- Adora Cheung, after roles including Partner at Y Combinator and CEO of Homejoy, founded Instalab in 2022, pivoting from cleaning services to healthcare focused on longevity medicine.
- Holds a Computer Science bachelor's degree from Clemson University and a master's in Economics from the University of Rochester; started her career as a product manager at Slide.com.
- Aims to merge health optimization with the demands of modern careers through at-home blood tests for over 60 biomarkers, founded on the premise of proactive healthcare.
In this podcast, Kyriakos the CEO of Terra, talks about Instalab’s journey with Adora Cheung. Motivated by her struggles to obtain necessary health tests, Adora aimed to simplify healthcare access. Instalab emerged as a solution to bypass traditional healthcare hurdles, offering direct and straightforward access to health testing. Adora's journey reflects her shift from personal health challenges to innovating a service that addresses a common barrier in healthcare.
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Introduction and Instalab's Genesis
Kyriakos: How did you get the idea about the Instalab and how did you start?
Adora: We're not very good at social media or paid marketing yet, but we hope to improve soon. The idea for InstaLab came after my last startup. I had neglected my health, becoming overweight with inflammation and skin issues. Before starting anything new, I decided to focus on my health, researching what tests I needed and my genetic risks. After months of research, I began my health journey, realizing the importance of baseline tests.
Many tests I wanted were not considered necessary by my physician, claiming I was too young or not sick enough, and insurance wouldn't cover them. It took months to get a lab requisition. The results showed I was not in a good place, with high levels of various markers. I was frustrated by the difficulty in understanding my health and getting the necessary tests. My doctor struggled to explain the results, suggesting I find someone else for answers.
This experience, shared by many, inspired InstaLab. Our goal is to make proactive health care accessible and straightforward.
Challenges with Traditional Healthcare and Instalab's Approach
Kyriakos: I think that's a universal thing because I remember when I was going to doctors before I came to San Francisco I was in Cyprus and it was a universal thing I would go with my blood biomarkers for example and they would never actually tell me what to do and it's so it seems that the problem is global like before we jump into that like why do you think that the doctors have that is it because they don't have time or why does this problem exist
Adora: Yeah, I think there is a set of doctors who just don't think that doing anything outside of the norm, the standard, is considered over testing and not necessary. But the problem is the standard is not very good. There's a reason why, you know, the number one killer is still heart disease when it shouldn't be. It should be, you know, way down on the list. And so I think you just have this sort of standard that doesn't make sense to be the norm. And then the other part is, especially in the US, we're an insurance-based business, sorry, insurance-based system, and physicians are, you know, they have to take in a lot of patients, and so they can't get that much time to explain things to patients. They pretty much do a sort of one-size-fits-all approach, which, you know, obviously is not to personalize at all.
And so there has been a wave in recent years of so-called concierge medicine, functional medicine, in which there is a more nuanced approach to how to help you. And so unfortunately that comes with membership fees or like high annual fees and stuff like that that's not covered by insurance, but that does give the doctors.
they at least get 3 minutes, one hour with you to explain things to you and to really, you know, do the research to figure out what's actually best for you in terms of testing. So I think, you know, I think the past 1, maybe the past two or three years, there's been a lot of movement toward, you know, this more personalized approach and deeper testing. And people are just taking it, taking this testing in their own hands and just paying the money to do it.
But hopefully, you know, especially there's, you know, there's plenty of companies doing blood testing now. And my hope is that all of us will have the data to show that advanced testing early results in less deaths, results in less heart attacks, results in less everything, to get insurance companies motivated by money, by, you know, not having to do heart surgeries and all these things.
Instalab's Development and Service Expansion
Kyriakos:you had this idea, you validated with folks that you spoke with that you were shown earlier. What did you do after? Like, what was the first steps? And did you get a phlebotomist?
Adora: Funny enough, I was trying to start really small. I was like, where's my little niche corner in the world I'm gonna start? And we actually started not with patients. We started with clinical labs. And so we were building software for clinical labs in the very beginning. And we figured this is a source of where the problems sort of begin, which is everyone gets these lab reports and they get even a basic lipid panel.
Kyriakos: Oh wow.
Adora: If you explained it well to someone, they might actually do something else. Like they might actually take action. Like if you have recommendations or explain the results in a better way, maybe they would be more proactive about it. So we were building software for labs to output a better report essentially. And we had about three labs, really interesting. They, you know, we had set up contracts with them and blah, blah. Turns out not a good business to sell.
software to clinical labs. Then we then we started going up the chain, we're like, okay, let's talk to physicians now, maybe there's software and reporting and stuff we can sell to doctors also didn't have very much success from there. And so we said, Okay, forget all of this, we're just going to start from scratch. And we're going to go directly to the people who are most incentivized to get the testing and to make the changes, which is the patients. And so that's the, that's basically we're
version of Instalab today is where we started, is we decided just to go straight to the patients. And then from there, like I said, I had many conversations about this whole entire problem with folks. And so our initial customers were just friends of mine's who just roll up their sleeves. We hired a phlebotomist. We actually started in New York City and found friends in New York City who were willing to start with us. And then from there...
We hired a full bottom in San Francisco and so on and so forth. And right now we're almost like a referral based product in the sense that people find out about us through a friend essentially. And yeah, so that's how we've gone around so far.
Kyriakos 17: And you hired that first person that is taking blood from patients. Where did you focus at the very beginning? Like did you focus on a one specific biomarker or many biomarkers or how did you approach
Adora 31: We focused initially on a cardio panel. So we actually have in-house a lipidologist alongside longevity medicine physicians. But we started with the number one issue in America, which is heart disease. And so we started with that. And then I think selling that, especially to the crowd we were selling it to, 2 to 4 year olds was a little bit hard because most people don't think about heart.
heart disease that young. And so we expanded our panel to include more things that people were interested in. So now we have this overall longevity panel, which is basically a good screening to do once or twice a year to understand where your overall health is. And then you can find areas that you need to work on and just dig into there or dive into there.
Kyriakos: Why is this at the beginning? But was it because it's a big market or why did you choose it?
Adora: It just, I just think every, it's just, like I said, it's the number one killer, heart attack, strokes, heart disease. And it's the most, it's just frustrating. It's the most preventable disease also that's high on the list. You know, cancer is another thing. It's like, you could do early screenings and stuff like that. Heart disease is just get it, you know, understand where you are and there are clear pathways to reduce your risk. And so we felt that was a big market there just to tackle one itself.
Kyriakos: Got it. And what, for heart disease specifically, what kind of biomarkers are you measuring?
Adora: Um, so there's obviously the standard stuff, which is the lipid panel. Um, then there are these markers that are getting more popular. So there's APO B, which is, um, a better predictor of risk than LDL cholesterol, um, which has been used for years. Um, there's, uh, LP little a, which is a genetically determined biomarker. Um, there is APO. We do an APOE genotype, um, which is most people know it as the marker for dementia.
for your risk for dementia, late onset dementia, but it's also a marker for risk for heart disease related to cholesterol. And then there's a set of markers. So very related to heart disease is glucose metabolism and metabolic health. And so we do insulin and glucose, fasting insulin and glucose. We measure your insulin resistance. And then from there, there are these secondary.
cardiovascular markers that are related. So you've got homocysteine, which is then impacted by B9, vitamins B9 and B12. You've got your uric acid, and you've got these other inflammation markers like ferritin. And then down the chain, you go to your complete blood count. And then also we take at the appointments, we take blood pressure and blood pressure BMI and yeah, those two.
So yeah, so I would say that's, yeah, so correct, good.
So basically what happens is that all these values are very high and your goal is to help the user to optimize them and drop them lower or how are you helping them?
Adora 159: Yeah, first we're trying to just trying to get a baseline. Where are you at? And then it's funny because our panel has over 5 markers and you could have a lot of red, but really, and if you see a lab report, it's all red. You kind of make, you might freak out. It's like, oh my God, where do I even start? But in reality, most people, you can group all of them together. So for us, our patients are either, they need help in cardiovascular health with lipids.
and you know, homocysteine and all that stuff is related to it. Or they have metabolic health issues. So insulin resistance, or blood pressure, those are the top three things. And I think that's like common across America, not just our, our patients.
But yeah, so we what we try to do is we try to identify what's the one thing you should focus on now. And then what are the two to three things you can do right now to
Optimize those values to do risk yourself from that from those chronic conditions And like I said most of the time it's just you know, it's like two or three diet changes Maybe some supplementation and then if you know some people like myself I have genetic condition that causes my triglycerides to be high despite all the diet changes I make and so you just need supplementation or medication to help bring that down and
Yeah. So, so yeah, the overall, the idea is to group the biomarkers together and identify two or three things to bring them all down at once.
Legal Considerations and Longevity
Kyriakos: I think the big problem is recommendations. Helping patients or users understand what they need to be doing is key. However, there's a fine line between legal and illegal recommendations, especially in the US. How do you tackle that? Do you have a doctor for recommendations?
Adora: We are a medical practice with physicians who review everything. Most recommendations are similar based on diet or current activities, needing personalization. Initial recommendations are standard. We explain why certain actions are necessary and personalize further recommendations, including dosage adjustments, based on follow-ups. We have physicians review each report, especially for edge cases our software might not catch.
Kyriakos: You mentioned longevity earlier. How can you help someone live longer?
Adora: We're not a biotech company focused on new medicines but aim to increase lifespan and health span by reducing chronic condition risks like heart disease, insulin resistance, dementia, and cancer. Many risks, like those from lipids, are not visible or felt, so we emphasize blood testing. We also aim for an optimal state of well-being, both physical and mental.
Future Directions, Technology Integration, and Company Culture
Kyriakos: Considering five years from now, how much technology versus physicians do you anticipate integrating?
Adora: We plan to significantly develop our software, leveraging advancements in machine learning for personalized recommendations. This approach might not require many physicians, possibly two or three, maintaining physician review for now. Regulatory approval might be needed for AI-driven medical advice, but our goal is an AI doctor to reduce costs and expand access.
Kyriakos: Why did you choose to send a TASO device for blood collection instead of finger pricks?
Adora: Finger pricks are painful and less accurate for our comprehensive panel, which requires more blood than a prick provides. TASO is less painful and collects sufficient blood from the arm. It's designed for convenience and reducing barriers to testing. For larger panels, we prioritize home collection to avoid lab visits, though future plans may include more affordable lab visit options for those seeking lower-cost testing.
Kyriakos: Can you talk more about company culture and your approach to hiring?
Adora: We're a small team of five, preferring to keep the company lean unless a role is essential. We've hired physicians and phlebotomists out of necessity. Hiring for roles outside our expertise involves consulting with knowledgeable professionals. For other roles, we seek ambition, hard work, and good communication, preferring trial work periods to assess fit.
Kyriakos: Looking back a year from now, what practices in healthcare do you think we'll find outdated or wrong?
Adora: The insurance system might be viewed as outdated, particularly its inefficiencies and barriers to preventive care. The future could favor more direct, cost-effective healthcare models emphasizing preventive testing and care, potentially shifting away from traditional insurance dependencies and towards more patient-centered approaches.