Merel Boers revolutionising stroke diagnosis with NICO.LAB

Did you know that 1 in 6 of us will have a stroke at some point in our lives? We all know what a stroke is and how dangerous it can be, but the numbers are still pretty shocking. There are 13.7 million new strokes every single year according to the World Stroke Organisation (WSO), and the truth is, a huge portion of those strokes are fatal. 5 and a half million people die of stroke annually, and roughly the same number survive but are left with permanent brain damage. According to the WSO, that adds up to a staggering 116 million years of healthy life lost every year to stroke-related deaths and disabilities. 

Merel Boers has dedicated much of her life to reducing those numbers. After three years studying Technical Medicine at the University of Twente, she spent another three years completing a masters in the same subject, then wrote a PhD thesis on brain imaging for stroke patients. Later, Merel continued her stroke research at the Academic Medical Center (AMC) in Amsterdam; what she and her colleagues saw was that, although stroke treatment in the Netherlands was very advanced, the treatment often came too late to save lives. ‘Hospitals approach things from the treatment side,’ she explains. ‘They look at what they can do for the patient – what kind of medicine they can use, or what surgery they can do – but they don’t think about everything that leads up to it. We were still pretty old school when it came to diagnosis in The Netherlands. Everything before the treatment was so slow, and I found it very strange that people just accepted the way it was.’

Alongside her AMC colleague Renan Sales Barros (now CTO at Nico.lab), Merel devised an artificial intelligence technology called StrokeViewer that would analyse CT scans and recognise the signs of stroke in a fraction of the time it would take the average doctor. ‘First I built a small prototype, then Renan optimised it and made it actually useful for clinical practice,’ she says. The two recognised that they had something that could genuinely change the game and save lives, but they weren’t immediately sure how best to do that. ‘I thought research would be the way to go, but it wasn’t very satisfying – it’s just paper at the end of the day, and doesn’t all of a sudden lead to a change. If you really want to change things and disrupt the field, I figured we needed to build a company.’

Alongside colleagues Henk Marquering and Renan Sales Barros, Merel founded Nico.lab in 2015. It was the natural progression for StrokeViewer, but despite their boundless entrepreneurial spirit, Merel and her co-founders struggled with their lack of experience in the early days. ‘We were just researchers and physicists – we didn’t know anything about running a company,’ she explains. Initially, that was scary. We really wanted to make a difference, but you hear a lot of negativity and it’s hard to know who to listen to. It’s actually very demotivating, but you realise very quickly that falling and getting up again is part of the process.’

Still, Merel was confident in the technology. She knew it had amazing potential to save lives. ‘That motivated us and gave us confidence,’ she says, but having the product is only part of the battle – you still have to convince people that they need it. ‘We thought we’d build a great product and people would just want to use it, but that wasn’t the case at all! The medical field is dominated by old school ideas and it's very hierarchical – the older professors and doctors have a lot of power and can be very reluctant to change. What we were doing was completely new, and it was very, very difficult to change their perspective.’

Since then, though, StrokeViewer has changed the perspective of the entire industry. Nico.lab focused on making their technology more intuitive and user-friendly – once doctors started using it, the difference it could make became crystal clear. ‘Forcing people to use it was never going to work,’ Merel explains. ‘We had to let them see it for themselves.’ Today, StrokeViewer is the standard of care in 12 hospitals across the Netherlands – that’s about 15% of the Dutch market – and the latest results suggest that Nico.lab’s tech is really making a difference. ‘We are closely monitoring the impact,’ says Merel, ‘but with recent results, we think StrokeViewer could help 8% of patients avoid spending the rest of their lives severely handicapped.’

The success of StrokeViewer has made Nico.lab friends throughout the medical industry, and the company is in the midst of a growth spurt – Merel hopes their numbers will double by the end of the year. Nico.lab’s star was firmly on the rise when Merel stumbled upon Techleap.nl – in fact, she was a little sceptical of the process when she first applied to be part of the Rise Program. ‘I had some doubts about being part of such a diverse group,’ she says. ‘We have players from completely different fields – education, fintech, travel – and I wasn’t sure what I could learn from those companies.’ 

‘In the end, that diversity was what held the most value. Everyone runs into different things in their own space, but you can dilute them all down the same pure issues.’

Aside from valuable contact with her fellow entrepreneurs, Merel picks out a mentor session with Picnic founder Michiel Muller as a particularly special moment. ‘I found that really inspiring,’ she says. ‘He works in a completely different field, but his advice on how to optimise your business – even when you’re dealing with small margins – was invaluable.’

With hospitals full of coronavirus patients in recent months, Nico.lab has also been on the front line of the fight against the virus. Alongside MedTech company Aidence, Nico.lab has launched another AI platform, similar to StrokeViewer, but designed to perform lung scans of patients and detect Covid-19. ‘Coronavirus challenged us, but it also created opportunities,’ says Merel. ‘Suddenly we couldn’t go to hospitals, we couldn’t speak to radiologists, cash was running out. That was when we started to worry, but we just had to look at what our resources were. We have an incredible group of smart, talented people here – that’s our biggest strength. Realising that was a game-changer for us.’

Today, Nico.lab has the feel of a company that has come of age. The young upstarts are now leading the way, and in StrokeViewer, they have something that can save thousands of lives, not just in The Netherlands but all over the world. Merel concedes that they couldn’t have done this without immense support, but she didn’t always know it was there. ‘If I had any advice, it would be: don’t underestimate the amount of support you have from people,’ she says. ‘I always had this idea that I had to do things by myself, that I had to prove myself. You will come across a lot of negativity, but often there are twice as many people standing behind you who want to support you and see you succeed. It’s important to always try and see the positives.’