Michelle Routhenstein, MS, RD, CDCES, CDN

The longevity movement is getting a sobering reality check: shallow clinical depth, weak retention, proximity bias, and glossy branding chasing growth in a field that relies on trust, proof, and time. The answer isn’t slick marketing or a slightly different wrapper. As a recent Forbes piece argues, the category needs to grow up. The right model has less to do with “longevity” and more to do with actual healthcare: evolved early detection and prevention tightly coupled to downstream specialty care. Not a med-spa selling supplements, one-off biohacks, or system shaming. The right approach surfaces risk early, intervenes with clinical pathway, and closes the loop with high-value specialists. If you can’t show real-world ROI and a clear connection to traditional care, churn will be high and CAC unsustainable. TAM will be smaller than you think, and LTV will disappoint. Impact becomes curiosity-driven instead of outcomes-driven. I like Matthew Holt’s “elevated primary care” idea —smaller panels, better payment, tight integration —but with a twist. The prevention layer should feel like elevated PC: high-touch navigation, validated metrics, longitudinal accountability, and seamless handoffs to specialists. The key is building the connective tissue between early signals and definitive specialty care, measured over decades, not subscription periods. Operationally and economically, that means a hub-and-spoke system on carefully curated rails. Pair a premium experience with reimbursable codes and employer channels so LTV isn’t hostage to fickle discretionary spend. Physician-led is non-negotiable (and shouldn’t be obscured by clever marketing or handwaving). Protocols and evidence over celebrity, vibes, and fancy websites. Build for sustainability and longitudinal care, not yearly lab panels and passing the buck to AI. Longevity isn’t dead, but it is niche. It will keep leaving once-well-funded startups in its wake. More importantly, it’s the wrong frame for what we’re really after: better healthcare through a tightly integrated, proactive system. (Forbes article in the comments.)

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About 20-30% of founders reaching out to me, are looking for clinicians to “clinically validate” their product. Today we will be talking about what exactly this means. Let us start off by talking about what clinical validation is NOT. 👇 It is not: ❌ Getting a clinician to look through your app once and “signing” it off. ❌ Speaking to a few patients on a WhatsApp group and getting thumbs up emojis. ❌ Pitching your idea to one doctor and getting a polite response. (I have seen people claim the above as validation before.) __________________________ Robust clinical validation comes in 3 escalating stages: 𝟏. 𝐀 𝐬𝐲𝐬𝐭𝐞𝐦𝐚𝐭𝐢𝐜 𝐚𝐧𝐝 𝐭𝐡𝐨𝐫𝐨𝐮𝐠𝐡 𝐫𝐞𝐯𝐢𝐞𝐰 𝐨𝐟 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐚𝐜𝐜𝐮𝐫𝐚𝐜𝐲 𝐚𝐧𝐝 𝐯𝐚𝐥𝐢𝐝𝐢𝐭𝐲. This essentially requires a real clinical expert with experience delivering care in the field that you are innovating in to comb through your product offering, looking closely at: How accurate your current outputs are How closely this reflects current practice The evidence base behind your recommendation It is time consuming and requires working closely with your product team to iterate changes as they work. 𝟐. 𝐀 𝐬𝐦𝐚𝐥𝐥 𝐬𝐜𝐚𝐥𝐞 𝐜𝐨𝐡𝐨𝐫𝐭 𝐬𝐭𝐮𝐝𝐲 𝐢𝐧𝐯𝐨𝐥𝐯𝐢𝐧𝐠 𝐫𝐞𝐚𝐥 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐨𝐫 𝐜𝐥𝐢𝐧𝐢𝐜𝐢𝐚𝐧𝐬. This will involve a structured approach of testing out your product or service with your target end users. The goal being to assess the usability and safety of your product, efficacy is a bonus. Here you are looking to get unbiased feedback about how your product works and how it fits into the current pathway. (It is incredibly useful evidence and great PR too) 𝟑. 𝐀 𝐩𝐫𝐨𝐩𝐞𝐫 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐭𝐫𝐢𝐚𝐥. Not all HealthTech offerings need to come to this stage. But those that are therapeutic or diagnostic certainly do - particularly if you need to obtain regulatory approval. Trials can be run in the community or in hospital settings. It needs structure, a proper protocol and ethics approval. With set endpoints, ideally randomised and with a control arm. _____________________________ 𝐑𝐞𝐚𝐥 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐯𝐚𝐥𝐢𝐝𝐚𝐭𝐢𝐨𝐧 𝐜𝐨𝐦𝐞𝐬 𝐰𝐢𝐭𝐡 𝐞𝐯𝐢𝐝𝐞𝐧𝐜𝐞. Either you generate new evidence for your novel product, Or you deliver services based on current best evidence. 👉 Either way, you need proper clinical expertise for this. So the next time, you hear someone asking for clinical validation, Probe to see if all they want is a clinician to be on their shiny deck to raise investment, Or if they are genuine in wanting to deliver the best care possible. P.S. What else would you add? Dr. Louise Rix | Dr Rizwan Malik | Dr Gordon le Roux | Dr Thomas Maggs | Amy Pillinger | Dr Claudia Pastides |

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There’s no shortage of startups and point solutions trying to optimize pieces of healthcare, and many of them are doing important, innovative work. But I think we sometimes forget that one of the most powerful things we can do is trust the people already delivering care. We’ve all seen a wave of third-party solutions trying to improve access, reduce costs, and enhance quality. And while the intentions are good, the reality is that too many of these solutions end up creating more fragmentation. Instead of working through the physicians and care teams our patients already trust, they often operate in parallel or around them. Beyond the fragmentation issue, it’s administratively burdensome to keep bolting on new solutions. And it’s confusing for patients who continue to receive outreach from yet another company that isn’t part of their care team or their health plan. By simplifying the system, we not only boost efficiency, we create a more cohesive and patient-centered experience. At the end of the day, patients don’t need more apps, emails, phone calls, or texts. They need a care team they can count on. When we cut through the noise, the clearest path forward is one that is streamlined, supportive, and rooted in trust between patient and provider. At GuideWell Health and Florida Blue, we’re focused on building models that put care back into the hands of the providers our members know and trust. And we’re using innovation to simplify the experience, not complicate it. When payers and providers work in true partnership, everyone benefits - especially the patient. #healthcare #primarycare #careteam #valuebasedcare #patientfirst #innovation #payervprovider Tracy Williams Raul Daza Gina Mangus Alicia Zoya Dana Dunn Santori Florida Health Care Plans GuideWell Emergency Doctors Sanitas Medical Center

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Why Doctors Must Think Like Startups Axios recently reported that America’s doctors are working harder, earning less, and going bankrupt at record levels. Many are selling their practices to private equity or health systems, trading away autonomy while corporatization drives prices up and erodes patient trust. The system was not built for doctors to thrive. That’s why the future belongs to those who reinvent themselves as entrepreneurs. Operating like a startup means: - Owning your equity instead of working for diminishing reimbursement or another health system. - Innovating faster by bringing new science: biomarkers, AI, therapies, directly to patients. - Building sustainable care models with memberships and protocols instead of relying on outdated reactive consultations. Designing patient-first care focused on prevention, optimization, and outcomes Every startup begins with a bold vision and builds systems, teams, and technology to scale it. The same mindset will allow physicians to reclaim autonomy, grow sustainable practices, and shape the future of medicine. Here is short checklist doctors could use: ✅ Define your offering and audience: are you optimizing heart health, hormones, or full-spectrum longevity? Who do you serve? Be crystal clear. ✅ Start lean: test your model with minimal staff, digital tools, and focused services before expanding. avoid over investing in shinny tech and devices, you are not a med spa ✅ Build recurring revenue: replace fee-for-service with memberships, programs, or subscriptions for predictable income. ✅ Leverage technology: use AI, wearables, and digital platforms to scale reach, automate follow-up, and track outcomes. ✅ Brand yourself like a founder: create visibility through thought leadership, media, and community. Patients and investors buy into you before your clinic. ✅ Focus on outcomes: your KPIs should be health outcomes and should be able to measure and published them ✅ Create partnerships: collaborate with other docs, labs, hospitalities, and tech startups instead of competing against them. ✅ Fail fast, adapt faster: test services (protocols, memberships, products). Double down on what works, cut what doesn’t. ✅ Build culture & team: this is the most important part, you are has good as your front desk experience ;). Build a culture of high end service, trust and kindness. Of course, being a good doctor means practicing excellent medicine and delivering strong outcomes. But adopting an entrepreneurial mindset can ensure the long-term success and impact of your clinic. Join Longevity Docs is you are interested in building in Longevity Medicine Read more in our weekly newsletter: link in comment

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Every year at MDisrupt I meet with around 400 health tech companies. Over time, you start to see a clear phenotype of the ones that scale and the ones that fail. The companies that scale: 𝗕𝗿𝗶𝗻𝗴 𝗶𝗻 𝗵𝗲𝗮𝗹𝘁𝗵 𝗲𝘅𝗽𝗲𝗿𝘁𝘀 𝗲𝗮𝗿𝗹𝘆. They don’t wait until launch to talk to clinicians. They understand workflows and pain points from the start and they hire regulatory, product, and commercialization experts who know how to navigate the complexity of healthcare. 𝗧𝗿𝗲𝗮𝘁 𝗲𝘃𝗶𝗱𝗲𝗻𝗰𝗲 𝗴𝗲𝗻𝗲𝗿𝗮𝘁𝗶𝗼𝗻 𝗮𝘀 𝗮 𝗴𝗿𝗼𝘄𝘁𝗵 𝘀𝘁𝗿𝗮𝘁𝗲𝗴𝘆. It’s not a checkbox. It is the foundation for building trust with regulators, clinicians, and payers who need to see ROI before they reimburse. 𝗧𝗵𝗲𝘆 𝗳𝗼𝗹𝗹𝗼𝘄 𝘁𝗵𝗲 𝗺𝗼𝗻𝗲𝘆. They validate that they are solving a real clinical problem and they quantify the ROI, whether that is cost savings or revenue compared to the current standard of care. 𝗧𝗵𝗲𝘆 𝗴𝗼 𝘀𝗹𝗼𝘄 𝘁𝗼 𝗴𝗼 𝗳𝗮𝘀𝘁. Instead of pouring early money into flashy marketing, PR or large sales teams, they focus on regulatory, evidence, and engaging clinical opinion leaders. When the foundation is strong, commercialization scales quickly later. We all know that healthcare moves at the speed of trust. And in this industry, trust cannot be rushed. It has to be built, step by step, with evidence and expertise.

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What’s driving the $1B explosion in vagus nerve stimulation by 2032? I just finished reading the latest Persistence Market Research report. Global trends. Clinical insights. Tech breakthroughs. And one thing is clear: The world is waking up to the nervous system. Here’s what stood out: ✅ VNS is expanding beyond epilepsy - into stress, stroke, sleep, PTSD, immunity ✅ Non-invasive devices are leading the charge (fastest-growing segment) ✅ Demand is driven by the need for scalable, accessible tools — not surgeries or prescriptions ✅ Market CAGR: 9.3% ✅ And yes - Pulsetto is officially listed as one of the players shaping this space "We’re seeing the rise of non-invasive VNS as a daily tool for performance, recovery, and stress resilience." - Persistence Market Research, July 2025 This is the category shift we’ve been betting on since day one. A third path: science-backed self-regulation. At Pulsetto, we call it Stress Fitness — and we’re building it into a global category. 👉 Link to full report in the comments.

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Okay, so I’ve spent 15+ years learning how health content actually compounds—and finally wrote down the framework that explains why some brands win big with content while others stall out. It’s what I call the Organic Health Content Flywheel. 🔄✨ Here’s the gist: Most health brands treat content like a one-off tactic—publish, promote, move on. But the best operators know it’s not about one article or even one channel. Instead, it’s about creating a system where every piece of content feeds the next… and where growth accelerates over time. 🚀 Because not everyone’s ready to commit right now—but you can nurture those relationships rather than lose them! 💌 This flywheel is what I’ve advised on, consulted, and supported 25+ Healthyish Content clients with—from Truemed to Oshi to Midi to GoodRx to Elion to many more—helping turn their health content into their most durable, compounding marketing channel. Inside the guide I put together, you’ll find: 📧 The most effective way to capture emails from your content (with examples!) 🌱 How to nurture leads and build long-term relationships (with examples!) ⚡ The key to doing this right so the flywheel accelerates (and yes, examples!) If you’re investing in content already but not seeing exponential returns—and feel you might just be leaving potential patients on the table—this is the missing piece. Want the full playbook? 👉 Comment FLYWHEEL below (AND add me on LinkedIn if you haven’t already) and I’ll send it your way.

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Most founders underestimate the hardest part of building in healthtech... When we speak with founders, they often say the biggest hurdle is regulatory approval or fundraising. These are by no means easy feats, but one of the most common challenges is finding a clinician who understands the specific problem they are tackling. Not someone who nods politely and says “interesting.” Someone who sees your problem every week. Who can say, “This is what actually happens.” Who points out the thing your whole product missed. We spoke with a founder recently who spent months trying to find that person. They messaged doctors on LinkedIn. Chased introductions. Held three calls. Got zero useful insight. Then they found the right clinician, someone who had actually used the exact device they were trying to replace. That one call changed everything. They learned why the current workflow existed. Where adoption would fail. And how to fix a safety issue that could have derailed the whole thing. That insight came not from a generalist. But from someone deep in the problem space. At Orbion Connect, this is exactly where we focus. We look at specialty, clinical setting, and experience. We ask what kinds of problems they care about. And then we match. Because a feedback session with the right clinician is worth more than 10 polite calls with the wrong one.

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What happened in mental health last week? ⏺️ Talkspace acquired Wisdo Health, adding peer support services to its offering. ⏺️ Wysa acquired Kins, a physical therapy services company based in the U.S. ⏺️ Blossom Health raised $18M for its virtual psychiatry and therapy offering. ⏺️ Ashley Addiction Treatment raised $17M to advance their research efforts and expand their programming. ⏺️ Moneta Health raised $4.5M for its AI-powered cognitive rehabilitation platform and expanded access through a partnership with Benefis Health System. ⏺️ SonoMind secured €3M to advance its novel neuromodulation ultrasound device for treating drug-resistant depression in psychiatry and neurology. ⏺️ Behavioral Health Tech Launched BHT Impact, a new initiative aimed at supporting youth-focused behavioral health innovators. ⏺️ Hazel Health announced layoffs of approximately 11% of its staff. ⏺️ The Coalition for Mental Health Investment published "Strategies for Financing Mental Health", a guidebook to bridge the estimated $200-$350 billion annual global mental health financing gap. This is an interesting document actually. It’s very “McKinsey-esque”, but it provides a MECE overview of the challenges in scaling mental health innovation and shares some ideas on innovative financing models to serve them. ⏺️ BrainsWay received FDA clearance for an accelerated Deep TMS protocol for major depressive disorder, reducing the acute treatment phase from 4 weeks to just 6 days. This happened a few weeks back, but I missed it originally. ⏺️ A new study from ieso US evaluated its generative AI care program for US adults managing anxiety and depression. The study found zero AI-induced safety incidents and measurable improvements (avg. -5.3 GAD-7; -5.8 PHQ-9, N=85). (link) ⏺️ A new paper in JAMA showed that amongst adolescents, high or increasing addictive use trajectories were associated with elevated risks of suicidal behaviours or ideation compared with low addictive use. Thanks to Luis F Voloch for getting this on my radar. _ 📩 Like this? I send it as a weekly email (including links) to thousands of mental health operators. Sign up using the link in the comments. 👉 Also, follow me Steve Duke, for more insights on #mentalhealth.

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