Discover How Psychedelics Are Revolutionizing Mental Health Treatment with Niko Skievaski, co-founder and CEO of Althea

[00:00:03] Hey, everybody. Welcome back to the Outcomes Rocket. Saul Marquez here. And today I have the privilege of having an amazing person, a friend, a colleague and a leader in health care, Niko Skievaaski. He was previous co-founder and president of Redox. And you guys have heard him before.

[00:00:22] He's been on the podcast a couple of times. I'm excited to have him back here to talk about the new things that he's up to, stories of being a founder and ways that you too have success in health care. Niko, thanks for being back with us.

[00:00:36] Yeah, thanks for having me. I haven't interacted with the health tech world in almost a year now, so it feels like a reunion of sorts. I miss it. Miss you guys. Man, we miss you, brother. We missed you. And we're excited you're back.

[00:00:52] So definitely looking forward to this conversation. And actually, folks, where was I? Oh, yeah, I was at five in Los Angeles and Niko and I had a call. And I remember walking through the halls, just catching up with Niko. And we're like, dude, we got to do this.

[00:01:05] But like when you get your thing going, let me know. And here we are. So excited we're here. Niko, let's kick things off by first of all, telling people what you're up to. Yeah, so I am exploring a new space sort of tangentially related to health care.

[00:01:21] And that's the mental health world. And it's specifically how psychedelics can be used in that space to create, you know, much better outcomes than what we've seen from typical psychiatric approaches to solving various mental health illnesses.

[00:01:35] So it's something that I kind of stumbled upon over a decade, maybe. But with recent advancements in that space, there seems to be a lot of ways where software can actually help with the facilitation of this new type of medicine.

[00:01:49] And so that's what we're exploring with the new company. It's called Althea. And we're early. We don't really know what we're building, who's going to pay for it, how fast the market will move, how big it'll be. But that's the exciting time in a business.

[00:02:02] And that's really where I seem to thrive. It's that creative aspects of figuring out those things. Man, that's great. And I remember meeting you for the first time. It was at Dr. Stefan Albini's DACA South meeting. And you guys were early, you know, your creation of Redox there.

[00:02:20] And I could see that sort of your passion and your smarts and how you connect the dots really made it work. Let's talk about Althea in a second. But before we do share with us and all the founders and entrepreneurs

[00:02:33] that listen to our podcast, like that journey, you know, what advice would you give founders looking to have the type of success you had at Redox? Oh, yeah. So I was just placing myself back in San Francisco at that conference. And man, I had such passion for interoperability.

[00:02:51] And really, you know, it wasn't we weren't coming at it from the perspective of a technical solution to the problem. We were coming at it from the perspective of the lack of interoperability in health care was preventing new technologies from making the impact that they should make.

[00:03:08] And, you know, every time you go to the doctor's office, you see 100 ways that technology can improve the experience. And so we really saw it as an injustice. And I think that that we're getting back to the keys to success,

[00:03:21] seeing it as something bigger than ourselves, some bigger injustice that was happening in the world that we could play a small part in solving was a huge contributor to give us the confidence and courage and passion and resilience that it took to do what was necessary

[00:03:38] to bring Redox from an idea of this cloud based multi-sided network into the reality that it is today, which is a massive platform that sees 30 million plus patient records every single day and translates those and standardizes them and makes them available for the digital health community to utilize.

[00:03:57] So it was really kind of, you know, seeing something bigger. And it's similar now as I think about psychedelics. And when I look at all of the trends in the world, right, like AI and climate change and political unrest and mental health crisis

[00:04:12] and wars, all of these things are so depressing. But when I look at psychedelics, I see a bright spot in the landscape of society and see something that could actually have an impact in all of those areas potentially. And, you know, we're starting in the mental health space.

[00:04:29] It's the most acute one that, you know, we can kind of relate that to an existing health care model. But when I think about the impact that psychedelics have had in my life and the people who I've worked with, I think there's so much more potential

[00:04:42] for it to really leak out into all aspects of society. And I think that's really cool. And first, I want to just reemphasize a point you made around bigger than yourself. You know, I think that's a critical piece to highlight for founders.

[00:04:58] And I'm taking it in for myself, too. You know, right before our podcast, Nico, I had a call with a woman. Her name is Maggie, and she is a patient. And she's been dealing with a chronic illness her whole life. And she's basically disabled and she is resilient.

[00:05:16] And the thing that she said to me is similar. What you're saying to me, Nico, is that she is doing this not for herself, but for others, because it's more than just her. She teaches a mosaic class and through mosaic, she teaches that

[00:05:30] you could be broken, but still be able to add value. And so what you're saying is so powerful. And so the psychedelic piece and mental health, I'd love to break that down and unpack it here, because I'm very curious

[00:05:46] how it works, because I don't know a thing about it. And our listeners probably don't either. We're too focused on AI. Give us the real stuff. I think give us the real stuff, man. I would say in some ways it's almost the opposite of AI.

[00:05:59] AI is taking the logic, the things that can be predicted and automating it and helping us make decisions more quickly and with more information, whereas psychedelics kind of take what's purely human, the creative aspects, art, the feeling of awe and mysticism and bringing that to the forefront.

[00:06:21] And what are those qualities actually create in people? My first psychedelic experience was around the same time I started Redox around 2013 or so. I was in the north woods of Wisconsin on a frozen lake, and it was absolutely magical. It was this overwhelming feeling of awe and beauty,

[00:06:38] and it seemed to put everything into perspective. And it made me excited about the life that I get to live and the opportunities ahead. And since then, you know, over the past decade or so, I've been using psilocybin in particular more intentionally,

[00:06:51] maybe like one or two times a year. And each time it gives me a fresh perspective on whatever life events I'm facing at the time. Last year was a big year of transition for me. So I took sabbatical from Redox for the first time in about a decade

[00:07:05] and took a step back and realized like the company had grown up. It seemed like it didn't need me anymore. And I realized it probably hadn't needed me in a few years at least. So I it made me think, why was I still there?

[00:07:17] Was it because I needed Redox? Like, who am I without Redox? And so I was questioning like my identity and my ego. And and beyond Redox last year had a lot of other transitions. My dad was diagnosed with cancer and died shortly after his diagnosis.

[00:07:31] I got a divorce with my partner from a decade. And it's in these ego questioning moments that psychedelics have really helped me grapple as my foundation seemed to be crumbling. I could either look at that as disasters or as opportunities.

[00:07:45] And that's what psychedelics have always given me, the mindset and perspective to reframe challenges as opportunities and things that I get the privilege to work on. And so, you know, over that time and using psychedelics, I had also been growing increasingly interested in the resurgence of research

[00:08:04] that had been happening around the country at some of our top medical research institutions like Hopkins and UCSF, NYU. So beyond the indication for tech bros working through their outsized egos, psychiatrists were also finding substantial efficacy for some of the most challenging to treat mental illnesses out there,

[00:08:23] like PTSD, treatment resistant depression, anxiety, addiction, smoking, cessation, alcohol use disorder. These mental health conditions are really the causes of what psychologists are calling the deaths of despair. In twenty twenty two alone, there were over two hundred thousand people

[00:08:39] in the United States that died from these deaths from things like depression, from alcohol use disorder, from overdoses. This trend has been increasing dramatically over the last decade. And so that's really what I look at when we talk about this mental health crisis

[00:08:54] in the United States and psychedelics are a bright spot in that they are much more effective than treatments that we've seen in the past. And it's typically a psychedelic compound combined with therapy. So a therapist will sit down with a patient and first off, they'll set expectations,

[00:09:13] really make sure that they understand what they're getting into, set intentions around why they're doing this work. And work up to that point where they can actually administer the drug. And so there's clinical trials right now using psilocybin, MDMA, LSD, DMT,

[00:09:31] Ibogaine, all different sorts of these psychoactive compounds and really coupling them with different types of therapy and different types of diseases to determine what is best. But the outcomes from them have been staggering and substantially better treatment than what we're seeing

[00:09:46] with your standard SSRIs or therapy or other existing modalities to treat these types of things. Yeah, this is fascinating. And so I guess there's a stigma around it as well. So let's talk about that. Let's talk about that. And why does that exist?

[00:10:02] Is that because of the history, like the 60s and the trials and all that? Like talk to us about that, because people are wondering it. I'm wondering it. Yeah. You know, so psychedelics were initially popularized in the 50s

[00:10:13] with the advent of LSD and really the reintroduction of psilocybin back into Western society. You know, psychedelic mushrooms have been around since the beginning of well, since before humans. But they were really kept in indigenous communities and used as sacrament in different practices.

[00:10:28] But they were kind of rediscovered in the 50s and brought back into the psychiatric sphere. And so there was a lot of research, both nationally funded as well as individually conducted in the 50s and 60s that focused on using psychedelics for different types of mental health disorders.

[00:10:46] They definitely had played a component as they escaped the lab, they say, and influenced a lot of the cultural revolution that happened in the 1960s. And because of that, you know, revolution is always met with resistance. So they were subsequently made illegal and lost funding from federal sources.

[00:11:04] And, you know, the nationally funded research sort of dried up around it. And so too did the interest in it because of the stigma that was created through them being made illegal and the subsequent war on drugs.

[00:11:14] So they went into a dormancy for about like a whole generation of underground practice. But right now they're really coming back. It's funny, some of the a lot of the people who were alive in the 60s that took part in that psychedelic revolution that was happening

[00:11:30] and were driven underground came back and were leading, you know, as renowned researchers and older people to really focus on bringing back that research. And we have to give a tip of the hat to Johns Hopkins that really, you know,

[00:11:45] as a renowned healthcare institution took huge steps in bringing this research back and looking at psilocybin and Roland Griffith's lab over there. But once Hopkins started studying it again, I feel like it kind of gave permission

[00:11:56] for a lot of other research institutions to start picking it back up. And so we're starting to see in about a decade or so ago, we started to see research pick back up again. And as that research was showing these profound effects

[00:12:09] with a caution towards what's happened in the past. So people were being very cautious about the bounds of their clinical studies and how they're approaching it. We started seeing it open back up again. And so it's been interesting because beyond the clinical research,

[00:12:23] because of the effects on PTSD, we're seeing a lot of bipartisan support in supporting reform around psychedelics because, you know, obviously we have lots of veterans that have PTSD and depression. And so there's been a lot of support around it.

[00:12:37] And so beyond the fast track pathways in the FDA for certain types of compounds moving through the actual FDA clearance process, we're also seeing state reform take place. 28 states have contemplated some sort of psychedelic program, including states like Texas and Oklahoma and places that would traditionally

[00:12:56] and so far have not really touched cannabis reform. So it's moving faster and with more bipartisan support than cannabis did and with more clinical backing and formal FDA processes, which cannabis never really pursued. There are literally dozens of drugs right now that are going through the FDA pathway.

[00:13:16] And we're likely to see in the next six months, the first FDA approved psychedelic compound with therapy, which will be Lycos Therapeutics, formerly MAPS, Public Benefit Corporation for the treatment of PTSD. In their phase three clinical trial,

[00:13:32] they saw 71% of their participants no longer met the criteria for PTSD after three sessions of MDMA assisted therapy, which is just unheard of for a disease like PTSD. So it's amazing. And where my mind goes is there's a thought physiology barrier I mean, it's connected, right?

[00:13:54] What we think and who we are. And isn't about a pattern disruption that is very deeply rooted that happens. Like talk to us about that because I'm very curious about that. Yeah, yeah. There's a lot of research going on around

[00:14:06] what's actually happening from a neurochemical perspective in the brain. What new pathways are created, what neuroplasticity is generated through the use of psychedelics. And so there's that kind of neurochemical approach, the pharmacological approach to these drugs, which certainly has some aspects to it.

[00:14:24] But a lot of people who have been working in this space and who have had a psychedelic experience will say that beyond the brain chemistry, there's a phenomenological thing that happens, an experience that these drugs take you on the journey,

[00:14:37] they call it where you're actually going into places in your conscious and subconscious that otherwise might not be accessible in a normal state. And it's similar. So they've actually put people who are tripping on LSD in an fMRI scanner, as well as putting people who are experienced meditators

[00:14:55] or people who have a spiritual practice who pray monks of these sorts. And it's similar brain states that are achieved in that aspect. So I kind of think of it as a shortcut into a kind of enlightened state.

[00:15:09] And you can kind of touch it, but you don't own it yet. But by simply touching that state, you can bring so much healing back. And so there's the neurochemical aspects, and then there's the phenomenological pieces of it. And I think both of those are certainly working together

[00:15:23] to create healing in antidepressive properties that these drugs have. And these drugs are not all the same either. Some of them work on the serotonin 2A receptor and have profound effects there. Others like MDMA just release a lot of serotonin and dopamine

[00:15:38] and other compounds that can kind of put you in a state where you're more susceptible and open to therapy, making the relationship with the therapist deeper and having more trust and having larger ability to actually break out of patterns that you might have in your ways of thinking.

[00:15:53] So there's lots of different aspects, and that's where a lot of research is going right now. So beyond figuring out what drugs work for what diagnoses, there's a lot of basic research looking at what actually is happening in the brain, and what are the risks of that?

[00:16:09] What are ways to improve that? Some of the challenges with psychedelics are they oftentimes create journeys that last a long time, you know, eight plus hours. And when you're delivering that type of medicine, you have to have facilitators, therapists to sit with these people.

[00:16:24] And oftentimes it's two therapists and one client. So you can just imagine the delivery model, how cumbersome and costly that is. And, you know, it might be a few sessions over a few months that require preparation and integration afterwards. And it can be variable too.

[00:16:40] These journeys, they all look different for each person. Some are ecstatic and joyful, some are sorrowful and full of grief. And so being able to administer these types of medicines comes with a ton of challenges. And so it's really all of these challenges

[00:16:57] and the opportunities around the research that we're looking at from a software perspective, a purpose-built software platform to aid in regulatory compliance around the use of these medicines, practice management, supply chain handoffs, research opportunities, pharmacovigilance, helping pharma companies really understand how their drugs are being used.

[00:17:16] So it's that problem space that we're diving into. And as I said, we're not exactly sure where we're going in it, but with my experience spending, gosh, like the past 15 years or so at the front lines of technology and healthcare at Epic, then at Redox,

[00:17:31] I've seen how technology can improve healthcare delivery. And so my hypothesis in this business is that software can be helpful here and my co-founders and I are being patient and receptive, trying to really respect the wisdom that has come before us

[00:17:45] while trying to figure out where we can help out. Because like most things in healthcare, it's not really gonna be a software innovation that is going to be the game changer. It's really gonna be how can we insert that software at the right point to not replace

[00:18:00] the fundamentally human interaction that goes on in healthcare, but augment it and help it happen in a more personal way by removing barriers and making compliance, billing, tracking, reporting, all of that happen kind of behind the scenes. I love that, Nico. So you believe psychedelics is the future

[00:18:20] and there's gonna be a big industry built around it and there's an opportunity to help facilitate it. Yeah, certainly. And because of the pathway that psychedelics are coming to the world through these like state programs, so Oregon and Colorado have created state-run programs where people can legally go

[00:18:39] and take psilocybin with a facilitator. That's sort of one program that we're seeing and we're gonna see more and more states come out with these types of things. And then we're also seeing FDA approval, but because of this way that it's coming to market,

[00:18:52] I think it's gonna happen outside of your typical health system. So this company that I'm starting is partnered with the University of Colorado Medical School Anschutz and really they're not going to touch psychedelics until it's FDA approved. But we're gonna see so much use

[00:19:07] and so much research happen in society that it would be a missed opportunity if we didn't learn from that and apply that into the medical realms as we're getting formal FDA approval for different types of compounds. So that's really where I see the software playing in

[00:19:22] is bridging that gap between what we're seeing in state-run programs, which are legal at the state level and the medical research that's happening that will bring these compounds and approaches to the masses through formal FDA approval and eventually insurance coverage and distribution through typical healthcare channels.

[00:19:41] Oh, that's fantastic. Well, look, I appreciate you previewing this with us today. And it's definitely an interesting approach. I mean, you highlight the PTSD opportunity itself, right? I mean, helping our veterans, I can't think of a more amazing cause. And then beyond that,

[00:20:00] the epidemic of mental health that we have in this country. Like what we're doing is not working. Let's be open to new approaches. And I love it. I think it's a fantastic approach. I'm rooting for you. I know all of our listeners are rooting for you, Nico.

[00:20:16] What would you leave us with closing thoughts wise here as we wrap up our chat today? Hmm. That's a good question. I've been thinking a lot about values lately. And so I'm just gonna throw that in. It might seem like a curve ball,

[00:20:30] but when I think about what I wanna work on and how I wanna spend my time, which I got to do a lot of over the last year, what it came down to me was values and thinking like, what are my values as a human?

[00:20:43] And do I know what those are? And have I seen where my behaviors and the time I spend is aligned with those values? And I think if we all did that a little bit more, we'd be happier and also probably create more exciting companies

[00:20:57] and societies and communities to be a part of. So that's what's been on top of my mind lately. So I'll leave you with that. I love it, man. Not the great way to close out. And certainly something that I think a lot about reinforce with our team,

[00:21:11] the importance of our values as an organization, but even family values. So I love it, man. Thanks for closing us on such a centered note. Nico, always appreciate connecting with you and keep in touch, man. Whenever you have an update, come visit us again. Yeah, for sure.

[00:21:26] Thanks for having me. This was awesome. Thanks, Sal.