The Billionaire Doctor Who Plans to Cure Cancer

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Dr. Patrick Soon-Shiong (courtesy Wikimedia Commons)

Recently, I had the opportunity to speak to billionaire surgeon-inventor Dr. Patrick Soon-Shiong about his plans, both private and through the Cancer Moonshot 2020, to cure cancer.

Soon-Shiong, who made his fortune by founding and selling two pharmaceutical companies, has gathered a group of pharmaceutical companies, academic institutions, and insurers to spur cancer research and to attempt to make breakthrough gains by the year 2020. This effort dovetails with the Obama administration’s $1B plan to fund cancer research led by Vice President Joe Biden, whose son, Beau, recently died after a long struggle with brain cancer.

Soon-Shiong’s path to cancer research began while doing research for NASA that involved harnessing stem cells to make insulin. He stumbled upon a paper that reported that the binding of zinc to the blood protein albumin is what transposes it into pancreatic islet cells, enabling the production of insulin.  This discovery led to an “aha” moment.   “A light bulb went on. In fact you should feed the tumor, not stop the tumor.  And if you could take a nanoparticle of albumin and attach Taxol [a common cancer drug] at the core, then it [the tumor] would take up the albumin and kill itself, like rat poison.”  This revelation led to his creation of the cancer drug Abraxane, or albumin-bound paclitaxel (Taxol).  Abraxane is used currently in a wide variety of cancers, including breast, lung and pancreatic cancer. “To this day, oncologists don’t understand the mechanism of action of Abraxane,” he said,  “They think of it as another form of Taxol.”  According to Soon-Shiong, Abraxane works so well is because the binding to the blood protein albumin allows it to penetrate cancer tissues better.

Abraxane has had huge clinical and commercial success, but he says the path to getting there wasn’t easy.  Initially, after developing Abraxane, he approached large pharmaceutical companies but was unable to gain support despite showing that it had remarkable results in animal models.  He was forced to make the painful decision to leave a secure academic career to risk launching his own company.  His risk paid off.  He ultimately founded both APP Pharma and Abraxis BioScience to support his work.  In the end, APP Pharma was sold to Fresenius SE for $4.6B and Abraxis BioScience was sold to Celgene for $4.5B.  Then, in 2011, he founded NantWorks, a holding company with a portfolio of firms to pursue his diverse entrepreneurial interests.  One of these is NantHealth, a company that has developed a fully integrated digital health platform to collect and analyze genomics and proteomics data on cancer research patients.

Soon-Shiong, a bit of an heretic in the world of oncology, has ideas that veer from the traditional approach to cancer treatment.  One example is how he wants to harness patients’ natural immune abilities to treat their cancers.  “As we sit here speaking, we are creating 10,000 cancer cells a day.  And the natural killer cells in your body are monitoring it and killing it,” he said, “Cancer is a normal evolutionary process.  And guess how we’re trained as oncologists?  To give you the maximal tolerated dose of drugs to kill those natural killer cells that are protecting you, which makes no sense.  This is the dogma in oncology and even in drug development.”

He’d like to see drugs given at lower doses to cause what he calls “cytostress” instead of “cytotoxicity”.  The natural killer cells of our bodies look for cells that are under stress (by detecting distinct proteins and enzymes that are released) and then destroy those cells.  He suggests that chemotherapy should be administered at what he calls the “lowest effective dose” instead of the much higher “maximal therapeutic dose” typically given in clinical trials for cancer.  The lowest effective dose, he argues, won’t completely wipe out patients’ immune systems, and thereby allow patients’ natural killer cells to target “cytostressed” cancer cells.  He argues that this approach will revolutionize cancer treatment and lead to more cures and cites numerous personal anecdotes when this approach has worked for his patients.

Unfortunately, for the time being, he’s had a difficult time convincing oncologists and drug companies to move away from what he calls the “schizophrenic dichotomy” of treating with the maximal therapeutic dose that destroys natural immune function.

Another challenge to finding a cure for cancer, according to Soon-Shiong, is developing health IT systems to support cancer research.  “Cancer is really a rare disease,” he said, “Because of the molecular signature, because of the heterogeneity, no single institution will have enough data about any [single] cancer.  So you actually need to create a collaborative overarching global connected system.”  He continued, “The problem is now you have the other obstacle to the advance of medicine and the cure of cancer…it is going to be bombastic, dogmatic IT.”  In order to solve this problem, Soon-Shiong is collaborating with other health IT experts in the Commonwell Alliance to facilitate the development of the digital architecture needed to support the interoperability of electronic medical records.

His critics question the sheer breadth of the projects he’s begun under his NantWorks empire, but Soon-Shiong seems too consumed with making his ideas a reality to worry about critics.  At a time when one might expect him to retire, he seems to be only just beginning. “At this point in my career, it’s just:  let’s show that there are patients that are alive.  Let’s show we’ve created less suffering in cancer patients and then expand it globally.”

GV’s Approach to Healthcare Investing: An Interview with Dr. Krishna Yeshwant

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Please note:  This article was originally published on TechCrunch.com.

Healthcare investments — in particular, investments in digital health — are booming, and don’t seem to be slowing down. According to CB Insights, digital health funding hit nearly $5.8 billion in venture funding last year, surpassing the previous record of $4.3 billion in 2014.

One of the top venture firms, GV (previously known as Google Ventures), recently came out with their year in review, revealing that more than one-third of their investments are in the life sciences and healthcare. (They currently have $2.4 billion under management.) “I can think of no more important mission than to improve human health and global quality of life,” CEO Bill Maris said in a recent announcement.

One of the strengths of the GV life science and health investment team is having a diverse mix of PhDs and MDs as investors, including general partner Dr. Krishna Yeshwant. Yeshwant continues to practice internal medicine part-time at Brigham and Women’s Hospital in Boston, and credits that with helping to keep him in touch with the challenges facing healthcare.

I recently sat down with Yeshwant to talk about GV’s investment strategy.

Yeshwant started his career, interestingly, studying computer science at Stanford. From there, he helped found two tech companies, which were eventually acquired by Hewlett-Packard and Symantec. He could have successfully continued on his path in tech, but decided instead to go to medical school after his father became ill and needed a cardiac bypass. “I remember just being in the hospital thinking this is just messed up. There are so many areas for improvement,” he said.

He went on to pursue an MD-MBA at Harvard. During this time, he became involved in a lot of medical-device work, and even started a diagnostics company. This work eventually led him to work with Bill Maris at Google Ventures.

Thus far, one of GV’s largest investments has been with Flatiron Health, an oncology-focused technology company based in New York City. According to Yeshwant, the concept was developed by two former Google employees who received support from GV. “Flatiron is basically integrating EMR’s (electronic medical records) in the outpatient and hospital setting,“ said Yeshwant, “and it provides data back to physicians as well as aggregating data to aid with discovery and help with regulatory processes.”

Others have also recognized Flatiron’s enormous potential. Flatiron recently announced they received $175 million in Series C funding from Roche Pharmaceuticals. In addition to the funding, Roche plans to be a subscriber to Flatiron’s software platform. Their hope is to use the platform to identify and bring innovative treatments to market faster.

Yeshwant strongly believes in the need for more tech solutions in healthcare like Flatiron Health. “There’s a fundamental need for infrastructure. A single disease type of lung cancer is actually lots of diseases. Other more complex diseases are going to need more data sets, multisite trials, and we need to create infrastructure for that,” he said.

It’s hard to argue with him on that point. Massive amounts of biometric data are being collected in healthcare right now, but there aren’t nearly enough tools for storage, communication and analysis of that data. There’s a great deal of opportunity for healthcare startups that can specialize in data management and analysis.

Three such companies in which GV has invested in this space are Metabiota, which provides risk analytics to prevent and reduce epidemics; Zephyr Health, which uses global health data and machine learning to provide treatment insights to pharma and medical device companies; and DNAnexus, a company that helps companies store their genetic information.

“Once you’re in a world where you can scale up and down your computational analysis, you can ask lots of simultaneous questions of your aggregated data sets and that’s well suited to the cloud environment,” said Yeshwant. “We invest heavily in those spaces.”

Besides software-based companies, GV is investing in a diverse range of other types of companies in healthcare and the life sciences. One such area is the genomics space. Thus far, GV has made major investments in Editas, a CRISPR gene-editing company; 23andMe, which offers chromosomal analysis to consumers; and Foundation Medicine, a company that offers genomic analysis of various cancers.

Yeshwant also feels one of the biggest challenges (and opportunities) in healthcare is helping healthcare organizations shift from fee-for-service to fee-for-value. “That’s the direction we’re going,” he said. “How do we migrate big systems in that direction? That’s the fundamental question.”

GV therefore has made some significant investments in companies that are shaking up the traditional provider model, including the telemedicine company Doctor on Demand and the innovative primary care provider, One Medical Group. “Anything you can do to move healthcare from a high cost setting to a low cost setting is generally going to be successful in that model,” said Yeshwant. “Telemedicine is a good example of that. We have a company called Spruce Health which is essentially asynchronous care. Value based care is a big area for us.” (Spruce Health is a platform for dermatologic care.)

Yeshwant hinted that future projects may be in the areas of population health and chronic disease management, investment in companies that engage consumers directly and possibly even some work in women’s health. One thing’s for sure: We can expect more exciting things to come in 2016 and beyond for GV.

 

 

Cool Startup: RubiconMD

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Primary care practice stands on the precipice of radical transformation as emphasis shifts from offering volume-based to value-based care. Look no further than the recent Supreme Court ruling to see that the ACA and its mission are becoming further cemented into the U.S. healthcare system. The goals are lofty: higher quality and greater access to healthcare at a lower cost. For most, it’s hard to imagine what this healthcare landscape will look like in the future.

But Gil Addo, the CEO and founder of the NYC- and Boston-based healthcare startup RubiconMD, seems to know. His novel vision of the future involves shaking up the traditional model of primary and specialty care practice in medicine.

A Yale and Harvard Business School graduate, Addo’s experience as a consultant and in commercializing innovation has included industry stints at both large and small tech and biotech companies. In early 2013 he met co-founders Dr. Julien Pham, a physician formerly on faculty at Harvard Medical School, and Carlos Reines, another Harvard MBA.

As of December 2014, they have raised over $1.4 million funding and support from major investors, including athenahealth and Waterline Ventures.

We sat down with Addo recently to talk about this innovative company and discuss his plans for the future.

Tell us about what you do at RubiconMD.

RubiconMD is meant to enhance access and bring appropriate specialist expertise into the primary care setting. The patients will see their primary care providers and whatever the issue is–if it is outside the PCP’s expertise and results in a referral—the physician can upload any relevant information, such as images, labs, and studies, and ask questions. We figure out who the most appropriate specialist is and then route the case to them so that they can respond within a few hours.

That’s the crux of the entire interaction. It’s a clinician-to-clinician electronic consult.

How did you get the inspiration to start RubiconMD?

I was very interested in this problem of enhancing access and wanted to find a way to solve it. I had a personal experience that motivated me to take this on. I had a grandmother who had to travel thousands of miles to Boston for treatment of a brain tumor, and then back and forth for all the follow-up. Why couldn’t her local provider oversee her care with appropriate support? There had to be a better way.

I traveled to India and looked at different healthcare delivery models and found that better way. There they have an extreme version of what you see everywhere: the appropriate expertise is in a concentrated area and people are everywhere else, so they bring the appropriate expertise into community health centers.

I started iterating on that model and borrowed things from other settings until I arrived at a solution that fit the U.S. healthcare market. RubiconMD allows increased access to the right specialist and brings that expertise into the primary care setting, to the front line.

How did you figure out if this might be something that primary care physicians would actually be interested in?

Once we figured out that the idea made sense at a system level, we had to figure out if this was a solution that physicians would use. Julien brought his clinical expertise and introduced the idea of “curbside” interaction, an informal and natural way that physicians interact with each other. We were able to validate the model on a small scale and see that physicians would actually use it and find value.

We ran a larger scale pilot to see if this would save people money. We used two large clinics with a panel of specialists and ran it across 15 or so specialties. The findings have been remarkably consistent.

  • In a third of the time, this support avoids a specialist visit. This has been consistent across all deployments and different populations.
  • Another third of the time this process improves the referral. You’re able, even though you’re referring, to send along the appropriate labs and studies and waste less time. And you make sure the patient goes to the right specialist.
  • For the remaining third of the time, it’s peace of mind. It validates what you were going to do.

The cost savings is from improving care outcomes and avoiding duplicate and inefficient use of resources. Almost $300/per opinion is saved, aside from other benefits such us reducing wait time and avoiding ancillary costs to patients.

Is this billable to insurance?

It is not. Right now, we work with value-based organizations incented to provide high quality primary care in the most affordable way possible who see this as a way to extend their capabilities, provide better and more timely care in the primary care setting and avoid unnecessary services.

Payers show interest, as this is a great tool to enhance outcomes and reduce costs while improving patient satisfaction.

What are the challenges that you’re having? 

No shortage of challenges. We focus on the sphere of healthcare that is value-based and incented to provide high quality care at the lowest cost. But U.S. healthcare still has a very large fee-for-service component and the biggest challenge is that we’re dealing with so many groups fighting themselves. It’s a system in transition. We’re trying to bring this into that environment and show them how we help them transition. It’s tough but enough of the market has moved and enough changes in primary care have happened that we have been able to gain momentum quickly.

What are your next goals, short-term and long-term?

Short term, we want to continue better servicing our customers, provide better tools to meet their needs and fit even better into workflow. We’re obsessed with enhancing workflow and not making additional work — providing a tool that syncs with the way physicians want to practice medicine.

Long term, we’re focused on the idea of democratizing medical expertise. As our longer-term vision, we want this to be the default. We want people to think of RubiconMD as the way to get high quality consults more efficiently and locally so that there’s no barrier for clinical expertise.

This article was originally published at MedTechBoston.com.

Cool Startup: twoXAR

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Andrew M. Radin (left) with friend and twoXAR business parter Andrew A. Radin.


It’s not every day that you meet someone with the same name as you. And it’s even less likely this person will have similar interests and be someone with whom you might want to start a business.

But that’s exactly the story of the two Andrew Radins, founders of twoXAR.

Chief Business Officer Andrew M. Radin met his co-founder and Chief Executive officer Andrew A. Radin battling over a domain name–you guessed it–andrewradin.com.  About six or seven years ago, the former asked the latter, who owned the domain, if he could buy it from him and was told (in not so many words) to get lost.

Somehow, this exchange sparked a friendship, first on Facebook, then through commonalities such as travel to China, working in science and tech and their independent, entrepreneurial pursuits.  A little over a year ago, as Andrew A. Radin completed work on a computational method to enhance drug and treatment discovery, he naturally thought of joining forces with his namesake and friend, Andrew M. Radin.

For Andrew M. who was just completing his MBA from MIT Sloan, the timing was right and the discovery compelling enough to turn down other appealing job offers and join Andrew A. in forming the aptly named twoXAR (pronounced TWO-czar). Based in Silicon Valley, the company predicts efficacy of drug candidates by applying statistical algorithms to various data sets.We caught up with Andrew M. Radin recently to hear about their exciting new venture and their progress.

Tell us about what you do at twoXAR.

We take large diverse, independent data sets including biological, chemical, clinical etc.–some subsets include gene expression assays, RNA-seq, protein binding profiles, chemical structure, drug libraries (tens  of thousands of drugs), whatever we can get our hands on–and use statistical algorithms to predict efficacy of drug candidates in a human across therapeutic areas. The raw output from our technology (DUMA Drug Discovery Platform) is the probability of a given drug to treat a given disease. It all takes only a matter of minutes.

Where do you get your data sets?  Are they from clinical trials?

Some of our data comes from clinical trials, but we pride ourselves on using data sets that are largely independent from each other and come from a variety of sources along the biomedical R&D chain–as early as basic research and as late as clinical data from drugs that have been on the market for 30 years.  All of these data sets are extremely noisy, but we specialize in identifying signal in this noise then seeking overlapping evidence from radically different data sets to strengthen that signal.

These data come from proprietary and public sources. The more data we have, the better results DUMA delivers.

Could you give an example of how you could use this tool in pharmacologic research?

Our technology allows us to better characterize the attributes of a disease beyond just gene expression. We can examine how a drug might be related to a myriad of informational evidence streams allowing a researcher to build more confidence on a prediction for drug efficacy.

Let’s take Parkinson’s Disease as an example. Existing treatments focus on managing the symptoms. The real societal win would be to stop, and possibly reverse, the progression of the disease altogether. This is what we are focusing on.

In Parkinson’s disease, we’ve acquired gene expression data on over 200 Parkinson’s patients sourced from the NIH and examined over 25,000 drug candidates and have found a handful of promising candidates across a variety of mechanisms of action.

So you can “test out” a drug before actually running a clinical trial?

That’s the idea. Using proprietary data mining techniques coupled with machine learning, we’ve developed DUMA, an in silico drug discovery platform that takes a drug library and predicts the probability of each of those drugs to treat the disease in question in a human body. We can plug in different drug libraries (small molecules, biologics, etc.) and different disease data sets as desired.

At this stage we are taking our in silico predictions to in vivo preclinical studies before moving to the clinic. Over time we aim to demonstrate that computational models can be more predictive of efficacy in humans than animal models are.

It seems, intuitively, that this would be really valuable, but I would imagine that your clients would want to see proof that this model works.  How do you prove that you have something worthwhile here?

Validation is critical and we are working on a number of programs to demonstrate the effectiveness of our platform. First, we are internally validating the model by putting known treatments for the disease into DUMA, but blinding the system to their current use. If in the results the known treatments are concentrated at the top of our list we know it’s working. Second, we take the drug candidates near the top of the list that are not yet known treatments and conduct preclinical studies with clear endpoints to demonstrate efficacy in the physical world. We are currently conducting studies with labs who have experience with these animal models to publish methods for peer-reviewed journals.

You have a really advanced tool to come up with potentially great treatments, but what’s to say that’s better than what’s going on out there now?  How do you prove it’s better or faster? 

If you look at drug industry trends, the top drug companies have moved out of R&D and become marketing houses–shifting the R&D risk to startups and small and medium drug companies. Drug prospecting is recognized to be extremely risky and established methods have produced exciting results in the past but have, over time, become less effective in striking the motherlode. Meanwhile, the drug industry suffers from the same big data woes as many industries–they can produce and collect petabytes and petabytes of data, but that goldmine is near-worthless if you don’t have the tools to interpret it and extract the gold. Advances in data science enable twoXAR to analyze, interpret, and produce actionable results with this data orders of magnitude faster than the industry has in the past.

It seems that this could be scaled up to have many different applications.  How do you see twoXAR transforming the industry? 

In regards to scale, not only can computational platforms look at more data faster than humans without bias, much smaller teams can accomplish more. At twoXAR, we have a handful of people in a garage and we can essentially do the work of many wet lab teams spanning multiple disease states. Investors, researchers, and patient advocacy groups are very interested in what we are doing because they see the disruptive potential of our technology and how it will augment the discovery of new life-saving treatments for our families and will completely recast the drug R&D space. One of the things I learned at MIT from professors Brynjolfsson and Little is that the increasingly exponential growth of technological progress often takes us by surprise. I predict that tectonic shifts in the drug industry will be coming much quicker than many folks expect.

To learn more about twoXAR, visit their website and blog.

This article was originally published on MedTech Boston.

Richard Parker on Global Payment Models & His Career Transition

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(Please note:  This article has been re-published from MedTechBoston.com.)

Richard Parker, former Chief Medical Officer at Beth Israel Deaconess Care Organization (BIDCO), is a man of many talents. In addition to working as a physician, medical director and board member at BIDCO, he has also worked as a political consultant.

Now, after working for the Beth Israel Deaconess Care Organization for more than 15 years, Parker is off on a new adventure – one he calls his most exciting yet: starting his own healthcare consulting company, Parker Healthcare Innovations. we recently sat down with him to hear about this career shift.

Q: Tell us about your work at Beth Israel Deaconess.

In 2000, I was asked to be the medical director for the physician organization and I agreed to do it if I could still see patients, so I was medical director 50 percent of the time and seeing patients 50 percent of the time. That was the beginning of a lot of learning about the business of medicine, pay for performance, contracts, how doctors are motivated, information technology, and EMR.

In 2012, we had the opportunity to apply for the Pioneer ACO. In the greater Boston area, there are 5 organizations that are Pioneer ACOs: BIDMC, Mount Auburn, Partners Healthcare, Steward, and Atrius Health. That was a very fast learning curve because previously we were just dealing with the commercial population, which was up to the age of 65; now, we had to add all patients over the age of 65 who were in this Pioneer ACO. It was a different game.

Older patients are not the same as younger patients. There is more illness, more chronic disease, more hospital admission, and so now, instead of thinking about patients one at a time (which is how we learned to care for patients in medical school), we had to think of populations of patients – about systems and public health. I had to think: What can we do to make our systems better so we are improving the quality of care for patients in tangible ways and decrease costs? And this is the irony and the conundrum: it is actually possible to increase quality and decrease cost at the same time.

That allows for the transition from fee for service (FFS) to global payments. In the FFS model, patients come in, we treat them, and we bill them; that compels more treatment, more admissions, more referrals. In the global payment world, we turn that 180 degrees, we say, ‘Okay, doctors – maybe hospitals – you have a budget. If you come in under budget, we’ll share the surplus with you. If you come in over budget, you’re going to write us a check.’ That is an extremely different financial model. So at Beth Israel, I was trying to figure out how to build the systems and then how to translate this message to providers.

Q: What kind of results have you had with the Pioneer ACO?

We’ve seen excellent results. In fact, the BIDCO Pioneer ACO was the leader in the Boston Market and we’re the third most financially successful Pioneer ACO in the country. We’ve seen a lot of success. By the second year, we saw results in terms of quality, cost and patient satisfaction.

Q: So, the big question: What motivated you to make the switch from that work to starting your own company?

Part of my motivation was waking up one day and saying, “I’ve been in the same place for 30 years.” I started as an intern at Beth Israel Deaconess and I’m now going to be 59 years old. I’m fortunate to be healthy and have a great family and if I wanted to do something different, this seemed like the right time to do it. With the success we have had at BIDCO, this would be a great time to use it as a launching pad to do something different.

Q: What is your vision for Parker Healthcare Innovations? What would you like to achieve?

The first part is assisting doctors, hospitals, and to a lesser extent, health plans, that are trying to make the transition from fee for service medicine to a global payment system. Some of the things I talked about earlier, the challenges, these are things I now know a lot about, through working with Beth Israel Deaconess for 30 years. The challenges exist in the areas of governance, information technology and care management. Though people often think about this as a financial enterprise, really this is an opportunity to improve systems of care and the quality of care.

For example, I started a nurse practitioner home visit program. The sickest now get a nurse practitioner visiting their homes monthly. Now, with the nurse practitioner making a home visit, we’re not seeing them in the hospital as much. Patients are healthier, happier, families are happier. This is a big win. This is a real obvious example of a systems approach to disease management.

There are certain diseases that we need to focus on in order to be successful. In the Medicare population, there are six: heart failure, diabetes, emphysema, chronic kidney disease, behavioral medicine, and palliative or end of life care. I anticipate helping groups of doctors, hospitals, and insurance companies in how to move in this direction because I know how to do it. Every system is different. There’s a lot to figure out and it’s not for the faint of heart to make that transition.

The other thing I’m doing in my company is giving a presentation on the topic of stress. My goal is to give this presentation to companies and to colleges because I feel that chronic stress has become a really enormous problem and I saw this when I was practicing medicine.

Q: What other trends do you see in the future? What else should the healthcare world be preparing for?

One colossal trend will be the demand for more value for money. There will be continued pressure on all of us to stop wasting so much. Healthcare costs are a big drain on the economy and businesses, whether you’re self-employed or you work for a big corporation, everyone is paying this colossal cost. The issue of cost in healthcare hasn’t been adequately addressed; it hasn’t been touched.

On a brighter note, I’m hoping that we’ll see more intelligent self-care, maybe leveraging technology. Technology is fabulous but only if used in a useful way. Hopefully with all this technology we can help people with self-care, around chronic illnesses, like weight management, stress, blood pressure control, diabetes. Hopefully we’ll see some really good things in that space.

I’d also like to see more care at home, less in the hospital setting. I consult to a home IV infusion company, called Soleo Health, and I think doing treatments for patients in the home is better, more comfortable and cost-saving.