon as you do that, your share price tanks. They always have a pipeline of assets — and if they come across a good asset somewhere else that could complement their ecosystem, they acquire it too.
We really reflected on that. And we thought — what if we can create one platform that gives you the configurability, agility and adaptability to support different use cases? Right away you get a big saving, because for each use case you don't start from scratch — you configure it and run parallel streams of multiple product lines through one single platform. And you really see which one adds value. Maybe asthma is the right one. Maybe rare disease is. Who knows? This way, without waiting, you can run these assessments in parallel, cost-efficiently, and see which ones work.
But it's also because of the story you tell. Nobody's interested in partnering with you for just one disease — hospitals and pharma cover multiple diseases. And they don't want 200 different partners on the digital health side. They already struggle with the 10, 20, 30 systems they have inside the hospital. Imagine multiplying that by 300 external partners.
We made a big bet on this model, and it's worked really well — a flexible platform, combined with betting on some companies that had good assets complementary to it. As you know, we did a couple of acquisitions on the journey. If we hadn't done that, we'd have been dead by now — that I'm sure of. How this strategy makes us the biggest, most impactful healthcare business in the world is still a question mark. But when I look at our FDA clearance, I think it was a pivotal moment for the industry. When I look at our EU MDR Class IIb — being the world's first and only configurable, disease-agnostic platform — that's a pivotal moment. Seems like we're on the right track.
Can we talk about focus and shiny-object syndrome? I appreciate that when you spread your bets a bit, there's an anti-fragility — if one thing doesn't work out, something else might. But there's also the argument in entrepreneurship that if you don't focus on one thing and do it really well, and you spread your team across multiple things, you're not really doing anything properly. So two questions. How do you think about focus and how many things to prioritise? And are there times when you still have to say no to attractive opportunities because you'd be spread too thin?
“Focus is not saying no to the things you don't want to do anyway. Focus is really saying no to something that, with every bone in your body, you want to do — and you still say no.”
Dan
Focus is the hardest challenge — it's been the hardest challenge for me, especially in digital health. There aren't clear, obvious winning use cases you can make a big bet on. And it's not a marginal improvement of current systems — you're completely trying to reinvent something. It's not telemedicine, where okay, I used to see my patients and now I talk to them over video. It's not that kind of thing.
What I always tell my team — and try to encourage myself with — is something Jony Ive of Apple taught me. I think he was sharing Steve's perspective on focus. He said, "Look, Dan — focus is not saying no to the things you don't want to do anyway. Focus is really saying no to something that, with every bone in your body, you want to do. You know it's the right thing, the good thing to do — and you still say no." We try to implement that philosophy more and more. Every year we get bigger, we actually try to be more focused.
At the beginning we had to be flexible to see what works. Then every year we make it tighter, so we can go faster on the things we've tested and now have visibility that they actually work. We have the evidence behind it — so we're not focusing blindly, because you can also be focused blindly.
We really wanted to build our platform and technology initially for ourselves, so it enables us to experiment — but still with one platform, so our cost of experiment isn't $10 million per disease, which is usually what it takes to build an application for a new disease. Forget the regulatory evidence, which costs even more. By building that platform to enable our own experiments, we not only discovered the use cases that really work — we also created a platform our partners love. Because as an AstraZeneca or a health system, you can partner with one company and support many of your use cases. Diseases are more alike than unalike in many respects, and the nuances that differ, you can adjust for on the platform.
That's what we're really trying to become — the platform that drives innovation and enables anybody to launch their digital health innovations really fast and cost-effectively. Because it doesn't matter, Mustafa, how good we are — we're not going to solve all of healthcare through digital health by ourselves. We need to embrace and empower the ecosystem. That's why our FDA approval is a milestone for every small company and every big pharma — to take this and launch their own solutions, the same way you subscribe to AWS for your cloud and build your own app. Imagine that for healthcare, in a regulated world. That's just the beginning.
Dan, when I look through Huma's different arms, this follows on from what you've been saying — but it seems like in every tentacle of Huma you've decided not to go right to the coalface. You go slightly upstream. When you do decentralised clinical trials, instead of focusing on one disease and doing one DCT, you go upstream and build the platform that lets everyone else do it. If a company were to launch a telemedicine platform, you don't bother with that — you build the white-label solution other startups use. So in every focus, you've chosen to go slightly upstream and build the AWS, the infrastructure of that layer. Is going upstream to focus on infrastructure always a sensible decision for a business? Or are there times when it doesn't make sense? Because by that logic every company should go more upstream, and that leads to bigger impact, bigger valuation, more interest from everyone.
It's a really tough call. It's not like ten years ago I sat down and said, "let's build a multi-disease, configurable, FDA- and EU MDR-approved platform." We started a journey where we needed to at least support multiple use cases, because you can't put all your eggs in one basket. We built something for ourselves, then did more projects — both in pharma clinical trials and in healthcare. And we realised our clients, big pharma and big healthcare companies, were thinking of solving similar problems. Then suddenly we thought — it would be really cool to open that up and think of it as an infrastructure play rather than a pure product play. But we still want to use our own platform to build our own products, because that's the best way to build a great platform for other people. We don't want to lose that for the foreseeable future.
It's great, because it gives us an advantage — we can be 80–90% cheaper and maybe 5 to 10 times faster when we launch things ourselves. But the true innovation comes when you enable other people to innovate. That's not too dissimilar from the AWS story — they built AWS for themselves initially, from what I know. Then they thought, maybe I should open it to other people, because I'm solving a big problem for myself that's applicable to everybody else. I know how hard it is to get FDA and regulatory approval, and how important it is to be Class II — because without Class II you can't do decision support, predictions, screening or diagnostics. You can only transfer data from A to B and let someone else do something. I can solve that for myself; we can solve it for everybody. We really want to be the company that lets two people in a garage, two people in a small clinic in the middle of Scotland or in Palo Alto, or the biggest pharma company, launch a solution quickly — without it costing tens of millions of dollars and several years.
But if we extrapolate away from Huma — generally, in health companies and startups — do you think that framework of going upstream always makes sense? Are there downsides? Because it looks like a big gravy train, and it's amazing.
“You build something at the infrastructure level, and if you have no user, it dies. When you have infrastructure that benefits nobody, you're dead.”
Dan
It is. But there's a downside: you build something at the infrastructure level, and if you have no user, it dies. When you have infrastructure that benefits nobody, you're dead. We didn't build our infrastructure for other people initially — we built it for ourselves. So it works. Even if the "open it up" idea doesn't work in the short term, we know it's beneficial long term. We still have a great business, and it gives us a competitive advantage — 10x cheaper, 10x faster. And at some point we'd love others to adopt it, which they're doing slowly since our FDA and EU MDR clearances, both new. If it takes off, exciting. If it doesn't, still okay — we can be patient.
So the word of caution is: you might create an infrastructure play that no one needs, with a high upfront cost.
You might not have any users. And if you don't have any users, it's like a TV channel with no content — nobody wants to watch it.
I've been reading a book by Felix Dennis, the British billionaire media magnate, called How to Get Rich. He has a whole chapter on ownership being the most important thing in any business venture — actually he says ownership isn't the most important thing, it's the only thing that matters. As many health startups scale using venture funding, the founders' ownership dilutes. Do you think that's a fair point? Is the real meta to run a private business with no external funding, retain full ownership and autonomy, and not bother with this?
I understand why he makes that point, and it really depends. In most industries, if you're patient and have a 20-, 30-year time frame, you can build a meaningful business with very limited fundraising — but probably not a business that changes the world. Because when you're changing the world, you're going against lots of things, and you have to pay for that either with money or with time. The problem with paying with time is that if it takes long, things change — your surroundings change, all the assumptions change. So if you're doing pioneering work, it's really important to raise money and invest in your growth to accelerate.
It also increases the speed of your learning, because it lets you make some mistakes, learn from them, and double or triple down. Ultimately it saves you time. But you pay the price with less ownership, sometimes less control. For me at Huma, the most important thing wasn't the control I or the team would have — it was making sure no single party would have the most powerful type of control over the business, in case they had a different agenda to ours. Because our business is about doing good for patients, and we want to be able to do what we want and not be pushed to compromise.
Give you one example. When COVID happened — you might have seen it in the news — lots of people could make a lot of money, and lots of people did. We made every COVID-related project not-for-profit, some of them pro bono: from supporting the AstraZeneca vaccine clinical trial to virtual wards and hospitals-at-home, some of them national projects. That wasn't an obvious bet — it was an uncertain time, we had limited money, and we could have been dead after delivering those projects for free. But my shareholders and supporters all agreed it was the right thing to do. And in the worst case, even if they hadn't shared our view, we still could have pushed for what we saw as right for patients and society. That matters more to me than control.
And I do think entrepreneurs and team members who put their lives into bringing change in healthcare and deliver results should be rewarded. I don't like seeing entrepreneurs who have only 2% of their company after all that time. That's not right either.
You did an interview with James Somauroo, and I wrote down a quote: "If we maximise impact, the commercial aspect will come." It relates to "if you build it, they will come" — this idea that you just create value and everything else, the commercial, follows. In the last few years, has that seemed true for you? Because to me it sounds idealistic — cute, but in the real world I'd imagine you need a lot of focus on the commercial, and there could be a counterfactual universe where you create a lot of impact, you're a great player, but the commercial never really arrives and you die.
There's a challenge in the industry — we collectively have a perception of impact. And there are two different things: real impact and perception of impact. Give you an interesting comparison. I met a CEO of one of the big pharma companies — Eli Lilly, I think, I could be wrong — and he said, "We've touched 100 million people with our drugs in the history of the company. This time next year we'll have touched another 100 million." My impact is nothing close to theirs yet, because the kind of reach and touchpoints they have has been far more transformational — drugs that save lives. So yes, we've had some impact, but for many people it was small.
I still truly believe if you bring impact, people want it. You need technologies you can't live without. If it's a nice-to-have, that's a perception of impact, a perception of being important. I totally stand by it. And of course, if you do impactful projects but don't charge for them, don't monetise correctly, don't sign a contract — you won't make money. And if you don't make money, you'll die anyway. So assuming people do things correctly: if you bring impact, the money and the upside should come. And if it doesn't, it means either the industry isn't ready, or it's not real impact — it's a perception of impact.
I appreciate the difference between real and perceived impact. But when you're creating that impact, part of it is packaging it, branding it, communicating it effectively. One thing I noticed with Huma is that everything you do is a bit aesthetic — beautiful, well thought out, designed, from your website to your products. There's a real focus on it being a pleasure to use. You mentioned knowing Jony Ive, so maybe he gave you tips. What have you learned about branding, communicating, storytelling? Any high-level, high-yield things you've picked up?
Look, sometimes my team comes up with a presentation, and if it has a few dots not in the right place, I just don't look at it. Not that I'm arrogant or want to be hard to work with — I just cannot consume it. I can't focus on it. If it's ugly, I can't focus on it. But also, in the back of my mind: if someone created something really good and didn't put the effort into packaging and presenting it nicely — because that part should take 5% of the effort if you've done the work — then, if you've already done the 95%, most likely you'd do the 5%. If you haven't, it puts a big question mark on it for me. Maybe that 95% is also rubbish.
People in the company know: if you come up with an ugly presentation, it doesn't matter how many disclaimers you put — "we did it quickly, don't look at this" — I just don't look at it. I can't. Some people are colourblind; it doesn't matter how much you force them, they don't see green. I'm like that. So we try, as a company, to do as much as we can in a polished way. Honestly, I still think we do a very mediocre job, in my opinion. I appreciate you like it, but I think it has to be ten times better. We invest a lot in building evidence — I think we're the most published company in our industry, from Nature to you name it — but we do the 95% and still have to do that final 5% even better.
There's a quote in creative spheres about how great creatives start out because they have really high taste. Even when you have no creative skill, you have a lens where you appreciate good design — and it's the mismatch between what you see in the world and your high level of taste that makes you become creative, because you try to close the gap. My question is: leaders who are detail-focused, extremely particular, with grand ambitions can be difficult to work with. Have you had to temper that in yourself to be easier to work with? Because when I surveyed your company — which Connie helped with — a lot of people said very positive things about you creating authentic, long-lasting, trusting bonds, being a likeable person. But you do have this side where you're very detail-oriented, almost a perfectionist. How have you balanced those two energies?
“When I see something wrong, it's like someone takes a knife and cuts me. It hurts that much. I really try to contain it, but a man only has so much energy to contain if you keep getting stabbed.”
Dan
Dilemma of my life. People think — and I sometimes exaggerate to make the point — that I'm too much into perfection because I want to be hard to work with. The reality is it really hurts. When I see something wrong, it's like someone takes a knife and cuts me. It hurts that much. I really try to contain it, but a man only has so much energy to contain if you keep getting stabbed.
And from the other side — when I see perfection, when someone does something better than even I could imagine, it's the greatest feeling, the joy of life. I was at Founders Forum last week chatting with Brent Hoberman. Brent was nagging about some spray in the toilet his team didn't put out, and he had to deal with it — one of the most successful entrepreneurs in the UK, still zoomed in on whatever was in the toilet, passionate enough to talk about it at a conference. Maybe that's what's needed. If you compromise, where do you stop? You can always argue you don't need this or that, maybe we shouldn't put as much effort here — and suddenly you have something really ugly. People get it. It makes working actually joyful. They want that from you, and they expect the same from me. If I show up with something ugly, they return the favour. And that's cool.
What have you learned about relationship building, networking, the human aspect of motivating your team? Any lessons that come to mind — that through your experience with Huma, this is how you deal with people effectively, inspire and motivate and build good relationships?
This has been a very interesting topic. People talk about how you have to inspire your team. It almost feels like engineering — "let me inspire my team, let me make them inspired." I don't do that. I'm just me. I'm passionate about something, and that's that. I'd be the most bored person if I weren't passionate, and then I probably wouldn't inspire anybody. Can you engineer it? Maybe. But it doesn't feel genuine to me.
I have a bit of a problem with this whole idea. If you do what you do as a job, I understand — you need to go in, despite whatever you think, and try to inspire people. But if it's what you really believe in, you don't need to inspire anybody, because you're already inspired yourself. You're just sharing your story and what you want to do. Some people get excited about it and some don't, and that works out, hopefully. I never, ever thought about it. Maybe it's just me. I don't think that way.
Dan, with the greatest respect — when I hear founders like yourself, even earlier talking about your grand ambition to improve the world, open-source everything you're doing, really make an impact — my bullshit radar starts tingling quite hard. Because in my view, most great people's ambitions can probably be traced to the seven deadly sins rather than some great altruistic thing. So, what do you think of that? And B — what did you find your actual motivation was?
I really agree with you — it's usually one of the seven. That could be the driver. But you can use it for good, manage it for good. You can be a very strong, capable person and not hurt people — do good with it. That's where things get really interesting: when you can do whatever you want, but you choose to do something positive. And going back to open source — it's the only way, by the way. It actually helps the business to make things more open. As an example, we decided recently not to maintain any of our patents. If our patents are bad and not useful, what's the point? And if they're good and useful, let's make sure they don't block anybody else from doing it. That's how we think.
Fair enough. So you do walk the walk as well as talk the talk. But what was the motivation you found? Why do you do what you do?
I'll tell you one day.
Okay, fair enough. The last thing I wanted to touch on: how does your life materially change when you grow a company as large as Huma? When I was reading up on you, I saw you spoke at Davos this year. Doors must open. You mentioned speaking to Jony Ive — you're connected into this network of great entrepreneurs and innovators. Does life really change when you build something this big, and when that message gets out to the world? Is it a case that you can cold-call the CEO of Pfizer and they're on the phone in two seconds? What's changed? What's become easier — and what's become harder?
Life gets harder, because you have something to lose, and you can lose it publicly, because everybody knows what you do. It's a really tricky place, because suddenly it changes your perspective on the world. You start to optimise. If historically you were purely optimising for your dream — let's get there, as unimaginable as it sounds — at that time you had nothing to lose. Now suddenly you do. The level of strain and stress and pressure is huge. I never actually had anxiety in my life until the company started getting big. I never understood what anxiety and stress were. Because you get to a place where not everything is in your control. You can't just single-handedly lift, solve things when the shit hits the fan. And at the same time you're in everyone's eyes, and different people expect different things of you — the way you walk, the way you talk, what you say, what you don't say, what you deliver, from financials to impact. It's a really tough place to be.
But it's also a gift, because it really pushes you to grow, to learn new things you didn't know before. And one side benefit is you get to meet some inspiring, unique characters. Albert Bourla of Pfizer — I've met him several times. I've been in the homes of some of the most important pharma CEOs, discussing things intimately. If you want to get there, you need some of the smartest, most experienced people talking to you, sharing with you — not transactional sharing, really intimate discussion. That's the greatest gift, and what I always wanted.
I talked about university. The reason I wanted to go to the best universities wasn't that I care about education — I actually have very little regard for how education is done in today's world, and I think someone has to transform it. The benefit was that I could be surrounded by a pool of really smart people. Not every smart person in the world — sometimes they don't do education and are equally capable — but I could maximise my chance of being in the same room with them. Knowing what's happening in the minds of the smartest people, some of whom are now executives at big companies — I really wanted that. I didn't want to die not knowing what the most important, smartest people in the world think. And I think I'm really close to achieving that.
Do you think making a study of successful people and trying to learn from them — because that's basically what I'm doing — is a worthwhile goal? Or are you just avoiding doing something yourself, maybe reading winning lottery tickets, with survivorship and winner bias, just studying? Is it a useful activity to get into the minds of really excellent, great people?
It's a really tough one, and I know you're doing it. It can consume you. We're all unique in our own way, and so many factors play a role in our success — I don't know how transferable they are from one person to another. Is there a book you can read and suddenly become successful? It makes me think, when I see "read this book, become a millionaire."
The way I look at it is very simple. We're extremely lucky to be alive — biologically speaking, the likelihood of us living the way we live is tiny. If we really work hard and push ourselves, with the understanding that whatever we do is okay — I don't think everybody should be an entrepreneur, I don't think everybody should have the characteristics we call success. Everything is okay. We should become what we really want to become, what we truly want — not what the world tells us. Because in that way, I shouldn't have started the company. Why would you do digital health? The normal delivery of care was fine, you could argue.
There's a bit of a problem in the world that success is just the money or the fame. I don't see it that way anymore. I used to. I used to think, as a company, the most important thing at Huma is the mission — nothing else mattered. But what I realised is that the most important thing is the time you spend with the people you're delivering that mission with. Because if you don't have that, the mission will never get fulfilled.
I hope you enjoyed that episode. You can find all my links by going to bigpicturemedicine.co.uk. If you've been enjoying the podcast, please consider leaving a review — and all of these episodes are now available in video format on YouTube and on Spotify. Thanks for listening.