Dr. Muthu Alagappan, CEO and Founder of Counsel, on defining a new healthcare paradigm in asynchronous care

Today, excited to get to know Dr. Muthu Alagappan, CEO and Founder of Counsel, the modern solution for access to care.

Before founding Counsel, Muthu was the CMO of Notable Health for almost 4 years and was an Attending Physician at Beth Israel Deaconess Medical Center and UCSF Medical Center. He graduated with his MD from Stanford Medicine and (fun fact!) was also the Student Commencement Speaker for his graduating class.

Founded in 2023, Counsel provides patients with high-quality, personalized medical advice from expert doctors within minutes. Counsel recently announced $11M in seed funding from investors like A16z, Floodgate, Asymmetric Capital and Pear VC! We at Pear VC are proud to be partners to Counsel!

If you prefer listening to the podcast, here is the recording.


Muthu’s Background and Career Path

  • Starting from early childhood, Muthu always had a dual interest in both technology and healthcare, influenced by his physician father and growing up in Houston, Texas, which is the world’s biggest medical center. When Muthu arrived at Stanford for undergrad, it was an amazing place where Stanford really thrived on cross-pollinating ideas across different domains from medicine to art and humanities to AI. He learned that having multiple domains of experiences is a super valuable combination. Stanford had a really popular concept of being a “T-Shaped” person, the idea of having a depth of experience in one area, with the ability to connect that experience across multiple domains. This “T-Shape” concept really stuck with Muthu, which became a big focus of his to develop a deep expertise in one area but still maintain connectivity and knowledge in others. As he has evolved in his career, he admits that he’s more of an “H-Shaped” person now, having two domains of expertise, connecting both artificial intelligence and clinical medicine. He shares that we are starting to see industries are starting to collide in ways they haven’t before.
  • Throughout his career, Muthu has always had a contrarian underdog mentality.

“What do we believe today that won’t be true in the future? What are paradigms that today feel ubiquitous but in the future may change?” 

This led him to pursue opportunities and companies where people were excited to change those paradigms. Muthu was drawn to Notable in 2019 on using AI to supercharge administrative workflows, which was more of a contrarian of an idea back then, now ubiquitous and seems obvious today. Muthu served as Chief Medical Officer at Notable for almost 4 years, supporting some of the biggest health systems in the country. Today, Muthu has shifted to a new paradigm in asynchronous care with Counsel.

Founding Story of Counsel

  • Muthu shared that founding a company was a major decision—one he approached with years of careful thought, aiming to achieve a true alignment between his expertise and a meaningful, impactful problem. His commitment to healthcare stems from understanding that success in this field demands a blend of AI proficiency, clinical medicine insights, and go-to-market strategy—all essential and deeply interwoven in healthcare innovation.
  • Counsel specifically addresses the urgent issue of healthcare access. In the U.S. and globally, we’re confronting a critical shortage, with the healthcare system on track to face a gap of 100,000 clinicians within the next 5-10 years, if not sooner. This shortage already reflects in long wait times, averaging 40 days to see a primary care physician in most cities. As a result, many patients turn to Google for medical advice, often leading to decisions that strain the healthcare system and negatively impact their own outcomes, such as unnecessary ER visits or unneeded MRIs.
  • Muthu explains that Counsel offers immediate, trusted medical guidance from real doctors through asynchronous messaging, providing advice within minutes to help patients make informed decisions and reduce unnecessary visits. As a virtual medical practice, Counsel reimagines how people access care, enabling patients to consult a doctor right from their phone, anytime they have a question. It’s like having a doctor in the family, ready to provide insights and support at a moment’s notice—ultimately improving access and enhancing the care experience.

“Growing up with a physician parent and physician myself, I know the magical feeling of having instant trusted advice anytime you need it about your health. How do we democratize that magical feeling to everyone through Counsel?”

Counsel’s Business Model and Go-to-Market Strategy

Muthu’s advice to startup founders on navigating GTM:

  • Muthu emphasizes that early go-to-market efforts in healthcare can be challenging without prior industry experience. He recommends bringing in an expert who understands healthcare incentives and partnerships early on, as the sales cycles in healthcare are lengthy and complex. It’s essential to address a pressing problem—one that is top-of-mind for your champion. If it’s only their second or third priority, the opportunity may not have as strong a foundation for success.
  • Muthu advises taking the time to find partners whose mission truly aligns with yours—like selecting the right lifeboat to reach the next big island. He emphasizes the value of finding long-term champions who are deeply invested in your success. For Counsel, this meant using an “echolocation” approach, engaging in wide-ranging conversations to identify what resonated most and led to meaningful alignment.

Advocating for Asynchronous Care as a Specialty

  • Counsel recently published an opinion piece in STAT, advocating for asynchronous care to be recognized as its own specialty. This push aligns with findings from the Corewell study in NEJM, which highlighted the effectiveness of dedicated “inboxologists” in managing patient messages. The study demonstrated notable benefits, including faster response times and more efficient triage of patient needs.
  • Muthu notes that patient behavior is shifting decisively toward messaging-based care and medical advice. Over several consecutive years, inbox messaging rates have nearly doubled annually, underscoring that asynchronous, text-based communication is rapidly becoming the preferred way people engage with healthcare.

“The last 100 years has been about in-person and video-based care, the next 100 years will likely be about messaging.”

  • Most providers currently treat messaging as an optional, add-on service, offering responses when possible but without a dedicated focus. But what if we made messaging-based care a specialized role? By doing so, we could provide high-quality, consistent asynchronous care, unlocking significant benefits for both patients and the healthcare system. Asynchronous care is particularly well-suited to many conditions, allowing ongoing monitoring at a low cost.
  • Counsel is at the forefront of this movement, defining, designing, and developing the right clinical protocols, optimized provider interfaces, and quality metrics specifically for asynchronous care. We’re thrilled that Counsel is leading the way in establishing asynchronous care as a recognized specialty.

What other healthcare paradigms will continue to change in the next decade?

  • Muthu is energized by the shifting paradigms in healthcare that are making the field more patient-centered rather than provider-centered. For instance, the current structure of medical specialties is designed around provider needs, often leading to confusion for patients. Muthu envisions a future where Counsel moves away from provider-centric structures, like specialties and “encounter-based” care, in favor of models that focus on the patient’s specific needs, creating a truly patient-first approach.
  • He’s also highly optimistic about generative AI’s transformative potential in healthcare, especially in streamlining administrative tasks to make the experience simpler for both patients and providers. While early advancements are likely to emerge in automating referrals, prior authorizations, provider templates, and scheduling, Muthu believes the most profound impact of AI will ultimately be on clinical care. He notes that while clinical applications face hurdles due to regulatory and safety requirements, as well as misaligned financial incentives, Counsel has developed a model that aligns all stakeholders to support these innovations.
  • In the broader context, Muthu sees immense promise in AI for life sciences, with potential breakthroughs in accelerating drug discovery and advancing personalized medicine. He’s hopeful that Counsel, along with other clinical AI pioneers, will help drive transformative changes in how AI is integrated into patient care.

Building a Team for an Early-Stage Healthcare Startup

  • Muthu seeks individuals who thrive in early-stage environments, as it requires a unique skill set and mindset. Strong mission alignment is essential. Counsel has built a lean, talented team unified around the mission, and they’re always on the lookout for those passionate about healthcare, AI, and startup growth.
  • The team is primarily composed of full-stack engineers, AI/ML engineers, researchers, and product managers, but they’re open to any roles for people who are energized by Counsel’s mission and stage. Explore the open roles: https://jobs.ashbyhq.com/counsel!

Rapid Fire questions:

  • Listen to the episode on what people are surprised to find out and other pieces of advice from Muthu in our rapid fire questions at the end.

Sponsor note: This is the Pear Healthcare Playbook podcast. This season is brought to you by Banc of California. Banc of California partners with leaders to help them identify the right products and services for their business needs.

OnRamp announces $14.2M in funding to automate B2B customer onboarding

Today, Pear’s portfolio company OnRamp announced its $14.2 million in funding across a seed and Series A round, led by Javelin Venture Partners and Contour Venture Partners, with Quiet Capital, Correlation, Flybridge and angels Louis Beryl, Claire Hughes Johnson, and Steve Fredette. 

We first met OnRamp’s Co-founder and COO, Ross Lerner, when he was an MBA student at Harvard Business School. As we got to know Ross and his Co-founder and CEO Paul Holder, we were convinced of the critical onboarding problem they aimed to solve—an issue we had frequently observed within our own portfolio companies. 

The B2B customer onboarding process is a significant pain point for many companies, often leading to delays in revenue recognition and decreased customer satisfaction. OnRamp addresses this underserved market by automating and streamlining the post-sales process, which is crucial for accelerating value, reducing costs, and protecting revenue. 

OnRamp transforms a traditionally cumbersome task into a seamless experience through a no-code customer portal that allows businesses to automate complex onboarding workflows. This solution means any deal team or account relationship stakeholders can collaborate to reduce time to value for its customers and improve customer engagement and visibility.

Ross presented OnRamp to a handpicked investor audience at the PearX S22 demo day ahead of closing OnRamp’s seed round. Along the way, we’ve loved working with Paul and Ross on key hires, especially in building out pipeline and closing candidates in engineering and go-to-market roles.

Ross presented at PearX S22 Demo Day to hundreds of investors

Pear has also been a partner to OnRamp as they have expanded their product offerings to best serve large enterprises. We couldn’t be more proud that OnRamp now counts three of the Fortune 15 as its customers, serving industry leaders like Cardinal Health, CVS Health, and McKesson. OnRamp has tripled its revenue in each of the past three years and is on track to do so again this year, meaning that Paul and Ross have had plenty of opportunity to become power users of their own product. 

To book a demo with OnRamp, visit onramp.us and experience firsthand how they can transform your customer onboarding process!

PearX S20 alum Seven Starling raises $10.9M to expand access to specialized women’s healthcare

Today, PearX S20 alum Seven Starling announced a $10.9M Series A round to expand access to specialized women’s healthcare. The round was led by RH Capital and supported by Pear, Emerson Collective, March of Dimes, and others. 

We’ve been backers of Seven Starling since day one of their company, and we’re excited to double down on them in this round. Not only have they proven to be an unwavering team but they have built an important and high growth business.

We met the Seven Starling founding team (Tina Keshani, Sophia Ritcher and Julia Cole) over a Zoom call in March 2020. At the time, they were students at Harvard Business school working on a startup called June Motherhood at the time, an on-demand support service for expecting mothers, providing personalized care at home and online throughout pregnancy, birth, and early motherhood. 

Tina, Sophia and Julia when they were students at HBS

Ten days after our first meeting, COVID-19 shutdowns began. Despite the uncertainty at that moment in time, we decided to not only award them the Pear Competition, but also to invite them to join our PearX S20 cohort. 

Here are a few characteristics that made Seven Starling stand out to us:

  • Exceptional consumer DNA: The Co-founders, Tina Beilinson (CEO), Sophia Richter (CPO), and Julia Cole (COO), were a fantastic group. They were exceptional, clear thinkers and communicators, scrappy operators that had spent months researching the space, and had strong consumer DNA, having worked at great consumer brands like Warby Parker and Kind.
  • Proof of execution. During the time in business school the team had tirelessly worked to validate their idea. By the time we met them, they had built a no-code prototype and had enrolled their first patients. 
  • Strong mission and product vision: Seven Starling took flight to help women navigate the most meaningful transitions in their life.
  • Untapped opportunity in Women’s Health: 33 million suffer from mental health conditions every year. Women are also 2x more likely to suffer from depression than men. Just last year, one in three new mothers suffered from perinatal mood disorders. Maternal mortality in the US is higher than our peer countries and is actually worsening. According to the CDC, the number one leading cause of maternal deaths in the US is undiagnosed mental health problems. Seven Starling saw this gap four years ago and has reinvented the clinical standard for women’s behavioral health.

The summer of PearX S20, we worked together over Zoom. In just 12 weeks, they built an app, closed key partnerships and achieved their first revenue. They closed a Seed round right after demo day that included Pear alongside top-tier VCs such as  Emerson Collective, Magnify Ventures, and Expa. They were off to the races. 

This was a Zoom check-in during PearX S20. The S20 cohort also included great companies like Expedock, Federato, Gryps, Sequel, Interface Bio, wagr, and rePurpose. 

Our partnership with Seven Starling went beyond PearX. We’ve worked closely with their team over the last four years to help them build the foundations of a long lasting company. Here are some of the ways we partnered with Seven Starling over the last four years:

Navigating to product market fit and working through a pivot:

A year after PearX, we realized that scaling the initial product was not going as planned. Despite the customer love, the acquisition costs were too high and healthy unit economics seemed elusive. We had a difficult call where we aligned that “it was not working” and decided to iterate again on the product. We worked together very closely for a few months and we went back to listening to the customers. As part of this exercise, we realized our most loyal customers were looking for mental health support. OB-GYNS were also desperate for solutions for their patients – most couldn’t offer that mental health support themselves. 

We decided to initially focus on a very narrow value proposition: maternal mental health. Then, we figured out that we also needed to innovate in the acquisition channel. We partnered with OB-GYNs to build a trusted referral network that delivered high intention patients.

By focusing on a large but narrow value proposition ($8B+ maternal mental health market), we achieved product market fit and Seven Starling can now effectively grow into the nearly $55B+ women’s mental health opportunity. By innovating in the acquisition channel, we were able to grow rapidly with little cash spent: today 90%+ of Seven Starling’s patients are acquired through OB-GYN referrals, a key wedge into this market. A core value proposition to Seven Starling’s patients and referring providers is that they’re in-network with most major health plans including UnitedHealthcare, Cigna, Aetna, Kaiser Permanente, and Blue Cross Blue Shield. 

Hiring: 

Our team has helped Seven Starling make critical hires. Early on, our partner Vivien introduced them to a key advisor: Dr. Amy Roskin. She was so bought into the team’s vision, she joined as their Chief Medical Officer in 2022. Amy was an OB-GYN for over 20 years, was previously the CMO of The Pill Club, and was also an attorney who specialized in Telemedicine law. Laura from our Talent team also jumped into hiring for Seven Starling, helping them hire their founding engineer. This was their first technical hire and they’ve had a tremendous impact on their journey.

Vivien helped connect Seven Starling with Dr. Amy Roskin, Seven Starlin’s Chief Medical Officer, pictured on the left. 

Fundraising: 

Since we started our partnership, we have helped the Seven Starling team navigate each of their fundraising rounds from  determining the fundraising strategy, to pitch creation to coming up with the target investor list. We are happy to have a phenomenal group of investors around the table, all of which believe deeply in the vision of the company. 

Tina pitched live to hundreds of investors in Pear’s network in 2022.

Where are they today? 

Seven Starling  has grown tremendously over the past year, they have also delivered industry leading time to care with seven days to first appointment (industry average is three-six months) and 90% statistically significant reduction in PHQ-9 score after completing the program. Over 85% of patients are in-network plans which means patients access care for just their copay. This is all a result of the incredible clinical and operational execution horsepower the team has demonstrated.

What is next? 

We are excited about Seven Starling’s impact on women’s health. The space is still a huge untapped opportunity and behavioral health impact is inseparable from a woman’s overall health outcome. Seven Starling is positioned to meet the specialized needs of women throughout every stage of their lives, empowering them to thrive and achieve their fullest potential. I’m excited to join their board to support them on this ambitious and admirable mission. 

It has been a privilege to partner with the Seven Starling team – their operational excellence and clarity of thought has made the journey to date an exhilarating one. 

However, we realize the work is not over; we still have a lot to build! All of us at Pear VC are excited to continue our partnership with them.

PearX S19 alum Learn to Win raises $30M to continue helping large clients use data analytics and AI to improve training and onboarding

Earlier this week, PearX S19 alum Learn to Win (L2W) announced a $30M Series A round, led by the Westly Group and joined by Pear and Norwest Venture Partners. L2W’s software improves training & onboarding for a wide range of enterprise clients, from the Los Angeles Rams to the U.S. Air Force. They do this better than anyone else by using data analytics and AI to personalize learning effectiveness for their customers.

We first backed L2W in 2019, and now five years later, we are honored to double down our support for them. To mark the occasion, we wanted to reflect on our partnership with L2W and the amazing progress they’ve made over the last five years.

We met the founders of L2W, Sasha Seymore and Andrew Powell, in 2019 when they were students at Stanford GSB. We met as part of a business plan competition and our teams hit it off. They’d been chewing over the concept behind L2W for years, but they finally got it off the ground in 2018 while at the GSB.

Sasha & Andrew at Stanford GSB

We met them when they were just two co-founders and an idea with a little traction, and we decided to back them for a few major reasons:

  • First, the founding team was fully dedicated to pursuing the idea: Sasha and Andrew met their freshmen year as Morehead-Cain scholars at the University of North Carolina at Chapel Hill, and they were roommates throughout undergrad. They started discussing the concept of L2W during that time. Following graduation, they went their separate ways: Andrew to Mauritius and Sasha to play basketball in Europe. Although they were apart for three years, they continued to discuss the company and what it could be. And then completely by coincidence, they were both accepted into Stanford GSB at the same time and decided to room together once again. It felt like fate, so they were drawn to pursue L2W officially. 
Founders while students at UNC
  • Second, they solved a problem that they were passionate about: Andrew was really interested in education and had spent three years at The African Leadership University in Mauritius designing new learning models. Sasha was a basketball player at the University of North Carolina at Chapel Hill, had spent time studying the possibilities of peace through sports.They combined their passions in education and sports to create a new method for training athletes. Their initial pitch to us was: Learn to Win is a “Rosetta Stone” of playbook learning, turning playbook and gameplan materials into an interactive learning experience and providing coaches insight and analytics into what their players understand and what they do not.
  • Lastly, they knew the market was huge. While they started by focusing primarily on sports teams, they knew that there were many zero tolerance environments and industries used training tools that don’t match the demands they face. The L2W team had a vision to expand to industries like the military, aviation, and oil and gas. 

L2W pitch deck in 2019

They applied and were accepted into PearX’s Summer 2019 cohort. At the time, they knew they had a big opportunity in front of them, and they’d gained some early traction with a few clients.They wanted to use their PearX experience to really hit the gas and accelerate their company forward. Through the 14 week PearX cohort, they onboarded many new customers to their microlearning modules, and by the time Demo Day rolled around, they had 100+ clients and over $1M in sales. They also expanded beyond sports during PearX and signed a large contract with the U.S. Air Force. 

2019 PearX Demo Day pitch

PearX S19 cohort, which included companies like Windborne, Polimorphic, Learn to Win, Xilis, and Gradio.

Following Demo Day, they raised a $4M seed round in 2020 led by Norwest Venture Partners and joined by Pear and 20|20 Fund. They continued working out of Pear’s offices in Palo Alto for a period of time, so we had the chance to work side by side with the team and see their progress. Over the following few years, they grew from a team of 2 into a full-time staff of 30+. They continued to refine and evolve their product, and onboarded hundreds of enterprise clients like Chick-fil-A, the U.S. Department of Defense, and professional sports teams like the Carolina Panthers. In the last few years, they’ve expanded and refined their platform, involving even more learning science and AI to better help customers with their training. 

With this latest $30M Series A fundraise, we know they’ll be able to take it even further. Their path has been exciting to witness and we are excited to see where they take the tool next. 

PearX S21 alum Valar Labs raises $22M to continue building AI that helps oncologists make better decisions

Last week, PearX S21 alum, Valar Labs, announced its $22 million Series A round co-led by DCVC and a16z with participation from Pear. We’re incredibly excited for this milestone for Valar Labs and wanted to take this opportunity to look back on our history working with their team.

We met the Valar Labs co-founders at a free boba event we hosted on Stanford’s campus in 2020. After that first meeting and introduction, the Valar Labs team applied to Pear Competition. And from there, they joined our PearX S21 cohort. 

PearX S21 cohort, which included companies including: Valar Labs, Kale, and Aklivity

When we met the team, we were incredibly excited to back them for a few big reasons:

  • This is a massive and unsolved market opportunity. Valar is using AI to help oncologists choose the correct treatment for their patients. Unfortunately, for thousands of cancer patients each year, there is a high degree of uncertainty around which treatment option works best for them. This uncertainty leads to billions of dollars of potentially unnecessary drug costs, and even more importantly, wastes precious time for thousands of patients battling cancer. The sad reality is that most cancer patients end up on a treatment sequence that fails them, and Valar Labs is on a mission to change that.
  • The team had a clear vision for the type of product that could best meet this unmet need. Valar is truly a software company that enables capabilities that legacy diagnostic companies do not have. Unlike many diagnostics companies for which the core technology revolves around a novel laboratory assay, Valar uses AI to analyze images of a patient’s tumor and to predict the likelihood of response to different standard-of-care treatments. This information helps oncologists determine the best treatment pathway for a patient.
  • The team was well suited to tackle this problem: Valar’s co-founders, Anirudh JoshiViswesh Krishna, and Damir Vrabac, met at Stanford in 2020 when they were all part of Dr. Andrew Ng’s machine learning group. While at Stanford, they had the opportunity to spend time at the intersection of AI and medicine, speak to hundreds of oncologists, and find the key areas of high medical unmet need. Not only were they had were innately curious and incredibly quick learners, they also gathered the most esteemed KOLs in the space including Professor Eric Collison from UCSF and Professor Pranav Rajpurkar from Harvard/Stanford  to solve this problem. 

The team hit the ground running during PearX, and the Pear team was there to assist them in hiring their first employee, introduce them to strategic advisors on both go-to-market and the clinical side, and get their story in shape for fundraising. While whiteboarding with the team, it was clear that to be successful, they needed data access and partnerships with cancer centers. 

Valar’s Demo Day pitch in October 2021

Upon completing PearX, Valar hit a number of milestones in their company growth. After Demo Day, Valar Labs closed their seed round of $4.15M led by the a16z Bio + Health fund. They’ve leveraged their seed funding to reach clinical validation and form partnerships with top academic and medical institutions, and they’ve unveiled Vesta, the first-ever, AI-based oncology test for bladder cancer.  

Anirudh and the Pear team

When we first met Valar Labs, they were 3 founders operating out of a dorm room. Now they are more than 14 employees with $26M raised. Their growth path has been incredible to date and we know the best is yet to come for this team. 

How 3 PearX founders raised $3M+ each

Early-stage company building poses a unique set of challenges, and we’ve created what we believe to be the best accelerator out there for pre-seed founders. PearX is our exclusive, small batch, 14 week program. PearX alums have extremely high likelihood of startup success. In fact, 90% of our companies go on to raise a successful round from top tier investors and have cumulatively raised $2B in venture capital.

But don’t take our word for it – we spoke with 3 recent PearX alums about their experiences going through PearX, and what sets it apart from other programs:

Bobyard (PearX S23):

Bobyard automates the construction takeoff process with CV and NLP models to make cost estimates 10x faster while eliminating mistakes. After Demo Day, Bobyard raised a $3.5M round from Primary.

EarthXYZ (PearX S23):

EarthXYZ makes imaging hardware & analytics software to create & process the highest resolution hyperspectral data, using ML & genAI to deliver insights. They’re in the final stages of closing a sizable round; the only capital before this was their PearX check. 

Advex (PearX S23):

Advex works on synthetic data for vision, solving the biggest bottleneck for applied machine learning. After Demo Day, Advex raised $3M from Construct Capital, Emerson Collective, and Pear.

Answers have been edited for clarity and brevity. 

What did you learn from PearX? 

Bobyard: I learned what good looks like. I’m a solo founder and a first-time founder. I didn’t know how fast a team could move until I entered PearX. The structure of the cohort, working with companies that are in similar places as you, pushes you to go further. 

I also learned how important it is to deeply understand your customer and the value prop of your product. Ajay and Sean constantly pushed me to dive deeper into the customer psyche, discovering where my product could be worth a lot more.

Earth XYZ: During the accelerator, we nailed down customer discovery, understanding what our customers want from our technology and ironing out what we needed to build. After Demo Day, we got a ton of new customers — we juggled between supporting the customers while continuing to build on the technical side. 

Advex: During PearX, we went from having a potential customer to really fleshing out what our V0 was going to look like. We closed a real paying customer and since then, we’ve closed several more customers, raised the seed round, and grown our team to 5 people. 

What sets the Pear team apart? 

Bobyard: They have all bases covered. Pear knows the problems that most startups deal with, regardless of the vertical or the industry. 

Pear’s an order of magnitude smaller than the other accelerator programs out there, which means you get more than twice the attention, and you get support from a partner for each of the major categories. 

Earth XYZ: When I talk about Pear, the first thing that comes to mind is resources. I’ve heard friends who have gone through other accelerators where they receive a random firehose of generalistic knowledge. At Pear, I talked to dedicated partners 1:1 on specific strategies. 

How has Pear helped your company the most? 

Bobyard: I’d never fundraised before. Demo Day is a really special experience, but without structure and guidance towards preparing your presentation, it’s very difficult to pull off. 

The next thing is hiring. It’s pretty difficult to convince someone that’s better than you to work for you, but hiring a great team is so important to the company. I worked with Nate after the accelerator to hire the first founding engineers at Bobyard, and all of them turned out to be amazing. He helped me with the job descriptions, the interview rounds, what we should look for… it’s a lot of knowledge that accrues over many years of hiring for startups. 

Advex: As we’re now a seed stage company, we’ve really been leveraging the hiring help from Pear and it’s been a huge help. They’ve helped us understand how the job description should evolve over time, ensuring that we’re hiring the right person that we need for whatever the business needs are at the time. 

Describe Pear in 3 words:

Bobyard: 

Home— I spent all my waking hours in the Pear office during PearX. 

Support— the team believed in my vision and took a chance on me. 

Family— I work out of the Pear SF office now, and every day I see people from the Pear team. 

Advex: 

Grounding— they’ve helped us understand why our customers are reacting the way they are, given their previous experience. 

Flexible — helping us get what we need, whether it’s product or hiring. 

Friendly— they help us think about the past and the future, working on improving at all times and making good decisions moving forward. 

Any advice for early-stage founders? 

Bobyard: You should apply. When you do apply, don’t force yourself to be a founder you are not or a company you are not. Build conviction on the thing you’re building. 

Earth XYZ: If you’re a founder like me with deep tech, hard tech, or non-traditional software based companies, don’t be turned away from applying to PearX. Beyond software, Pear has a ton of expertise, and partners bring in their own network and resources. Early-stage building is company-agnostic in many ways, and the Pear team has a deep bench of expertise. 


Applications for PearX are due Wednesday, May 1. Apply today!

Pear portfolio company BioAge Labs announces oversubscribed $170M Series D financing

Last week, Pear portfolio company BioAge Labs announced its $170M Series D round led by Sofinnova Investments, with participation from a strong syndicate of new investors including Longitude Capital, RA Capital, OrbiMed Advisors, RTW Investments, Eli Lilly, and Amgen, among others, in addition to many existing investors. 

To mark this occasion, we wanted to share more about Pear’s partnership with BioAge Labs and its co-founders, Kristen Fortney (CEO) and Eric Morgen (COO). 

Pear’s founders, Pejman and Mar, first met Kristen in 2015 through an introduction by another company founder associated with the Stanford Genome Technology Center. At that time, Kristen was a postdoc at Stanford in Professor Stuart Kim’s lab, where she studied the genetics of extreme human longevity. At the time, Kristen had published extensively in the space of genetics and longevity, but the company was merely an idea. She was pondering the question: could we use genetic information and new machine learning techniques to develop a therapy discovery platform for longevity? Kristen’s vision at the time was just as clear as it is today. 

That year, Pear invested in BioAge’s initial seed financing, and we have gone on to successively back BioAge at every subsequent round, including the Series D. 

As it’s not common for a seed-stage focused firm like ours to invest up until the Series D round, why have we continued to support BioAge?

Significant unmet need and large market opportunity in obesity and metabolic disease

The company’s lead drug program, azelaprag, addresses obesity and metabolic diseases. A staggering 40% of American adults are considered obese, and many suffer from a host of comorbidities including diabetes, heart disease, and stroke.

One of the most exciting recent medical advances has been the remarkable success of GLP-1 receptor agonist drugs in achieving dramatic weight loss in such patients, while still being generally safe and well tolerated.

With this drug class expected to eventually exceed $150 billion in sales annually, the top two developers, Eli Lilly and Novo Nordisk, have catapulted to become the first and second largest pharma companies by market capitalization (~$740B and $550B, respectively, as of mid-Feb. 2024). 

As impressive as GLP-1 drugs are, one downside is that they can result in suboptimal body composition, in that they lead to the loss of both fat and muscle. BioAge’s preclinical studies have shown that azelaprag, which is a first-in-class oral apelin receptor agonist, can enhance body composition when combined with a GLP-1 drug. In a Phase 1b study sponsored by BioAge, azelaprag prevented muscle deterioration and promoted muscle metabolism in healthy older volunteers at bedrest.

A second limitation is that oral GLP-1 drugs have so far lagged behind the injectable versions in efficacy. Of course, most patients would strongly prefer orally dosed medications over injectables. In BioAge’s preclinical studies, azelaprag combined with a GLP-1 drug has been shown to double the weight loss achieved by the GLP-1 drug alone. Because it can be orally administered and has been well tolerated, azelaprag in combination with an oral GLP-1 drug may help to close this efficacy gap.

Human-first target discovery platform enabled by multi-omic analysis of aging human cohorts 

BioAge didn’t initially begin with a focus on a lead therapeutic asset in obesity. In fact, BioAge started as a target discovery company within the longevity space, with the ambitious goal of understanding the biology of human aging in an effort to extend human lifespan and healthspan. 

Although the longevity field has recently attracted much attention and investment, not all therapeutic strategies pursued have been equally scientifically rigorous. Many approaches rely on attempting to translate into humans tantalizing life extension or rejuvenation effects obtained in model organisms with very short lifespans like nematodes and mice.

But the biology of aging differs dramatically across species, and BioAge’s unique strategy was to partner with special biobanks that collected and stored blood from cohorts of people from middle age until death and that retained associated health records. By deploying multi-omics (primarily proteomics) and AI to interrogate the factors correlating with healthy human aging, the company generated unique insights into particular therapeutic targets of interest. 

From this platform, one of the strongest targets that emerged was the peptide that azelaprag is designed to mimic – apelin. Exercise stimulates release of apelin from skeletal muscle into the blood, and in BioAge’s cohorts, middle-aged people with more apelin signaling were living longer, with better muscle function, and better brain function. Correspondingly, in mice, azelaprag protected elderly mice from muscle atrophy & preserved function in vivo

Strong leadership team, advisors, and partners

As one might imagine, the team at BioAge has grown and matured substantially since inception in 2015. The leadership team today has world-class experience across biopharma. And in pursuing its Phase 2 study of azelaprag in combination with Eli Lilly’s GLP-1/GIP drug tirzepatide (Zepbound), BioAge will receive support from Eli Lilly’s Chorus organization, including the supply of tirzepatide and clinical trial design and execution expertise.  

It’s certainly uncommon for a postdoc straight out of the lab to lead a therapeutics company until a Phase 2 clinical study. But as Kristen relayed during a fireside chat at our Pear office, she learned a lot about what she needed to know on the job progressively over time, and she was not afraid to surround herself with experts specializing in the many functional domains required to take a drug program from a target to the clinic. 

This dedication to continual self-improvement and learning has been a hallmark of the many strong founders that we are fortunate to back at Pear. We are grateful that Kristen is helping to guide the next generation of such founders as part of our Pear Biotech Industry Advisory Council.

Pear Biotech Industry Advisory Council

For these reasons, we remain excited to support BioAge Labs. We eagerly anticipate the results of its mid-stage clinical trials of azelaprag in obesity, as well as the development of additional programs nominated from its unique human aging target discovery platform. 

Looking back at PearX S19 alum Gradio’s journey, now part of Hugging Face

Intro:

PearX S19 alum Gradio, which is now part of Hugging Face, has had a momentous few years. They recently launched Version 4.0 of their app and they have quickly become a leading workflow tool in the generative AI infrastructure space. We’re so proud of their success, and wanted to take a look back at the earliest days of the company, why we were excited to partner with Gradio’s founders from day 0, and some of their biggest milestones along the way.

How we met the team:

We first met Gradio’s founding team, Abubakar “Abu” Abid, Ali Abdalla, Ali Abid, and Dawood Khan through Pear’s Fellows program. They were housemates at Stanford at the time, and they came to us with an idea to speed up the process of collecting and labeling data for use with AI and ML. Put simply, they wanted to make it really simple for ML engineers to build and share computer vision models and ultimately to make more reliable models. 

Why we invested:

After meeting the team, we were excited to invest in Gradio from day 0 for a few key reasons:

  • The team: We knew this was the right team to tackle the space. Abu worked on this problems during his PhD in ML at Stanford. The founding team built deep technical products at companies like Tesla and Google. They also had an amazing advisor in Stanford Professor James Zou, who pioneered data valuation methods. 
  • The big market opportunity: Gradio was founded in 2019 when every company was on the precipice of becoming a data-driven or AI company. In 2019 alone, companies were spending $32 billion on data acquisition and labeling, and that number was slated to rise 50% year over year. This easily made this a multi-billion dollar market. 
  • The right product vision: We felt that Gradio could solve the biggest problems that data companies face. At that time, to build AI products, companies had to collect and manually label lots of data and then feed that data into machine learning algorithms and there was a crisis of poor data quality. It was a long and broken process that was ripe for innovation. Gradio’s product leveraged ML research to integrate with a company’s existing data pipeline to maximize the value of the data for ML. Essentially, they created the missing data valuation layer to maximize the potential of data for machine learning. 

How they evolved and what’s next:

They joined our PearX S19 cohort, and through the 14 week PearX cohort, they made huge leaps and bounds with their product. They ran four pilots with different kinds of natural language processing (speech or text) companies, ranging from legal contracts to financial records. Over the course of PearX, these smaller pilots led to landing bigger clients like Wells Fargo and TDBank. They used the learnings from this pilot to steadily expand to cover more areas of machine learning like video. 

Gradio founders meeting investors at Demo Day

At the end of PearX, Abu presented at our Demo Day to a room of tier one investors, and after Demo Day, Gradio successfully raised a seed round. Following the fundraise, our team continued working closely with Gradio’s team to find true product-market fit. This included exploring enterprise solutions across various verticals, which eventually led the team to pursue an Open Source approach to expedite product adoption. Gradio was open sourced, and it became the de facto tool for presenting AI / ML projects to a wide range of audiences. In the end, more than 300,000 demos were built using Gradio. 

In late 2021, they were acquired by Hugging Face. The Pear team partnered closely with Gradio’s leadership throughout the entire acquisition process. They are now a key pillar of Hugging Face, where they provide Hugging Face’s users, developers, and data scientists the tools needed to get high level results and create better models and tools. It’s a machine learning match made in heaven and together, they are building the future of ML. 

Gradio x Hugging Face

We’re excited for even more success from Gradio and will be cheering them on!

PearX S19 alum Polimorphic raises $5.6M to continue their work building a constituent relationship management platform for governments

This week, PearX S19 alum, Polimorphic, announced their $5.6m seed round led by M13 with participation from Pear and Shine Capital. We’re really excited about this milestone for Polimorphic because we’ve been able to witness their incredible growth from an idea that came about in their dorm room at MIT to becoming a leading infrastructure player for state, local, and federal government agencies. They’ve demonstrated some amazing traction: 30 governments actively using their platform and they continue to add 15 new customers every month. 

To mark the occasion, we wanted to look back over the last 4+ years of working with the Polimorphic team and some of the major milestones along the way.

How we met the team

We first met Polimorphic’s co-founders, Parth and Daniel, at MIT when they applied for Pear Competition. We invited them to join our upcoming PearX batch in the Summer of 2019. 

Polimorphic CEO & Co-founder Parth presenting at S19 Demo Day at Filoli Gardens

At the time, the founders were working on a product to make sense of government data. The first version was a tool to collect information from federal, state, and local agencies like press releases, legislation and more, making it easy to digest and consume for politicians and constituents alike but especially for younger consumers. 

How they evolved

Polimorphic has evolved quite a bit since 2019. After PearX, the team raised some additional capital and went on a country wide road trip to meet face-to-face with federal, state, and local agencies to learn about their needs. In January 2020, they set off on their trip and visited Iowa, New Hampshire, Washington DC, North Carolina, and Michigan. The pandemic hit during this road trip, and they were even stranded in Michigan for a while! 

Through many months of customer discovery, they learned that their data transparency product was not, in fact, the biggest pain point for governments. Instead, they learned that federal, state, and local government agencies dealt with a tremendous amount of manual work with the number of tasks they deal with – from applications to internal approval workflows to payments processing.

Polimorphic team at S19 Demo Day 

Why we invested

While the product has evolved since 2019, we knew there was a big opportunity here for this team to tackle. We were very optimistic about their unique ability to build in this space and we’re really excited that they uncovered this big opportunity. Some of the reasons we were, and still are, excited about this team include:

  • Market opportunity: We all interact with local, state, and federal governments for many daily tasks. We see a multi billion dollar opportunity in providing software to help federal, state, and local governments manage their day-to-day work. Governments still use a lot of pen and paper in their processes which is why many people view governments as slow moving. But interacting with our government does not need to be a slog.
  • Product vision:  The team saw this big untapped opportunity to digitize and add automation to our interactions with governments. Polimorphic helps digitize applications, payments, internal approval flows and use AI to help automate the busy work for government employees.
  • Founding team: We found Parth and Daniel so compelling. They were two undergraduate engineers thinking deeply about the problems our governments face. Parth’s grandfather worked in local government and he saw first hand the work that went into getting constituents their basic government services. This problem felt really personal to them. They were on a mission to solve these problems and had the grit and tenacity to focus on an otherwise unsexy space. We knew if they could land some customers, the product would be sticky and this has proven to be true.

What’s to come

Over the last four years, we’ve partnered closely with their team as they’ve refined their product roadmap. We helped them identify the biggest hurdles that governments face and encouraged them to really talk to their customers to understand those pain points inside and out. 

We also helped the Polimorphic team fine tune their pitch and raise additional capital. When looking to raise more funding, Parth presented again at our PearX W23 demo day and quickly found a lead investor for this round.

At PearX S23 Demo Day in October 2023

This team has made huge strides since we met them. It’s really inspiring to look back over the last few years to see how they’ve grown in a relatively short amount of time. They went from being stuck in Michigan during the pandemic with no customers to having 30 cities and counties (and growing!) using their software. They’re rapidly growing and are adding a new city to their platform every 2 days. They recently launched a GovGPT, the first gen AI tool that governments have made public to their constituents in the entire country. We’re excited for their future!

PearX S20 alumni company Sequel receives FDA approval

On August 3rd, PearX S20 alum Sequel, received FDA approval. Sequel’s co-founders, Greta Meyer and Amanda Calabrese, worked hard to develop their product and work through the FDA clearance process. This can be a grueling process, so it’s truly a huge milestone for Sequel to be able to launch their FDA-approved tampons. We wanted to mark the occasion by looking back on our journey working with the Sequel team.

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Founders, Greta Meyer and Amanda Calabrese

We met Sequel co-founders, Greta Meyer and Amanda Calabrese, when they were still students at Stanford. They were both undergraduate engineering students, where they participated in the LaunchPad d-school course in 2018 to design and launch a product. They were both professional athletes that had lived first hand, menstruation leaks during practice or worse an athletic tournament. Mar was tasked with helping them refine their fundraising pitch and this is how our partnership with Sequel got started. 

Sequel  joined our PearX S20 cohort, right at the start of the pandemic, when they were still called Tempo. And even though it was unexpectedly a virtual cohort, it was an outstanding PearX class, with many other breakout companies like: Seven Starling, Interface Bio, Federato, Expedock, Gryps, and rePurpose Global. 

PearX check-in during Covid.

After meeting Amanda and Greta, we chose to invest in Sequel for a few key reasons:

Big market opportunity:

Greta and Amanda were both superstar athletes and had a pain point: menstruation products are still not reliable for women. While participating in the Launchpad course, they dug into this more to see if others felt the same way. They learned that most women still prefer a tampon to all of the options out there, but they unveiled a common frustration for women: they had to combine their tampons with pads or pantyliners to avoid leaks. Amanda and Greta realized that, while the tampon had been around for ages, it hadn’t seen any innovation in nearly a century. They saw a big opportunity to build a women’s health company that was focused on innovating this big, unmet need for women. 

Their product vision:

We were excited about their mission and vision: to re-engineer the tampon. For their product, the two engineers envisioned a redesign of a tampon in a spiral-shape to fit more comfortably and better absorb periods to prevent leaks. They designed and patented their design, so it’s truly proprietary. We really liked the product innovation and their vision to shake up an old industry that’s dominated by a few huge players like Tampax. 

The founders:

Greta and Amanda were stellar founders and superstar athletes too: Amanda competes for the US Lifesaving Association and Greta played Varsity Lacrosse while at Stanford. They had first hand experience with tampons failing them while being active, and we loved that they were both extremely purpose-driven. 

Amanda and Greta presenting during Demo Day

During PearX, they built out a pretty robust go-to-market strategy, assembled influencers, and started a beta program. They got a quality system up and running to prepare for FDA testing. They were able to beta test with 75+ users before PearX Demo Day. They presented to thousands of investors at Pear Demo Day and raised a seed round from MaC VC, Long Journey Ventures, and others.

Since participating in PearX, they’ve had a number of exciting wins. Greta and Amanda were included on the Forbes 30 under 30 list for manufacturing and industry. Amanda moderated a SXSW panel on content creators and stigmatized spaces. And they received positive press from Fortune, the Wall Street Journal, Forbes and others. 

With FDA approval behind them, we are excited for the Sequel team to be able to focus on commercialization and getting their product out in the world. We know the best is yet to come for this company!