Quit Genius Updates Smoking Cessation For The Modern User

While the number of smokers has declined worldwide, tobacco still kills 8 million people each year. If that doesn’t alarm you, let’s remember there are a billion smokers in the world and vaping just rebooted nicotine for Gen Z. But in the last few years, a new space called digital therapeutics has emerged to fight these enduring hazards with contemporary solutions.

As the name of the category suggests, these startups add a software layer to new or existing treatments. Digital therapeutic companies often reinvent a service for the internet (like web therapy) or offer a mix of evidence-based treatments and accessories to create something entirely new.

The latter approach makes addiction the perfect problem for digital therapeutics to solve. Smartphones can provide doctors and technologists with valuable streams of data and open lines of communication, which permit them to address the underlying experience of addiction. This makes these solutions more holistic than a treatment that targets a single dependency.

Quit Genius wants to be the go-to app to treat addiction on that higher level. With one million users, the YC-backed startup founded by medical doctors is growing. Quit Genius fights smoking addiction through a cross-section of treatments such as nicotine gum, counseling, software, and a carbon monoxide monitor. Yes, a carbon monoxide monitor. (Picture a breathalyzer for smokers that can report data back in real-time.)

I spoke with co-founder and COO, Maroof Ahmed, MD about the rise of digital therapeutics, why his startup sells to employers as well as direct to consumers, and how Quit Genius responsibly ships a minimum viable product when a person’s health is at stake.

This transcript has been edited for brevity and clarity.

What problem are you solving?

Maroof Ahmed, MD: So my co-founders and I were medical doctors by background. And whilst we were spending a lot of time as doctors in training, we realized that there was a really, really big problem. A lot of people were spending time in hospitals, which was obviously super expensive for them, the healthcare system, and often their employers as well. And a lot of people were there as a result of smoking-related behaviors.

When we researched this in greater detail, we found that smoking is the biggest cause of preventable death worldwide. Even though 70% of smokers actually want to quit, only 3% of them are successful in the long-term. And as we were on the front line, we realized that as doctors, we didn't give them much tangible advice to succeed in the long-term. We’d just be like, “Go ahead, quit smoking. Here’s a number you can call where there's a six-month waiting list to get face-to-face behavioral support.”

So there wasn't much support for them. And as well as this being a professional problem for myself, it’s also a quite personal problem because when I was 16, a close relative of mine passed away as a result of smoking. It's something that is obviously close to my heart.

How did you develop a method to help people quit smoking?

Maroof Ahmed, MD: Hundreds of published papers show that the best way to quit smoking is nicotine replacement in combination with behavioral support. Nicotine replacement is relatively easy to get your hands on. We can pop down to Walgreens and get our hands on a nicotine replacement at a cost-effective price.

Behavioral support is more difficult to access. It’s super expensive because face-to-face therapists often cost up to $200 an hour. And on top of this inconvenience, you then have to tell your employer that you have to take 9 am off every Monday because you have to see your therapist for 12 weeks.

There’s often a taboo associated with that and it’s only available Monday to Friday, nine to five. Not many therapists work 24 hours a day, but a smoker could be craving a cigarette on a Saturday night when they’re out with their friends and they’re at the pub.

We wanted to use technology as a solution to provide a cost-effective and more convenient way to access behavioral therapy specifically for smoking cessation.

You’re saying that access to a human support system was out of reach for most recovering addicts, even if they could get their hands on the nicotine gum?

Maroof Ahmed, MD: There are two sides to addiction. There’s the physical side to addiction. You are addicted to nicotine, and you will experience cravings once you quit nicotine. And on the other side, is the psychological side, which is actually more difficult to overcome.

Every time you have coffee, you might be craving a cigarette because that's just a habit you formed. For the last 20 years, you’ve been smoking 20 cigarettes a day, and that's sometimes really difficult to overcome because you may not necessarily be physically craving a cigarette. But after having that coffee, you’re always naturally going to be reaching for that cigarette because it's part of habit formation.

So we use evidence-based cognitive behavioral therapy to break down the psychological side of addiction. We try to change the way users think and, as a result of changing the way they think, we like to change their feelings. And as a result of that, their behaviors as well. This cycle of behavior change has almost been proven by decades of research, but it’s been difficult to access because it's traditionally been delivered in a face-to-face setting with a therapist.

You offer an app, access to a therapist, and nicotine gum. Anything else?

Maroof Ahmed, MD: On top of the actual app, where we deliver cognitive behavior therapy. It’s delivered in bite-size chunks, like five minutes a day, through a video and audio session. And users get access to a Quit Coach, essentially a helping hand throughout the whole journey of quitting smoking. Users can access all this whenever, wherever they need. Round the clock support, 24 hours a day.

We also have a connected device, which measures the user’s carbon monoxide. This connects directly to the app, so everything's recorded and we get users to check in on a regular basis. This is useful because we can measure carbon monoxide in the breath and we can see how it decreases over time.

Like a breathalyzer for smoking?

Maroof Ahmed, MD: We like to tell users it's like Fitbit for smoking cessation. When you're trying to lose weight, you obviously measure your weight and see your weight go down. And when you achieve your target weight, it is motivational. It's the same principle here for smoking cessation. Smokers start with a high carbon monoxide level, and they can see that they go down over time. That’s very good.

Since you offer such different components as part of the same service, what space do you consider yourself to be in?

Maroof Ahmed, MD: Yeah, that's a super interesting question. So a couple of years ago, it would have been very difficult because, as you said, we overlap into many different fields. Now there's this new term coined over the last 12-24 months called digital therapeutics, which fits our value proposition very well.

Digital therapeutics is the simple idea that digital behavioral change programs can be as, if not more, effective at preventing and treating a chronic disease than pills and potions.

More and more startups have started to bundle their services as perks for employers. Sometimes it makes sense and sometimes startups are just reaching for a viable business model. Why do you market to employers if you’re treating individuals?

Maroof Ahmed, MD: So the reason we have a focus on employers is due to the sheer amount of money that smoking costs an organization. Organizations face massive direct healthcare costs associated with nicotine addiction, which includes vaping. According to the most recent reports, this is second only to MSK (people with opioid and musculoskeletal issues that often result in direct health care costs as well). Also, 40% of cancer claims are related to smoking, so this is costing employers huge amounts of money.

There's a crying need for employers to have a smoking cessation solution that can save on direct health care costs. 

You have offices in the US and the UK. The UK provides universal healthcare like the rest of the developed world. The US does not. You can easily distribute an app all over the globe, but how do such radically contrasting healthcare systems affect your business?

Maroof Ahmed, MD: We do have a public healthcare system in the UK, where the government has a strong focus on smoking cessation. Therefore it contracts with various vendors to help people quit smoking. Quit Genius has won a number of those contracts so that it can provide access to Quit Genius free of charge. That's the first point.

But on top of that, private employers in the UK often have private insurance for their employees, and a number of their employees are smoking, much like they are in the US, and they want them to quit smoking. So offering Quit Genius as a benefit can help with their direct healthcare costs.

Even though Facebook has lost some of its luster in recent years, Zuckerberg’s move fast and break things is still cited by early-stage startups, as is ship early and often. That may be smart strategic advice, but it takes on a different meaning when a user’s health is at stake. What do you consider an MVP, or minimum viable product, in your space?

Maroof Ahmed, MD: We try to create a fine balance between something that's evidence-based, but also something that users enjoy experiencing. And so one key difference with, like you said, a photo-sharing app is that we have a stringent medical advisory board and a number of doctors and psychologists on our team that will always check something before it goes into production — or to the design team, or to the content creation team.

One of the core values of our company is to build on the strong evidence base, so we've published six peer-reviewed papers. But on top of that, we try to follow the best practices because there's a ton of research on behavioral therapy and cognitive behavioral therapy from multiple academic institutions.

We still do multiple A/B tests with users. We're always testing what works best and what leads to the best user experience. The one caveat is it has to be evidence-based. Regardless of the user experience, if it is not backed by evidence, it doesn't go into the app.

Unlike a lot of other companies in health and wellness, we are trying to innovate quickly and iterate quickly. And a result, we have over a million users on our platform. 

Let’s just pause on that. You started in 2017, you’re still relatively early-stage, and you have a million users. That’s an impressive milestone.

Maroof Ahmed, MD: Yeah, a million users on our platform. As well as a thriving employer program. We have demonstrated real-world commercial success in the consumer market and we have helped over 60,000 people quit smoking for good.

You make an app that treats addiction. So I just have to ask, will Quit Genius ever address digital addiction?

Maroof Ahmed, MD: It's definitely an interesting question. Smartphone addiction et cetera is not something that we've thought about in great detail, just because we've had a strong focus on what's on our website.

Smoking is a big enough market in and of itself. Nicotine addiction is a massive problem and we have just launched the first purpose-built behavior change program for e-cigarette addiction.

We want to be that helping hand that gets people to quit their addiction. People are often aware of their addictions, they just find it difficult to succeed in overcoming them. So we want to be that helping hand to quit, whether it's smoking, whether it's vaping, whether it's alcohol — or even harder addictions like opioid addiction.

There’s Alcoholics Anonymous and Narcotics Anonymous. But you want to break down those silos, how we treat those addictions, and maybe even how we think about them. 

Maroof Ahmed, MD: Absolutely. And what's actually super important is we train our coaches to be addiction therapists, not to just focus on one specific problem. Addiction therapists often have niche knowledge on smoking cessation and nicotine replacement, but imagine having an addiction therapist that you can then speak to about all your problems.

That sounds compassionate and ironically much more human.

Maroof Ahmed, MD: Yeah, absolutely. You then build a rapport with that person and they know everything about your addictive habits. And once they've tackled that one addiction, the second addiction is far easier to tackle because the therapist knows the root causes.

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Key Takeaways

• Digital therapeutics have made it easier to treat complex diseases like addiction through more consistent tracking and access to counseling.
• Employers want to keep their healthcare insurance premiums low, which makes them great customers for a company like Quit Genius.
• It’s refreshing to hear about an effective advisory board at a tech company in 2019.