Junto Profile: MindCotine
According to the CDC, adult Americans have decreased their smoking habits from 20.9% in 2005, to 15.5% in 2016. However, cigarette smoking continues to be the leading cause of death among preventable diseases in the United States. An estimated 37.8 million Americans still smoke, resulting in 480,000 deaths every year. Public Health professionals continue to assess the efficacy of health initiatives targeted at breaking cigarette addiction; however, no one strategy has emerged as a clear solution.
Classic smoking intervention models such as the Truth Campaign and the CDC’s various national campaigns have been able to make dents into the number of smokers in the U.S., but few technology focused interventions have risen through the ranks.
When we came across biomedical engineer-turned-CEO, Nicolas Rosencovich, and his innovative solution to breaking cigarette addiction: MindCotine we were intrigued to learn more about the vision he had for integrating smoking cessation principles with the technology advancements. MindCotine uses virtual reality technology to help break cigarette smoking addiction. For $50, those battling cigarette addiction can purchase a kit, which combines virtual reality and Mindfulness-based Exposure Therapy, to help cigarette smokers gain insight and learn hope to cope with nicotine addiction. While virtual reality may not be the ideal solution for every user and population segmentation, the design principles and global approach that Nicolas has taken with his company most definitely provides a unique perspective about the potential for cutting-edge technology to be integrated with classic therapeutic and psychological principles.
Junto Health (JH): Can you describe what MindCotine does?
Nicolas Rosencovich (NR): MindCotine purpose is to empower a nicotine addictive person to change his or her smoking behavior for a healthier one. Each of the immersive (VR) scenarios are designed to represent a specific situation that every smoker can experience in their daily life. Each situation is a combination of CBT, while at the same time being trained and guided by a mindfulness narrative that takes the user into recognizing their bodily sensations. First, MindCotine induces a meditative state by bringing the user´s breathing into a calm and natural rhythm. After a couple of minutes, a real situation is presented in a immersive format whereas the design of the immersion brings forth the sense of craving, while at the same time the guided meditation touches the emotion associated with that situation. Lastly, we take back the user into a relaxation mood, in order to end the experience as a preparation before starting the regular day.
All this training is repeated once a day, over a 21 days program where the user begins with the acquisition of the MindCotine Kit that includes a Kit Id, needed to set up the VR headset (included in the Kit). In addition to the immersive sessions, the program includes a sets of lessons and coping skills exercises to overcome the cravings in real-time, and provides a supportive digital community of users, peers and mentors, in a forum/chat format.
JH: Why did you decide to found MindCotine?
NR: Since very young I become aware of being lucky and gifted with education and knowledge, and since then I have always been motivated to help others. Consequently, in my journey as a student in Biomedical Engineer, in Cordoba Argentina, I found my passion in the clash of neuroscience and technology. After participating in the first project in Argentina to treat phobias using VR and cognitive cue-exposure therapy, back in 2008, I understood the power of technology a mean to generate a positive impact on population’s health on a bigger scale. Unfortunately, many of my entrepreneurial health innovative initiatives, failed on support or execution, and were not pursued, until 2016. That year I decided to take action to my call of responsibility, and was so lucky to find that my friends and actual co-founders, Cristian, who had funded a VR agency in Mexico and was developing impactful social VR projects for climate change and refugees, and Emilio, psychologist and meditational practitioner who was working on the awareness of consciousness; we were all having similar ideas, values and determination to pursue the dream of a global positive impact. Consequently, by the end of that year, we complemented our experiences and expertise, and identified that the biggest global problem in mental health is the accessibility to solutions. In addition, Cristian, who was still a smoker at that time, suffered from asthma and needed to quit, failing repeatedly to do it. That is why we decided to target legal addictions, and MindCotine focus on helping every smoker in the world to have access to a tobacco cessation therapy, to train them to quit and remain healthy.
JH: What were you doing before you started MindCotine?
NR: Before MindCotine, I was a failed but resilient entrepreneur who had worked 6 years as the head of R&D, in CEC Electronica (www.cec.com.ar), Argentina, a medical devices company where I master my development skills in electronic solutions for surgery, kinesiology and aesthetics for LATAM market. Fortunately, in 2016 I went to Israel on an entrepreneurial tour to find luck with my new invention, a medical device for remodeling the maxillae bone to increase teeth movement and osteo-intregration, but failed to sell the idea. Therefore, I went back to my passion for neuroscience and continued my previous awarded invention, NeuroTest, a medical device for mental health diagnose, turning it into an early-stage mental health diagnose device using VR.
In addition, right before jumping into MindCotine, I co-founded a Social Art Gallery called Carrusel Galeria Sin Filtro, where amateur artists were able to perform and share their art empowering the freedom of expression, eliminating the selection criteria to increase inclusion, communitarian values and access to bigger audience.
JH: What is “Mindfulness-based Exposure Therapy” and how does it work in the context of your product?
NR: The Mindfulness-based Exposure Therapy is the combination of the two cognitive behavioral therapies/techniques (CBT: Cue Exposure Therapy and Mindfulness for Behavioral Change) to work within the virtual environments designed for our product.
We call it VR-MET, “Virtual Reality Mindful Exposure Therapy”, and it is based upon MBRP (Relapse Prevention), MBSR (Stress Reduction), and MBCT (Cognitive Therapy) merged in virtual immersive scenarios.
While being exposed to specific triggers that are known to elicit craving to smoke, the mindfulness narrative takes the user to get in contact of their bodily sensations with the sense of craving, thus generating the possibility to observe the present moment of that situation during the lapse of the experience. This step of acknowledgment brings forth a new space between the user and his or her understanding of the behavior, giving the opportunity to the user to change their relation with it.
JH: What was the biggest challenge you faced when first getting the company off the ground?
NR: The biggest challenge at the beginning was getting support from others, beyond ourselves, and to learn how to validate our assumptions and beliefs, no matter how are. In addition, at first, I thought that the sense of uncertainty and how to live and deal with that was our biggest challenge, however, very soon, we learned to embrace it, as a chance to create, measure, correct and evolve.
JH: What do you see as the current biggest problems with traditional tobacco cessation programs (for example, the Truth Initiative)?
NR: As only 5% of smokers are able to quit by themselves, the rest, ~950M smokers are in need of assistance and support to change a behavior that will lead them to death, due to the reductionist, selfish and linear view of life of our economic system, that gain profit out of people health.
Traditional tobacco cessation programs are based and distributed under the healthcare system, or dependent on social security, mostly inaccessible for the majority of global population of smokers (84% according to WHO), who live in developing countries and have little or no access to solutions.
The accessibility to affordable, efficient and scalable solutions, is not only a problem of the traditional tobacco cessation program, is also the main issue of the relentless, slow and non-inclusive healthcare system, that hopefully is facing a change in paradigm by the hand of the technology and awareness.
Regarding Truth Initiative, they have been doing a great job in last 10 years in the promotion and prevention of tobacco consumption in adolescents, and they have a very active role in the fight against tobacco consumption in United States. Some of their initiatives includes a tobacco cessation programs based on counseling, and we believe they are an amazing platform to be partnered with, in order to provide more solutions that fit the needs of the smokers.
Unfortunately, nicotine consumption has no boundaries and makes no discrimination; it is a battle to fight in collaboration with many armies, if we really want to slowdown the clock of a smoker dead every 5 seconds.
JH: Is MindCotine a device you are supposed to use throughout the day when you feel the urge to smoke or are there specific times of the day you should be using it?
NR: MindCotine is digital tobacco cessation program based on a mobile platform and combines a set of therapeutic elements to help the smoker change his addictive behavior and quit smoking.
In a 21 days program, it prompts the smoker to engage in 10min VR immersive session per day every morning, combining with coping skills training and meditation practice during the rest of the day and provides a supportive digital community of peers and tutors. Every MindCotine user gets a MindCotine Kit that includes a VR headset and other coping skills accessories.
JH: Do you suggest people use other addiction therapy alongside MindCotine to overcome tobacco addiction, or is MindCotine effective enough on its own?
NR: Nicotine addiction is one of the most complex and unsolved problems of today´s medicine. It is well known there is not just one solution that can fix it all, and none of the existent solutions is capable enough to solve the problem. We acknowledge the importance of this matter, and understand that by merging our solution with others, such as visits to a doctor, drug-based therapy, or cognitive therapy; the effectiveness can growth exponentially. As a complementary solution, MindCotine works perfectly, since it is a non-invasive, self-administrable, accessible solution. When used alone, MindCotine training has proven to have a 23% effectiveness to help people quit smoking, based on the preliminary results from research case studies.
This represents just the beginning of an extensive and iterative research and development process, to make the MindCotine solution, a unique and impactful way to quit smoking, enhanced by the use of technology.
JH: Has MindCotine been a part of any research studies about tobacco cessation? Do you have plans on selling some to in-patient clinics for research?
NR: MindCotine has conducted during Q3-Q4 2017 and Q1 2018 the first clinical trials. The results have shown a 23% efficacy of cessation rate, and a 67% efficacy in reduction rate in every person that ended the 21 days program. Research is one of the main pillars of our company, understanding that is the key to remain effective and efficient as a solution within the digital therapeutics field. Our plan is to keep on making progress in every aspect of the solution, validating every part of the program by studying it as it fullest so the program itself can improve in both efficiency and efficacy.
JH: How has MindCotine been received so far by the medical community? From people who have used it?
NR: From the very beginning, we understood the need of building a solution with a solid ground that will help in adoption from the medical and academic community, while at the same time provide a highly effective treatment for smokers. That is why we chose psychological cognitive therapies combined with mindfulness meditation, as both have been used in digital therapeutics and where already groundbreaking in addiction treatments. Since we have started several lead researchers in these field supported us with enthusiasm, like one of the pioneers in VR and behavioral change, who is Prof. Walter Greenleaf, from Stanford. Additionally, we have our first academic partnership with the University of Flores and the Systemic School of Psychology in Argentina, led by the research director Prof. Marcelo Ceberio from the Research Laboratory of Cognitive and Social Neurosciences. In addition to the academic support, we were invited to participate and present MindCotine in the world most prestigious digital health forums, like BrainFutures 2017 (Washington, DC), Global Health Innovation Conference 2018 (Yale), VR Health 2018 (Harvard) and VR Medicine 2017 (Stanford).
MindCotine initial business model is to help smokers by selling licenses to corporations under employee benefits, and healthcare institutions, to provide a personalized tobacco cessation solution to each smoker employee/member. Because of that, we have being invited to present MindCotine program to the Ministry of Health in Argentina and we are having an amazing traction with healthcare institutions like Sanatorio Modelo (Buenos Aires, Argnetina) and San Roque Hospital (Cordoba, Argentina) to provide MindCotine as part of the tobacco cessation program to more than 6,000 patients and members of their HMO. In addition, we are deploying MindCotine Corporate Tobacco Cessation program, run by their medical departments and assessed by a medical committee, after a demoing period. Such is the case of Fiat Chrysler Automotive Argentina, and others multinational companies.
User experience and adoption has been incredible good and unexpected, as the average user has been a 50 years old smoker, who had never used or heard about VR, neither mindfulness meditation. Due to the effectivity rates that will be soon publish in our first white paper, every user has had a positive effect their behavior towards reducing their tobacco consumption.
JH: Do you think the technology behind MindCotine has implications for other addiction cessation programs other than tobacco addiction?
NR: As mentioned before, MindCotine methodology is based on proven scientific research and widely used cognitive therapies that targets the core mechanism of addiction, which is reward-satisfaction loop, a brain activity present in every addictive behavior. By targeting this system, we are able to train the brain, using the same methodology, adapted and validated to new behaviors, environmental and emotional triggers. Therefore, and aligned with our purpose, we decided to tackle legal addictions, such as tobacco, alcohol, sugar and junk food and opioids consumption. However, as addictions have a strong social and cultural aspect, language, gender, ethnicity and environmental adaptation are compulsory to have a positive effect in behavioral change. We are working steadily to provide a solid and accessible solution that will incorporate, in a near future, new products including other addiction cessation programs.
JH: What is some advice you would give to someone who is thinking of starting a company in the health tech industry?
NR: From my personal experience and journey, added to our collective team knowledge, which is always a dynamic process of evolution, I would suggest a few simple and humble advices.
First, is to be passionate about your choices and to be purpose driven, as determination and grit are necessary, the key to be resilient is to have higher set of goals that will guide you in times of rejection and misbelief. The health tech industry can be harsh as it is a highly barrier market in many aspect.
Secondly, I would recommend using technology as a mean to provide new health solutions that have been already used and proven, so as not to “invent the new wheel”. However, I am sure that more often, due to disruptive technology, new methods of validation will need to overcome our standards.
Third, have a complementary funding team that has specific knowledge and expertise in the required fields. As, being a health tech startup, uncertainty is an everyday element, that is mitigated by strategic planning and execution. However, failing is part of the learning process, and self and team compassion is primordial in order to evolve. Have a solid friendly funding team.
JH: What are the next 3 big milestones for MindCotine?
NR: MindCotine’s next 3 big milestones are:
Launch and deploy MindCotine successfully, to our more than 1,000 pre-sold users, from all over the world, in October 2018.
Deploy MindCotine Corporate Tobacco Cessation Program in Argentina and USA to our 50 companies.
Publish a Whitepaper of our research and findings, in collaboration with lead researcher academic partnership.