The Harry Glorikian Show: Recent Episodes
Timothy
Harry Glorikian is an investor and business expert at the convergence of Health, life sciences and IT. His books show how technology is transforming healthcare, from both the patients point of view (The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less and Live Longer 2021) and the Industry insider's perspective (MoneyBall Medicine 2017). He's also a natural at conversation. And here on the podcast you'll hear Harry talking with the pioneers who are using technologies like AI, big data, predictive analytics, and wearable devices to change the way healthcare gets delivered and get consumers more engaged in their own health.
Your medical records don't make pleasant bedtime reading. And not only are they inscrutable—they're often mutually (and deliberately) incompatible, meaning different hospitals and doctor's offices can't share them across institutional boundaries. Harry's guest this week, Ardy Arianpour, is trying to fix all that. He’s the co-founder and CEO of Seqster, a San Diego company that’s spent the last five years working on ways to pull patient data from all the places where it lives, smooth out all the formatting differences, and create a unified picture that patients themselves can understand and use.
The way Ardy explains it, Seqster “smashes the data siloes.” Meaning, the company can combine EMR data, gene sequence data, wearable device data, pharmacy data, and insurance claims data all in one place. The big goal guiding Seqster, he says, is to put the patient back at the center of healthcare.
Harry's guest this week is Rohit Nambisan, CEO of Lokavant, a company that helps drug developers get a better picture of how their clinical trials are progressing. He explains the need for the company's services with an interesting analogy: these days, Nambisan points out, you can use an app like GrubHub to order a pizza for $20 or $25, and the app will give you a real-time, minute by minute accounting of where the pizza is and when it’s going to arrive at your door. But f you’re a pharmaceutical company running a clinical trial for a new drug, you can spend anywhere from $3 million to $300 million—and still have absolutely no idea when the trial will finish or whether your drug will turn out to be effective. Because there's little infrastructure for analyzing clinical trial data in midstream or spotting trouble before it arrives, some studies continue long after they should have been canceled, and positive data sometimes gets thrown out because of minor procedural flaws; in the end, 20 to 30 percent of the money drug makers spend on clinical trials goes down the drain, Nambisan says. Lokavant's platform allows drug makers and clinical research organizations to harmonize the results coming in from study sites, compare it to data from other trials, and discover important signals in the data before it’s too late. For example, a company might discover that it’s not enrolling patients fast enough to complete a trial on schedule, or that the researchers administering the study aren’t following the exact protocols laid out in advance. Such headaches might sound abstract and remote, but poor data management slows down the whole drug development process, which means fewer beneficial new drugs make it to market ever year; that's the ultimate problem Lokavant is trying to fix.
This week Harry continues to explore advances in "digital therapeutics" in a conversation with Paolo Pirjanian, the founder and CEO of the robotics company Embodied. They’ve created an 8-pound, 16-inch-high robot called Moxie that’s intended as a kind of substitute therapist that can help kids with their social-emotional learning. Moxie draws on some of the same voice-recognition and voice-synthesis technologies found in digital assistants like Siri, Alexa, and Google Home, but it also has an expressive body and face designed to make it more engaging for kids. The device hit the market in 2020, and parents are already saying the robot helps kids learn how to talk themselves down when they’re feeling angry or frustrated, and how to be more confident in their conversations with adults or other kids. But Moxie isn’t inexpensive; it has a purchase price comparable to a high-end cell phone, and on top of that there’s a required monthly subscription that costs as much as some cellular plans. So it feels like there are some interesting questions to work out about who’s going to pay for this new wave of digital therapeutics, and whether they’ll be accessible to everyone who needs them. Pirjanian discussed that with Harry, along with a bunch of other topics, from the product design choices that went into Moxie to the company’s larger ambitions to build social robots for many other applications like entertainment or elder care.
Why is hibernation something that bears and squirrels do, but humans don’t? Even more interesting, what’s going on inside a hibernating animal, on a physiological and genetic level, that allows them to survive the winter in a near-comatose state without freezing to death and without ingesting any food or water? And what can we learn about that process that might inform human medicine?
Those are the big questions being investigated right now by a four-year-old startup in California called Fauna Bio. And Harry's guests today are two of Fauna Bio’s three founding scientists: Ashley Zehnder and Linda Goodman. They explain how they got interested in hibernation as a possible model for how humans could protect themselves from disease, and how progress in comparative genomics over the last few years has made it possible to start to answer that question at the level of gene and protein interactions. The work is shedding light on a previously neglected area of animal behavior that could yield new insights for treating everything from neurodegenerative diseases to cancer.
Can a video game help improve attention skills in kids with ADHD? According to Akili Interactive in Boston, the answer is yes. They’ve created an action game called EndeavorRx that runs on a tablet and uses adaptive AI to help improve focus, attentional control, and multitasking skills in kids aged 8 to 12. And it’s not just Akili saying that: In 2020 the U.S. Food and Drug Administration agrees cleared EndeavorRx as a prescription treatment for ADHD, based on positive data from a randomized, controlled study of more than 600 children with the disorder. It was the first video game ever approved as a prescription treatment for any medical problem, and Harry's guest this week, Akili co-founder and CEO Eddie Martucci, says it opens the way for a new wave of so-called digital therapeutics. Even as Akili works to tell the world about EndeavorRx and get more doctors to prescribe the game for kids with ADHD (and more insurance companies to pay for it), it's testing whether its approach can help to treat other forms of cognitive dysfunction, including depression, the cognitive side effects of multiple sclerosis, and even Covid-19 brain fog.
In a day and age when it feels like there are drugs for everything—from restless legs to toenail fungus to stage fright—it's strange the drug industry has almost completely ignored one of our most important organs: our ears. Given that 15 percent of people in the U.S. report at least some level of hearing loss, you’d think drug makers would be doing more to figure out how they can help. Well, now there’s at least one company that is. Cambridge, Massachusetts-based Decibel Therapeutics went public in 2021 to help raise money to fund its research on ways to treat a specific form of deafness caused by a rare genetic mutation. Decibel is testing a gene therapy that would be administered only to cells in the inner ear and would provide patients with a correct, working copy of the otoferlin gene, which is inactive in about 10 percent of kids born with auditory neuropathy. Harry's guest this week is Decibel’s CEO Laurence Reid, who explains how the company’s research is going, and how Decibel hopes to make up for all those decades when the pharmaceutical business had basically zero help to offer for people with hearing loss.
f you’re a parent, you’ve probably had this experience many times: Your young child has a high fever, and maybe a sore throat, but you don’t know exactly what’s wrong. Is it a bacterial infection, in which case an antibiotic might help? Or is it a viral infection, in which case, you just have to wait it out? The symptoms of bacterial and viral infections are often the same, and most of the time, even a doctor can’t tell the difference. Viral infections are more common, but sometimes, the doctor will prescribe an antibiotic anyway, if only to help the parents feel like they’re doing something to help. But what if doctors didn’t have to guess anymore? What if there were a fast, easy blood test that a doctor could run in their own office to look for biomarkers that discriminate between bacterial and viral infections? Well, that’s the seemingly simple problem that a company called MeMed has been working on solving for 13 years now. Recently MeMed’s first testing product got approval from the FDA, and now the company is finally beginning to roll out it out commercially in the US. And here today to tell us more about how it got built, how artificial intelligence fits into this picture, and how rapid diagnosis could change the practice of medicine, is MeMed’s co-founder and CEO, Eran Eden.
In March of 2020, as SARS-CoV-2 was first sweeping the globe, Jacob Glanville joined Harry on the podcast to talk about the pandemic and how the kinds of antibody therapies being studied by his company Distributed Bio might help. At the end of 2020, Charles River Laboratories bought Distributed Bio on the strength of its computational immunology platform—which automates the discovery of antibody therapeutics. But Charles River let Glanville spin off the research programs he'd been pursuing, which included neutralizing antibodies to treat influenza and coronaviruses. And now those programs have been rolled up into Centivax, a South San Francisco-based biotech startup where Glanville is once again CEO. Glanville returns to the show this week to talk about what's gone right—and wrong—in the biopharma business during the coronavirus crisis, how the pandemic's end might play out, and why he sees such promise for antibody therapies against coronaviruses, drug-resistant bacteria, and even snake bites.
Until recently, getting a blood glucose measurement required a finger stick. The whole process was so painful and annoying that only diabetics taking insulin bothered to do it regularly. But there’s a new class of devices called continuous glucose monitors, or CGMs, that make getting a glucose reading as easy as glancing at your smartwatch to see your heart rate. A CGM is a patch with a tiny electrode that goes into your skin to measure glucose levels in the interstitial fluid, plus a radio that sends the measurement to an external device like your phone. The devices are pain-free to use, and they’re rapidly coming down in price. Harry's guest today, Maz Brumand, is head of business at Levels, a startup that wants to use CGMs to help everyone understand how their choices about food and lifestyle affect their health.
Healthcare is one of those areas where more data is almost always better. And I talk a lot on the show about how data is helping doctors and patients make smarter decisions. But a lot of the data we’d still like to have is stuck in those arcane Electronic Health Record systems or EHRs that medical practices or hospital systems use to track their patients. These systems tend to be closed, proprietary, user-unfriendly, and incompatible with one another. And we've repeatedly made the case here on the show that EHR technology is holding back innovation across the healthcare market.
That’s why we like to meet companies that are working to make EHR data more useful. And in this episode we welcome a pair of guests from a company called Verana Health that’s trying to do just that. The company recently brought in $150 million in new venture capital funding to help scale up its data services, which currently focus on the subspecialties of ophthalmology, neurology, and urology. Verana takes data on patients in these fields, cleans it up, analyzes it, and pulls out insights that could be useful—both for clinicians who want to increase the quality of the care they’re providing, and for pharmaceutical companies who need new ways to measure the effectiveness of their drugs and better ways to find patients for clinical trials. Here to explain more about all of that are Verana’s CEO, Sujay Jadhav, as well as its senior vice president of clinical and scientific solutions, Shrujal Baxi. (If you’re a longtime listener you might remember that we had Shrujal on the show once before, back in 2018, when she talked about her previous company Flatiron Health.)
As we say here on The Harry Glorikian Show, technology is changing everything about healthcare works—and the reason we keep talking about it month after month is that the changes are coming much faster than they ever did in the past. Each leap in innovation enables an even bigger leap just one step down the road. Another way of saying this is that technological change today feels exponential. And there’s nobody who can explain exponential change better than today’s guest, Azeem Azhar.
Azeem produces a widely followed newsletter about technology called Exponential View. And last year he published a book called The Exponential Age: How Accelerating Technology is Transforming Business, Politics, and Society. He has spent his whole career as an entrepreneur, investor, and writer trying to help people understand what’s driving the acceleration of technology — and how we can get better at adapting to it. Azeem argues that most of our social, business, and political institutions evolved for a period of much slower change—so we need to think about how to adapt these institutions to be more nimble. If we do that right, then maybe we can apply the enormous potential of all these new technologies, from computing to genomics, in ways that improve life for everyone.
Genialis, led by CEO Rafael Rosengarten, is one of the companies working toward a future where there are no more one-size-fits-all drugs—where, instead, every patient gets matched with the best drug for them based on their disease subtype, as measured by gene-sequence and gene-expression data. Analyzing that data—what Rosengarten calls "computational precision medicine"—is already helping drug developers identify the patients who are most likely to respond to experimental medicines. Not long from now, the same technology could help doctors diagnose patients in the clinic, and/or feed back into drug discovery by providing more biological targets for biopharma companies to hit.
"Our commitment to biomarker-driven drug development is very principled," Rosengarten tells Harry. "There are some amazing drugs out there that, when they work, work miracles. But they don't work that often. Some work in maybe 15 percent of the patients or 20 percent. If you could tell which of those patients are going to respond, then at least the ones who aren't can seek other options, and we would know that we've got to develop [new] drugs for the others."
Harry's guest Eric Daimler, a serial software entrepreneur and a former Presidential Innovation Fellow in the Obama Administration, has an interesting argument about math. If you’re a young person today trying to decide which math course you’re going to take—or maybe an old person who just wants to brush up—he says you shouldn’t bother with trigonometry or calculus. Instead he says you should study category theory. An increasingly important in computer science, category theory is about the relationships between sets or structures. It can be used to prove that different structures are consistent or compatible with one another, and to prove that the relationships in a dataset are still intact even after the data has been transformed in some way. Together with two former MIT mathematicians, Daimler co-founded a company called Conexus that uses category theory to tackle the problem of data interoperability.
Longtime listeners know that data interoperability in healthcare, or more often the lack of interoperability, is a repeating theme of the show. In fields from drug development to frontline medical care, we’ve got petabytes of data to work with, in the form of electronic medical records, genomic and proteomic data, and clinical trial data. That data could be the fuel for machine learning and other kinds of computation that could help us make develop drugs faster and make smarter decisions about care. The problem is, it’s all stored in different databases and formats that can’t be safely merged without a nightmarish amount of work. So when someone like Daimler says they have a way to use math to bring heterogeneous data together without compromising that data’s integrity – well, it's time to pay attention. That's why on today’s show, we’re all going back to school for an introductory class in category theory.
We've learned from previous guests that machine learning and other forms of AI are helping to identify better disease treatments, get drugs to market faster, and spot health problems before they get out of hand. But what if they could also help patients find the best doctors for them, and help doctors frame their advice in a way that patients can relate to? This week, Harry's guest, Briana Brownell, talks about the computational tools her company Pure Strategy is building to find patterns in people’s personal preferences that can lower cultural barriers, enable better matchmaking between patients and doctors, predict which patients are most likely or least likely to go along with a treatment plan, or help doctors communicate their recommendations better. "Not everybody makes decisions in the same way," Brownell says. "Not everybody values the same things. But by understanding some of those psychological and value-based drivers, we can get better health care outcomes."