Entrepreneur RX_Katrina Firlik: Audio automatically transcribed by Sonix

Entrepreneur RX_Katrina Firlik: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hey everybody, and welcome back to Entrepreneur Rx. This week, I'm really excited to chat with Katrina Firlik, who is a neurosurgeon turned digital health entrepreneur. She's a co-founder and chief medical officer of HealthPrize Technologies, it's a company that combines education, behavioral science, and incentives to improve health outcomes for change. Katrina, welcome!

Katrina Firlik:
Thanks for inviting me, John. Great to be here.

John Shufeldt:
Pleasure. So this is very cool. I mean, you know, there's not a lot. First off, there's not a lot of neurosurgeons, period. And there's certainly not a lot of neurosurgeons who have turned entrepreneur, so we'll get to all of that. But share your background a little bit because it's pretty interesting.

Katrina Firlik:
Sure. Well, going way back, I wasn't actually initially planning on going into medicine. I majored in cultural anthropology back in college because I love the perspective of, of learning about different cultures, different ways of seeing things. And I ended up kind of using that lens of looking at things from different perspectives throughout my career. But my father was a general surgeon, and so always as a child, I had that as a background, understanding what being a surgeon was like, what it entailed. And so I kind of had that as part of my, my natural family background. And then as I, as they went further in college, realized, you know, I want to do something practical, I want to help people, I love the intellectual background of anthropology that I'm studying, but I need to do something practical, hands-on, and I ended up in medicine, and I think partly because of my my father and understanding what that entails.

John Shufeldt:
Okay, So okay, undergrad was at Cornell.

Katrina Firlik:
Cornell University.

John Shufeldt:
Okay ... Biology. But you must have taken, obviously the pre-med classes there, so you had some inkling medicine might be for you.

Katrina Firlik:
Exactly. And I really, and this is something I sometimes encourage medical college students. I took kind of the bare minimum of classes required to enter medical school, and I did that very deliberately. First, I wasn't that great in physics, for example. But anyhow, I also loved the idea of studying broadly. So I took a lot of writing classes, creative writing, classes about different cultures, history, and that, I think, helped inform my worldview before going into medical school. And that I think is helpful. So I did, I did the, medical school then at Case Western Reserve, where I'm from in Cleveland, Cleveland, Ohio. So that's where I went to medical school and then on to neurosurgery residency at the University of Pittsburgh.

John Shufeldt:
And how big was your, how big was the incoming class? Was, how big was each class at Pittsburgh for neurosurgery?

Katrina Firlik:
We had three residents each year. And at the time, that was the largest neurosurgery program, not necessarily just in terms of number of residents, but in terms of case volume, number of neurosurgeons, we were a huge, huge department, and it still is, a very prestigious, large neurosurgery program.

John Shufeldt:
Yeah, I know. Pittsburgh's incredibly well-regarded for all sorts of things. Transplant is one of them, obviously, and neurosurgery. Okay. So then you did seven years.

Katrina Firlik:
Exactly, seven years. Yeah. Two of those years of research where you're kind of doing research and clinical work in tandem. But it is a full seven years, and the last year is considered the chief resident year. But it's a long haul.

John Shufeldt:
It's probably the longest haul. And then you did a fellowship after that I saw on epilepsy surgery. Just, so just educate me. What was that?

Katrina Firlik:
Well, that's actually a little bit of interesting, an interesting sidebar, I actually did that during one of my research years. Technically, that fellowship is done after you graduate residency, but I had an interesting opportunity to do that as part of my second research year. So I went to Yale and studied under the chairman there, Dr. Dennis Spencer, who is world-renowned in epilepsy surgery. And that was, that was a fascinating year for me.

John Shufeldt:
That's very cool. Okay. So that's, you know, I mentioned that I work at Barrows, and that's what a lot of the neurosurgeons do there as they go out and do a year of something somewhere else and then come back. Very interesting. Okay, so how long then? So you finished all that in seven years, and then what? What did you practice for how long?

Katrina Firlik:
Yeah, I practiced for, for six years. And during that time, I was obviously, I loved my practice. I was in private practice in Greenwich, Connecticut, and also on the clinical faculty at Yale, where I had done my fellowship, so I had that academic tie. And through that whole time I was kind of exposed on the side to the startup world, particularly in medicine, partly from being near New York City, partly my husband, at that point was transitioning to being a venture capitalist. So I was kind of following along with a lot of these startups that he was involved with and meeting entrepreneurs, meeting other doctors with ideas. And that kind of started to seep into my blood and intrigued me.

John Shufeldt:
Okay, so, back up. So your husband, when we talked about a little, was he ahead of you in neurosurgery?

Katrina Firlik:
Yes. Yes, he was ahead of me by two years and then was out in practice. And then, as I mentioned, made a transition to venture capital.

John Shufeldt:
Wow, that's so cool. Okay.

Katrina Firlik:
Well, you can say cool or crazy. We're both, we're both a little crazy for going through such a training and then, then transitioning to, you know, related fields. But it's definitely been a wild ride.

John Shufeldt:
No, I believe, I totally get it. And hats off to you, because that takes a large amount of guts to do. Okay, so you get infected with the venture capital bug by watching some of the companies that your husband's interacting with as a venture capitalist, which, again, is really cool. And then what? What was the light bulb? Did you ever think back at Cornell and cultural anthropology that you turn into an entrepreneur?

Katrina Firlik:
No, I never had that in mind. But looking back, what I do know is that, again, I like the idea of seeing things from different perspectives, that was always kind of my kind of intellectual first love. There's no one right way to do things, you know, whether that's how you live your life, you know what religion you believe in, how you solve problems, how you deal with a medical problem, but I like the idea of learning new things. That kind of is also the theme throughout my different careers. And so I was intrigued with taking on new challenges. And at first, you know, my last year in neurosurgery, I was transitioning to becoming a startup entrepreneur. And at first I thought, I wonder if there's a way to do both of these part-time. And then I came to the realization, in reality, what sort of patient wants a part-time brain surgeon? So that was a bit difficult.

John Shufeldt:
You know, it's funny. Like, I was dead set on doing CT surgery. And since I was like five years old and I had this, I was fortunate to end up in emergency medicine because in emergency medicine, you can do it part-time. I mean, I, you know, I worked 10 or 12 shifts a month and, and that was kind of considered full time, making do all sorts of other things. But you're right, a neurosurgeon, you know, the ones I know you kind of expect them the more, correct me if I'm wrong, but the more you operate, the better you get. And so you don't want somebody who's thinking of their startup as they're going through your frontal lobe.

Katrina Firlik:
Yeah, exactly. And so that's, I mean, there are, there are doctors that do that well. There are neurosurgeons that do, do that, whether they do a lot of research or someone like Sanjay Gupta who does that beautifully, there are ways of doing it. I am less adept at parallel processing, I'll say. So I really had to, at some point, make a decision to do one or the other.

John Shufeldt:
Yeah, very cool. So for the folks that are out there who are wrestling with this, because I wrote this book a while back, and it's about physicians turn into entrepreneurs, and one of the things that was fortunate for me is that, like I said, I could do both. What advice do you have for people who are in the kind of professions that you're either all in or you're really kind of all out of? You know, because the transition you guys made, you and your husband made, I think is, would be unconscionably hard. How did you get through that?

Katrina Firlik:
Well, really, you have to have eyes wide open in terms of the pros and the cons. There are obviously a lot of pros with just sticking with what you do well and what you train to do. I mean, that's the default mode that I would recommend for most people because that, it just makes the most sense. I mean, you've been through this long training, but at the same time you don't want to, you know, if you feel like there's a different path, you have to figure out again, can you do it part time and some specialties as we've talked about, or better than others on doing that, or if not really make sure you understand the pros and cons of the, of the transition. Obviously, if you're going into a startup, there are a lot of cons. I mean, you could, you could waste your time, waste money, waste your reputation. You're basically starting as an intern again in some ways when you're going into a new, a new field. And so you have to be comfortable being uncomfortable, really.

John Shufeldt:
Totally true. Was there an aha moment for you where it's just like one day, you know, you staple up the scalp and you're like, drop the mic, yeah, I've made my decision, so take me some time to get out of this. But I made my decision, or was it just a slow process?

Katrina Firlik:
It was a slow process. And I have to emphasize that it wasn't that I was looking to get out of clinical medicine, it wasn't that I was fed up in any way. You know, I was, it was a very fulfilling career. And I still believe being a doctor in clinical medicine is, is one of the best careers ever. And so it wasn't I was trying to get out is that I was getting more and more intrigued by this other path. And that's kind of what led me to to then slowly transition out of my, out of my clinical practice. And there were many things along the way, there was no one aha moment, but as I got to, thinking about, you know, what problems can I help solve, how can I use my brain in different ways, you know, the creative side of my brain, collaborative side, working with other people I started noticing as a neurosurgeon, we're always positioned at the end of the line. Somebody hasn't take their medication for four years for hypertension, they end up with the hypertensive hemorrhage, and then there I went down to the line and I started to think, you know, wouldn't it be cool if I could do something to prevent that from happening? And that's kind of what led to my ultimate company that I co-founded. But as I started thinking differently, I started seeing problems in a different way.

John Shufeldt:
So you wanted the line jump basically, you wanted to get ahead of the patient, so they didn't need to see someone like you at the end of the line. That's.

Katrina Firlik:
Exactly.

John Shufeldt:
The actually a really. That's actually a great description, and I'm going to steal that from you because I love that description. Okay, so you did a lot of writing in Cornell, you said. And then you wrote a book Another Day in the Frontal Lobe. When did you start writing that? Was that while you were still practicing or after?

Katrina Firlik:
Yeah, while I was still practicing. I didn't initially have the goal of writing a book, but what I did was, I took a lot of notes during my neurosurgery training, so I would have these three by five cards in my white coat pocket that you take for normal patient care. But I would jot little things that I noticed, you know, interesting patient conversation or something cool that happened in the operating room. And I did that just so I wouldn't forget, because you're so busy during residency, if you don't write these things down, you forget 90% of these little interactions. And so at the end of seven years, I look back at my notes and realize, Oh my God, I have all these anecdotes, stories I would tell family and friends. But I thought maybe I can, I can actually write some of this, and I loved writing as a hobby, so I took some of these interesting cases, I wrote them into what I would call an essay and thought, maybe I can get this into a magazine somewhere. So I sent it around and somebody, my husband and I know, happened to have written a few books and he liked it and sent it to his agent in New York without even telling me which, which was kind of fun. And she loved it and said, I got to meet you, I got to convince you to write a book, not just an essay, so really, that was the impetus to writing the book.

John Shufeldt:
That's so cool, it's so funny. I was just literally conversing with a couple of colleagues today and, and I started going down this path where, we were all in my group going to contribute five or ten anecdotes because in emergency medicine, as you can imagine, we all have these ones where you're like, you literally cannot believe someone said this to you or this happened. And other than me, no one was really there like, yeah, you know, we're so over this. But I was super intrigued and I wish I'd been prescient enough or precious as you were, to write these down and through ... cards. I'm sure I'm going to forget them all. Well, I'm sure I've forgotten a lot of them, but there were some of them that were just, they're great stories to tell, both humorous, but also very inspirational. So that's why I'm going to have to read your book. It's like, who's the other neurosurgeon when error touches the brain? And I love that.

Katrina Firlik:
Oh, yeah. He was also a Pitt graduate. Yeah, exactly.

John Shufeldt:
Okay, so. So you wrote your book and now let's talk about your your business .... So it's the line-skip business. Tell us how that germinated.

Katrina Firlik:
Yeah. So I co-founded a company called HealthPrize Technologies, and we're all about behavior change, just like the example I gave. You know, there are a lot of behaviors that patients can do to improve their outcomes obviously, we all know this as doctors and as my co-founder likes to say, Katrina perfected brain surgery so she looked for something harder to do: getting patients to follow doctor's orders, which is an overly paternalistic way of talking about what we do at the company. But the point, the point is, how do you change human behavior? That is, that is harder than most things. I and my two co-founders kind of came up with a novel way of approaching the problem of specifically medication non-adherence. And that's, we address many behaviors, but medication nonadherence is kind of our sweet spot because we realized there was a huge opportunity. I mean, as a, as an ER physician, you know, that taking your medication for a whole host of chronic conditions is essential for preventing.

John Shufeldt:
Life and death.

Katrina Firlik:
... Outcomes. Yeah. And so we basically realized the problem is more fascinating and wide reaching than you'd ever expect once you start digging into it. And I really, kind of, became an expert in the problem of medication non-adherence, which at first blush is somewhat, you think, simple, oh, people forget or they're too expensive, so they don't take their meds. It'sm it's way more complicated and interesting and really based more on human psychology than anything else. So that's kind of just, kind of the, the overarching problem we were looking at and how we're looking at. But we ended up combining education with gamification, and what we're doing is kind of harnessing patient's extrinsic motivation to do the right thing and then hopefully transitioning that to intrinsic motivation. That's kind of the overall concept here.

John Shufeldt:
Yeah, I suspected there was probably a gamification role to this, but, but on a percentage basis, what's the percentage of I can't afford it versus you know what, sometimes I just forget versus the whole psychological piece of this. And what is that psychological piece?

Katrina Firlik:
Yeah, great question. It's hard to disentangle percentages, but the interesting thing here is if you ask the average person on the street, how can people don't take their meds? They'd say, oh, like I said, forgetfulness or too expensive. And clearly those are those are problems, no question. But what's interesting is there have been randomized clinical controlled trials looking at free medication. How well does that work? It makes a tiny, tiny dent in the problem. And even if you look at countries with socialized medicine where the meds are essentially free, they have very similar adherence rates. So you have to know just based on those two pieces of data, it's not just about cost. Even though cost is certainly an issue, it's more that, it's hard to take something today when the benefit is years down the line. And if you don't understand why you're taking it or you don't believe in it, for example, you're just never going to stick with it. So it's, I would say on balance, it's more of a psychological problem than a cost and forgetfulness problem, especially if you're looking at patients who quit refilling altogether. You know, there's always the patient who they travel, they skip one or two doses per month, that's not the problem that needs to be solved, that's, that's not a huge problem, that's a small problem. We're talking about people who quit refilling, never even fill the first prescription, there's, that, that's such a widespread problem.

John Shufeldt:
Yeah, I can see that. I mean, I see this all the time with I mean, this is the most obvious one, of course, is antihypertensives. It is a problem that's 3, 5, 15 years out. And so people are like, you know, I said, well, they call it the silent killer for a reason and this is what you're trying to prevent. And now, they're always looking at me like, that's a long ways away. Like, I'm not going to worry about that today. That is a challenge.

Katrina Firlik:
And it's the same. It's actually, if you think about it, it's a, it's a pervasive challenge in human psychology, say, for example, saving for retirement is actually a very simple problem that is also similar, it's called present bias. You know, you'd prefer to spend the money today because you benefit today rather than saving it for when you're retired. Who knows, 20, 30 years from now. The same thing is true for medication. You've got to deal with the potential, maybe transient side effects, the co-pay, the hassle of getting it from the pharmacy when the benefit might be 30 years from now. So it's a very similar psychological challenge.

John Shufeldt:
Did you ever see, there's a recent Warren Buffett quote that I just, that I just read that I thought was so intriguing because he talks about this. And what he said is he was like, I'm going to buy you a car when you're 18, it's whatever car you want, I don't care how much it costs, but I may give it to you. So do whatever you want, that is the only car you're getting for your entire life. You can get no other car, so you're stuck with this one. So choose wisely. And he said if you gave people that option, they wouldn't go to, the car would be in the garage, they get the oil change every thousand 500 miles, not 3000. So the take home message was, why don't we treat our bodies that way? And it was a light bulb moment for me because I actually think I do treat my body that way, like once in a lifetime car. But most patients I see don't. I mean, I know you know this, but they don't have that same perspective, I wonder why that is.

Katrina Firlik:
Yeah, that's a great analogy. I love that. I'll have to steal that as well. But yeah, I do, I do think it's it's human nature. You know, like for example, if you look at how much patients are willing to spend on lottery tickets, for example, versus how much they're willing to pay for their co-pay, you know, there's a weird disconnect there. You know, you'd think they, you'd be okay spending money on the, on the co-pay equally but there are many people who would spend more on the lottery ticket. But that has to do with, again, present bias. You're hoping for a quick win as opposed to understanding why you need to take the medication. Sometimes it's an educational issue. Sometimes it's simply that a patient labels themselves I'm not a pill person. Sometimes it's mistrust of the health care system in general or Big Pharma, these are all real problems that, that require real solutions. And so it's a very complicated issue. And that's why we try to use the combination of extrinsic motivators. We actually use gamification and points and things like badges and leaderboards and that sort of thing that intrigues you intrinsically. But then we also give you points for taking the educational quizzes along the way. So you're kind of learning something daily and weekly, and then hopefully finally the intrinsic motivation kicks in and you no longer need a program like ours.

John Shufeldt:
What are the classes of medications that people most struggle with as far as adherence goes?

Katrina Firlik:
What's interesting is, it's really across the board. Obviously, the big ones are the ones that, as you mentioned, the silent killers. So whether it's high cholesterol, diabetes, hypertension, those are big ones where you don't necessarily feel the effect of the medication today or even this week. And so it's, it's hard to adhere for that reason, but you'd be surprised, even, for example, women with breast cancer taking adjuvant treatment to prevent a recurrence, adherence rates are not great with that. And you think, gosh, that would be 100% who would want a recurrence of their cancer? But it's not so simple. And again, it's, it's partly psychology. You know, a couple of years out, do you want the medication that's continually reminding you of being a patient? Maybe there are some side effects, there are also a whole host of issues. There's denial, and these are real problems, again, that that don't have a quick fix like make the drug cheaper, set a reminder on your phone.

John Shufeldt:
What was your biggest aha moment about being an entrepreneur? Because there's, I've got a few years on you and I've noticed over the years there is a certain group of people that they just, they're just they will never be entrepreneurs because they just A, don't think like that and B, they are just risk intolerant. What's your perspective on that?

Katrina Firlik:
Yeah, well, that goes back to me saying I don't recommend that everyone become an entrepreneur because it does take a certain personality and you do have to be very risk tolerant and you have to be willing to be an intern again in many ways. Again, you're learning new lingo, you're talking to different people, you're talking to potential investors, you've got to learn what the heck is EBIT, pre-money, post-money, you don't even know the terms. So you're kind of starting square one when you start a new venture like that, especially from my perspective, not having gone to business school or having that background. So you do have to be willing to be uncomfortable, be willing to fail, obviously, that's a big one, and so it isn't for everybody.

John Shufeldt:
I know a few neurosurgeons and you all don't seem like the type who have much tolerance for their own failures. And so I grew up failing, so I kind of embraced it young because that's all I knew. But the neurosurgeons I know have kind of led this fragile, perfect life, and it's a gross generalization. What I mean is they've always done well in school. They've always just been at the top of the class. And so their, their path was very linear for the most part. Was it hard, if that's true then, was it hard to have this all of a sudden switch from that you know how, I used to getting knocked around a little bit because this was a harder in some respects, I'm a little bit outside my lane, so this is going to be a little bit more challenging than what I was used to?

Katrina Firlik:
Yeah. And I agree and disagree with you in the sense that residency itself is, is challenging and it's hard to be perfect as a resident. And so you do get knocked around as a resident a lot. And so I actually that I think allowed me to have a tougher skin as an entrepreneur. So I think that training does, does make you a bit tougher. And I think the bigger, the bigger issue is that you have to be more comfortable with progress rather than perfection. You know, just as in a startup you're, it may not be perfect, you got to keep moving on and of keep going or else you're going to be left behind. And you've got to keep making progress, even if it's not perfect, and that is a little harder. That's not sort of a surgical concept, it's more of a startup concept, so that's a little bit of a cognitive shift.

John Shufeldt:
Was it a difficult cognitive shift for you? Because I think for some people it would be a difficult cognitive shift.

Katrina Firlik:
Yes. Again, that comes back to personality. How much of a perfectionist are you? How collaborative are you? I tend to be a little more introverted, which is not necessarily the best personality type for collaborating in a startup, so that was something that required a shift in my behavior. So again, there's not, there's no one size fits all in terms of how to be an entrepreneur, just like there isn't one size fits all in terms of being a doctor.

John Shufeldt:
You know, I've always thought that physicians are almost born to be entrepreneurs in many respects. Like you said, you have to be resilient as hell, you get knocked around in residency, no matter how tame the residency was, you get knocked around. I would think for a woman in a surgical residency, it's double that because, you know, so there's a woman named Ruth Bristol who I literally watch her up at Barrows, is a neurosurgeon, introverted, pleasant, warm, the whole nine yards. And she just must be tough as hell because it was kind of an all male field when she started, and yet she persevered her way through it. Is that what you found as well? Was it a good old boys club when you started or is that finally starting to change when you were when you entered?

Katrina Firlik:
Yeah, well, it is starting to change now more than ever. I mean, about less than 10% of neurosurgeons are women. But in residency, I think last time I checked, the numbers were like 17%. So it is, it is slowly kind of creeping in, in the more egalitarian direction, slowly. But I was the first woman admitted to my neurosurgery program, so there were many people that weren't used to working with women. And I think, a piece of advice I give a lot is obviously not to tolerate anything that's clearly wrong. But at the same time, you have to have a sense of humor. And I kind of go back to my lens of cultural anthropology, people are coming from different perspectives, and there's this weird, almost cultural conflict that occurs that requires some tolerance on both sides, some humor, and I think if you can learn to use humor, it's extremely valuable as a tool because people kind of quickly respect you for that. If you can kind of come back to them with with something funny, not disrespectful, but at least make light of the situation, it can go very far towards towards smoothing things out.

John Shufeldt:
Was that learned or was that innate?

Katrina Firlik:
I don't know. Probably, probably, probably more learned. I think, if you approach everything kind of more from a bitter perspective or combative, I think naturally people are a little bit like, oh, a little hands off. But if you're more collaborative, warm sense of humor, and again, I'm not, I'm not great at that, but I, but I kind of understand that that tends to be very effective. And I did see some examples of that. So I can't say it was innate and I can't say I'm great at it, but that's kind of the perspective I, I value.

John Shufeldt:
But it clearly worked and it's definitely works in an entrepreneurial world as well. I mean, having a sense of humor and a thick skin goes a long way to the few situations. And if you can make light of yourself, that obviously helps a lot. Where's HealthPrize going to go? Where do you see? Where you going to take it?

Katrina Firlik:
Well, it's been, it's been growing over the past several years. And the biggest transition is that we started off working for, for many different reasons on the pharmaceutical side, creating programs for different brands, for different conditions. But we're transitioning now to include the broader, you know, what we call the medicine cabinet of treating all conditions at once in a patient on the health plan side, on the insurance side. So that's a natural transition and one that we've been anticipating for a long time. And so we're kind of trying to broaden, broaden our, our reach.

John Shufeldt:
Is there, have you tied it in yet to just follow up medical exams? So, for example, colonoscopy every five or ten years, Pap smear, all those things could be tied into that as well?

Katrina Firlik:
That is definitely on our roadmap and that would be in the category of other healthy behaviors, we want to motivate patients to adopt, we educate patients about those things. We don't specifically have them in our protocol to track them because tracking the behavior is also important for us. We don't just assume someone refilled, we actually track the refills, so that is on our, on our roadmap. But right now, we, we educate, but we don't necessarily track those other behaviors.

John Shufeldt:
And do you, is this paid for generally by health plans right now as a per member per month benefit?

Katrina Firlik:
Exactly. That's the, that's the model.

John Shufeldt:
... That's awesome. It's a SAS model and it's, obviously it works. That's excellent. Okay, so continue to grow and then if you thought about an exit?

Katrina Firlik:
Yeah. And that's, that's, that's a, that is in the works. I mean not in the works but in the cards in terms of potentially near-term future because we have had several years worth of growth and excellent data. In fact, we're, I just presented some of our data in COPD, where we were able to show with controls a 44% lift in medication adherence, which is actually really huge. I mean, I mentioned a trial of free medication, that was published in the Journal of Medicine and other orgs, if you take one group of patient and make them pay for their meds, another group make all the meds free, what's the delta in the adherence? It was only 4 to 6 percentage points improvement if you make the medication free. Our program created a 44%, which turned out to be a 22 percentage point lift in adherence, which is I've been looking at the literature for years, that's kind of an unprecedented lift in adherence. And I think it's because we, we have the kind of human psychology approach and kind of extrinsic, intrinsic motivation, not just a one trick pony kind of intervention.

John Shufeldt:
So this next question is a perfect question for someone who is a cultural anthropologist, so I do a lot of work and indigenous lands. I wonder if what you are doing has to be scaled differently for different cultures. So for example, is there, if you took it out of the US, for example, would you, in different countries would there be different gamification, different, different metrics or up on Indigenous lands? I mean, I don't, so I see a lot of folks up there and they would do take their medication for free if they're part of, if they're on a plan or if they're not on a plan, they get it through IHS and there's, the metric, the adherence does not seem to be great and they're generally very stoic people by nature, so I wonder if this would work for that population?

Katrina Firlik:
Yeah, that's a great question and I wish we had more experience in that realm. That's obviously, that would be an amazing goal for us. And we do, we are kind of nipping around the edges of international programs. But what you're describing probably does require our solution plus potentially some sort of local intervention. And I know that that's been studied in other ethnic groups where, you know, you need some local buy in from from local leaders, local ways of expressing the medical education, because, again, part of it's a distrust of the larger system that you have to overcome, it's not just pure education.

John Shufeldt:
Totally. Do you think with all the craziness of the last two and a half years, do you think that that distrust has grown and it hasn't made your job more difficult?

Katrina Firlik:
Yeah, I do. I do think so. And that's, that's, that's a big challenge. I don't claim to have any sort of answer to that other than the fact that either we just keep doing what we're doing and focusing on the human psychology and not, not simply the, the forgetfulness. You know, there've been a ton of companies that have popped up that are all about reminders, whether it's a pill bottle cap or some sort of digital reminder. And again, those are very helpful for the otherwise adherent patient that misses a dose or two, that's great. But again, if you're trying to solve the larger problem of, of more serious nonadherence, you need a kind of comprehensive psychological approach.

John Shufeldt:
Yeah, well, combined with education, and I think that's key because I'm continually amazed at how little people know about their own bodies.

Katrina Firlik:
Exactly.

John Shufeldt:
I mean, just some days blown away with like, wait, how do you not, how did you get through grade school without picking this part up? It's it's mind numbing. Katrina, where could, where could, no pun intended. Where can people learn more about you and what you're doing?

Katrina Firlik:
Well, there's our company website HealthPrize, and I also have an author website, KatrinaFirlik.com, and that talks mainly about my first book. And I'm currently working on a novel that I'm just in the process of finishing, which is a totally different challenge, but hopefully that will be up and running shortly as well.

John Shufeldt:
That's awesome. I'm, I've been working on a novel for like 30 years and it's basically kind of done. I'm like I'm not sure I would want to put it out there anymore, but it was, it was cathartic and fun to write. Well, this has been amazing. Thank you so much. And wait, let me ask you one more question. Where are you and your funding rounds, I'm sure with your husband knowledge, you're well on the, well on the path, but have you done a series a round or is it all friends, family and angels?

Katrina Firlik:
Yeah, we have had VC investments, but the vast majority has been has been angel investment.

John Shufeldt:
Very cool.

Katrina Firlik:
Yeah. Yeah.

John Shufeldt:
Well, you'll have to let me know if the next series comes out, because I'm definitely a believer. Well, thank you so much for being on this. Everybody, we'll have show notes at the end on where to find Katrina. A link to her book, which I'm going to read this weekend because it sounds really interesting. Katrina, thank you so much.

Katrina Firlik:
Thanks, John. It was a pleasure.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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