DTx Spotlight: An Interview with Francesco Garosci

In this month's episode I sat down with Francesco Garosci , Co-founder and Head of Growth at Paperbox Health .

I had the pleasure of meeting Francesco at Frontiers Health 2023 and was so impressed by the work he and his team are doing to revolutionise the early diagnosis of neurodevelopmental disorders - blending innovative technology with accessibility to enhance the lives of children worldwide.

Addressing the crucial gap when diagnosing neurodevelopmental issues, Paperbox Health has developed "DINO", a pioneering web-based game that can identify the presence or risk of a learning disorder in children within just 15 minutes. Incredible right?!

With issues like this impacting millions of children globally, I wanted to take this opportunity to spotlight Paperbox Health to enhance visibility for their solution as they have just launched their first product in the market.

Hope you enjoy the conversation!

A lot has been happening since we met at Frontiers Health, but why don't you kick us off by telling us a bit about Paperbox Health.

"Paperbox health is an Italian-Based innovative startup founded?in 2022 by myself and my other two Co-founders Giacomo Pratesi ,?a physicist specialized in diagnostic systems?from La Sapienza University and Francesco Trovato , engineer/MBA with previous experience in?the?consumer branch of Angelini group, one of the main pharmaceutical companies in Italy.

"One year ago we also had Alice Ravizza join as a Co-founder and investor, covering the role of? head of regulatory compliance (PRRC). She brings extensive experience in the medtech industry having founded and invested in several medtech companies.

"Paperbox aims to bring innovative solutions to the market that allow for the early detection of childhood community and neurodevelopmental issues at a very early age.?In fact our first solution is represented by “DINO" by Paperbox which is an accessible and scalable?video game, aimed to early-identify learning disorders such as Dyslexia."

Great. You obviously can't target the children being affected here so, who is the target user and what is your business model?

"In the very beginning we always thought of families and parents as the main target of our service.? The vision hasn't changed?but?we decided to adopt a step by step approach that could be sustainable from the technical and scientific point of view, which includes: Specialists, Schools and B2C.

"Currently Paperbox is targeting neurodevelopmental specialists (such as speech therapists, psychologists, neuro psychiatrists,...) as the first adopters of our product release,?proposing them a solution which can largely facilitate their work by making the process more enjoyable for children but can also ensure a faster and improved process for data collection. Any specialist in this field is able to purchase our solution on our website through a subscription or a pay-as-you-go.

Studies estimate that around 15% of the global population is dyslexic but in Italy,?only 3.5%? of the student population is actually diagnosed.?

"As a logical second step, Paperbox is also targeting schools in order to satisfy the?rising demand from the education industry, as well as parents and families, to find a solution to early-identifying learning difficulties but that is also compliant with the recent ministry guidelines.? For example,?studies estimate that around 15% of the global population is dyslexic but in Italy,?only 3.5%? of the student population is actually diagnosed.? This problem of inefficient diagnosis has been highlighted as one of the main causes of early school dropouts and consequent unemployment and social problems.

"Finally,?Paperbox?plans?to enter the household of any family that is facing the troubling question of? “will my child be ok on their learning path?”. This will be achieved once “DINO” is scalable and medically certified as an early-detection solution.?We are currently still exploring the best way to position ourselves in the market but we have already collected evidence that this could be done through distributors of educational solutions, from direct sales through our website, or implemented?during a child's health check up with a paediatrician."

Tell us about “DINO” and why you chose video game as a means to differentiate it from current solutions.

"DINO is the solution that aims to early-detect learning disorders in students starting from the age of 5.?The initial inspiration to build this solution came from our first clinical advisor Sergio Messina,?and the recent Italian ministry guidelines.???

"Current methods are exclusively paper-based and require an in person and one-to-one submission for every child which increases the associated cost and lengthens the time to receive the results.?In addition, the process is often? annoying for the child therefore, the results are not always accurate.??

"During the development of DINO we started to digitalize the gold standard paper-based tests and bound them with a gamified process.? The result is that the child can process the same amount of tests, which would usually take up to an hour, in just 15 minutes - without the sensation of being examined and the risk of diverted attention during a test. In fact, DINO not only provides data related to the tests themselves, but it also monitors mood and attention levels throughout therefore, providing a?real-time comprehensive report?that also states the accuracy, or lack of, in the results.

"DINO not only excels in risk identification but also?can be used for continuous monitoring throughout the year. It is built to be language-agnostic and can be used with affordable and accessible hardware such as a €200 tablet with minimal internet connection."

What stage is the product at currently?

"DINO?can be identified as “technology readiness level 6”?and is currently ongoing a clinical trial in order to obtain a class 1 CE mark as a medical device.?

"Future versions of the solution will be able to detect other cognitive issues outside the specific learning difficulties (such as executive functions and speech difficulties),?support more languages and devices and also provide exercises, in order to improve the child's performance."

"2023 was one of the worst years for fundraising as a startup, but I'm glad to say we made it through even stronger and are aware of what a committed team can do with extremely low resources."?

What are some of the challenges you have faced on this journey and how have you overcome these?

"One of our key challenges was to get to the core of the problem and provide evidence for it.?In fact, none of us initial founders had previous direct experience within neurology however, this proved to be a positive as it helped us to eliminate any bias when creating the solution. Therefore, we had to study a lot and learn from the experts in the field before being sure of the problem and starting to build the solution.?

"Next was getting the first financing. 2023 was one of the worst years for fundraising as a startup, but I'm glad to say we made it through even stronger and are aware of what a committed team can do with extremely low resources."?

What’s next for Paperbox Health?

"In about a year from now, we see ourselves as a company which is actively expanding its commercial growth in Italy and has successfully received the CE Mark. Meanwhile, we will also be starting to tap into?the EU and English-speaking markets and entering the certification process of becoming a diagnostic DTx.

"The clinical trial will play a crucial role since the achievement of the certification will mean that?the world can be opened up to?a whole new level of digital health solutions."

What do you think 2024 holds for the DTx industry?

"I believe that DTx and digital health in general will bring the same disruption as molecule-based pharmaceuticals?did about a century ago. Especially in mental/ neurological health the?applications are endless.??

"Industry trends?suggest that?the demand for neurodevelopmental solutions will spike within a few years, exactly?as the demand for neurodegenerative solutions spiked a while ago.

"Much of the game is held by regulatory frameworks that need to be adapted in order to facilitate DTx market access.?

"Also the growing trust from the public and evidence of the positive impact of the digital health solutions will play a crucial role in their adoption."

If you'd be interested in contributing your thoughts to the DTx Spotlight series please get in touch.