How Healthcare Moves from Reactive Care to Preventive with Ray Pawlicki

Speaker A: M To put AI on top of science we don't understand can be helpful to a degree, but it's not going to get what people are expecting. They're going to expect to go to the doctor and when they get a therapy, they're going to expect it to work and not have the doctor say to them, well, we've got four choices here. We're not sure which one of these therapies for your high blood pressure are going to work. Now people are living longer and what's getting them is chronic conditions. Als, Alzheimer's, diabetes. You pick it. Ten years from now, that's going to be the issue. What's helping it is back to people taking control of their own healthcare. So people are now willing to pay for their own lab tests.

Speaker B: Do you see the same willingness to build more adaptive and personalized care frameworks? And is the structure of particularly of healthcare in the US helping or hindering that?

Speaker C: Welcome to Biology Matters, the podcast exploring how a deeper understanding of biology can transform healthcare at a time when it's becoming globally unsustainable. Chronic diseases affect billions of lives, placing enormous pressure on health systems around the world. Yet they remain poorly understood, difficult to manage and lacking effective diagnostic tools and treatment options. In this podcast, we speak with leaders across the healthcare and life sciences industries to discuss how new biological insights are driving precision medicine and helping us to solve chronic disease. The future of healthcare is here. I'm your host, Steve Gardner. Let's get into it.

Speaker B: So, welcome to Biology Matters, a podcast exploring how a, ah, deeper understanding of biology is transforming precision medicine and with it, healthcare. I'm Steve Gardner, CEO and co founder of Precision Life and I'm absolutely delighted to be joined by Ray Pawliki today, who, amongst other things, is our rather wonderful exec chairman at, uh, Precision Life. Ray, it's a real pleasure to have you on the podcast. You've had a long and illustrious illustrious career as a technology leader in various organizations. Novartis, Biogen, PepsiCo, Citibank, Hewlett Packard. You spent many decades helping organizations use technology and data as a strategic advantage and you've chosen now to focus on healthcare, particularly the really massive challenges of how we predict, treat and indeed prevent chronic diseases. So I suspect we're going to have a lot of ground to cover. Let's get into it.

Speaker A: Thank you for having me, Steve.

Speaker B: Well, I think you've got a uniquely broad perspective across senior leadership roles in the last 30 years or so, across consumer brands, life sciences, healthcare providers, that's hospital systems and payers, which are insurers in the US for non US listeners. And more than that, you've done it successfully in the US and Europe, which is equally impressive. Before we get started, just to give all the listeners a um, sense of your career, the trajectory that it's taken, do you want to just paint a picture of where you started and where you are now?

Speaker A: Happy to do so, Steve. And perhaps I will uh, pick up my career somewhat midstream as I entered into the life sciences industry 26 years ago or so. Prior to that, as you said, I had some roles in consumer products as well as technology. But joining Novartis in the year 2000 as their Chief Information Officer for the US based out of east, uh, Hanover, New Jersey was a wonderful experience for me to really start to understand the pharmaceutical market, which obviously leads into the healthcare market. I was fortunate enough to have a wonderful CEO by the name of Paulo Costa who really cared about patients, had a fairly humble upbringing and rose to the top at Novartis and really drove us in a direction to make a difference. After four years of doing that, they asked me to go to Basel, Switzerland to be their global CIO as you mentioned. And uh, that was certainly a learning experience coming from a US management system where to a certain degree brainstorm. You throw a bunch of ideas against the wall and you see which ones stick and then you run with them, which is quite different than a uh, Germanic style way of management, especially in Switzerland. I quickly learned you don't put out three or four ideas and then sort of graph them in parallel as to which ones rise to the top. But rather you think it through right to the end and you say this is the one I'm going to do and this is exactly how I'm going to do it. So I stubbed my toe a couple times on that. But a wonderful experience living and working in Switzerland and it really brough broadened out my understanding of healthcare in Europe and around the world as opposed to just the US and then came back to the US and was at Biogen for several years as their Chief Information officer again, another wonderful CEO by the name of George Skengos who really led the company from a ah, data perspective. We were very data based prior to that. Biogen wasn't as much. George was a scientist, he understood data and we got along quite well in how we're going to leverage technology to make a difference, which we did. He was ahead of his time, so that was I think 2008 or so, 2008, 2009 and he already Said technology is the key to this industry. And 17, 18 years ago there weren't a lot of pharmaceutical companies that were making technology a strategic pillar like you did.

Speaker B: Novartis was one of those organizations that led the push into data science in the discovery side of things. How close were you to those developments?

Speaker A: Reasonably close. And it was a, uh, major shift because to do research in a data based way. They decided to do that in the US in Cambridge, which caused quite a stir a little bit in the industry actually because that's sort of the crown jewels of a pharmaceutical company where you're going to be really designing, discovering your drugs. And that was always in Switzerland. And they decided to move that to the US and that was actually the beginning of, of Cambridge, Massachusetts becoming the hub for biotech. That was the first real stake in the ground. And poached a, uh, very focused guy out of Mass General to lead the research, which is another change as opposed to somebody who's come up the ranks. And he was also very much aligned uh, with we have to change the way we do things. We have to understand better the data underlying a lot of our decisions. And it led to Novartis being quite successful in Cambridge becoming or at least the Novartis hub in Cambridge being really essential to their growth.

Speaker B: Was it that perception of your role in Novartis and them being a pioneer to some extent in the space that led to the gig in Biogen or how did that actually come about?

Speaker A: It did actually, uh, I was based in Switzerland and really needed to come back for family reasons. But in doing so the Biogen decided that they wanted to talk to my CEOs that I had worked with. And that actually worked out quite well because both Paulo Costa and then later globally Thomas Ebely were both very focused on leveraging tech to move forward. And actually that was prior to George Skangos joining. I joined about a year before George, but it was really when George joined that it really took off. And I felt very fortunate to be having regular meetings with the CEO about here are a handful of ways we could leverage tech. Do we want to focus more on the development side? Do we want to focus on the discovery side? Do we want to focus on logistics or manufacturing or commercial? And you couldn't do it all at once. But we did things like we were the first company to roll out iPads, which was a big deal back in the day. And actually looking at some AI models way, uh, back when as well across

Speaker B: the various industries that you've worked in, that technological change can't have been easy. And the challenges that you've had to overcome must have been quite different. I mean, even with a willing leader, uh, some of those are quite conservative industries, particularly in Switzerland perhaps. How did you get that change agenda working? How did you actually start to persuade people that these were things that you needed to do and go about actually changing their day to day jobs?

Speaker A: Um, so in the end, you know, technology on its own, as I think we all know, isn't very useful. But technology combined with people and process is where the change really starts to be made. So we had quite a focus on the people side of things. In the end, almost all of this stuff comes down to people. And I piloted a, uh, culture program in it to see how it would work. And it didn't work well. And it had to do with, uh, a lot to do with how you listen, amongst other things. And we taught people in it to listen for possibility as opposed to listening for do they agree with me or not agree with me, or listen for right or wrong or a whole different sort of filters of listening. But we train people on how to sort of just stop where you are, put sort of your ideas, success strategies aside and listen for possibility. And then that worked. And then we took that and we ran that program throughout Biogen and trying to, whether it's a computer scientist, a biologist, uh, you know, any, any sort of scientist, getting folks to not listen for what needs to be improved or what's wrong with this and get them to listen for possibility was quite the challenge. But we did it. Not everybody, I mean, but for the most part, we moved the needle quite a bit in the culture. And once we got people listening that way, we had certain words that we used in the training, like I'd like to make a request and people would stop. Okay, a request. It's not that telling me to do something. And then we had words like an unreasonable request. And the person receiving the request knew that they could either accept, deny, counteroffer. There was a whole process. But if you don't put something like that in place and you just put in the technology and you try to hammer it top down, it'll work to a degree, but not to the degree that you expect and certainly not to the degree that might be possible otherwise. So that's a great question, Steve. Yeah, that was, uh, a big emphasis. So I started my first CIO job was at Pepsi for a small division, the uh, Pepsi wines and spirits division. And I learned back then at the age 30 or so that if you don't have the relationship with people. If you're not focusing on the process, that's going to change. If not focusing on the work, if not focusing on the people, it's just never really going to take off. And then by the time I was at Novartis and Biogen, with a few years underneath my belt, that became an emphasis. Most technologists have a towering strength of some sort in order to become a chief information officer. And there are a number of different types and they're all successful. One is not better than the other. And maybe, of course it started at Pepsi, which is all about marketing, the way you present yourself, that I understood how important it was to influence people and then I sort of ran with that over the years.

Speaker B: You took that considerably further. You've mentioned culture many times. I think you have a very unusual accolade under your belt, which, uh, at one time I think you were not only the cio but also running HR at um, Biogen, which really doesn't fit the stereotype of a nerdy IT towering specialist in one area. And this is obviously something that we've talked about a lot. Were you a glutton for punishment at that point or was it something that you really felt you needed to take on and in order to achieve the transformation that you were looking for? Culture was an important ingredient in that.

Speaker A: Uh, in the end it came down to the technology change and sort of the vision for the company driven by George Skangos was not going to happen in the existing culture and sort of word sort of spread that what we were doing in IT around culture was working. And so reluctantly one of the other phrases we used in it, in the culture training was I'd like to make an offer. So I had my one on one with George Skengos and I had my little agenda. My last item on the agenda was an offer. And at the end of the meeting he goes, okay, right, what's your offer? And I said, george, I hate to do this. You know, this is going to kill me and I haven't told my wife I'm going to do this yet. But I'd offer to be the head of HR on an interim basis because the head of HR had left. Because we're trying to drive this transformation, we're trying to get people to become data based and not move away from a top down type culture and really let the science drive the company, nothing else but the science. And to get the people to think that way, we needed to do the culture change. And George said, okay, let me think about that. And then some incident happened driven by the old culture. And I got a call two days later, hey, please take this and let's see if we can make a difference together. Which we did for a year. And then I was a little bit out of gas and was happy to hand the baton to the next guy.

Speaker B: I, uh, can only imagine. So you've given up being a CIO for a while and you have now taken up what we politely call a portfolio career. And you have several diverse roles. Before we explore some of those and the different perspectives, what inspired you to stay in this space and particularly to go looking at complex chronic diseases where many of the roles that you're playing at the moment, uh, are, uh, focused.

Speaker A: So it was sort of a stepwise realization, I'd say. I've now moved on, as you say, in a portfolio career, mostly in board director type roles. And shortly after I retired from Biogen with an intent to start to focus on board roles, I got a call from the CEO at Newmass Memorial Health, another real leader in the industry, Eric Dixon. And at this point I knew there was sort of an emerging trend that technology was getting embraced by the industry, whether it was pharmaceutical healthcare in general. And he called me. I forget exactly how he got ahold of me. He was in place for about a year and he said, right, the hospital system, UMass, Memorial Health and or hospital systems in general, if they don't get technology right, they're gonna go out of business. And I was like, wow, Eric, I'll chat with you. Let's talk about that. And I loved it because coming out of the pharma world, I didn't know a lot about hospitals. So this was a golden opportunity for me to really learn how a hospital system or how the provider systems work. And to do that alongside a CEO who really understood that technology was key to going forward. Otherwise the systems would collapse. And we spent four or five years putting in a really well done, epic system. And nowadays that, you know, that was a big deal, you know, maybe 10 years ago or whatever it was. Now that's just stakes to get into the game. If you don't have a really good EMR system, you're dead.

Speaker B: Yeah. These are the electronic health records that are the backbone of modern day healthcare.

Speaker A: And to Eric's vision, the hospital systems that don't have one or don't have one running well are in trouble. And then from there you can start to build. And that's when I started to understand chronic disease was a major issue. As I started to understand the provider system and that there were really, there was just like there was a budding trend and an emergent sort of understanding that technology is going to make a difference. That was not present about how are we gonna make a difference in chronic diseases. They just wasn't there. And that is 80% of healthcare spend. It was UMass. Memorial Health has a diverse population, some of the underserved population, some others, and it didn't matter. People with the chronic diseases, they were not well diagnosed, they were not diagnosed early and they would end up in and out of the emergency rooms on a regular basis. So that was my first realization that chronic disease is an area that has not gotten the attention or there just hasn't been the systems or biology to understand it. The science wasn't there to understand it when we were kind of stuck in the mud.

Speaker B: Yeah, and we're gonna. Obviously one of the themes of this podcast is all around, um, being able to predict and prevent disease from happening. You know, you're alluding to the fact that healthcare is becoming unaffordable, particularly in the US it's 18% of GDP, but at the same time we're seeing a really fast decline in healthy lifespan. And I know that this is occupying attention on both the provider, uh, and the payer side, but we're throwing around some words that probably don't mean that much to, uh, a non US audience. So I'm going to put you on the spot. This is going to be a little bit like me trying to explain the laws of cricket to, uh, to an American. Would you mind just sort of describing the organizational structure and the players in the US health system? You obviously sit on the boards of a number of these, so I think you have a pretty unique perspective here.

Speaker A: It is unfortunately incredibly complex, which is what drives the cost. So the US spends the most on healthcare and is well beneath the average on actual quality of life that we're able to, to engage with. And worse yet, it's very uneven. So in other words, in the US if you're fortunate enough to be in a place where you could pay for excellent healthcare, you get it. But again, it's very uneven. Not a lot of people would take advantage of that. But the complexity largely is due to the way everything is fragmented, where you start by going to a provider before you do anything, you need insurance. And if you're 65 or above, that is in fact Medicare. If you're 64 or younger, you're on your own. When you're on your own, that Means if you are working somewhere where that employer provides health insurance, you have to pay, and the employer will also pay if you're not, or if your employer doesn't offer it, you have to go out to what's called a marketplace and get it on your own. And if you cannot afford it, you fall into a different category called Medicaid, which is funded largely by the state. So to start with, every state's different for Medicaid. They do their own thing, reimburse what they want to do. So there's 50 different ways to help underserved population. So you have Medicaid, you have commercial insurance that you buy yourself, you have it through the employer, you have Medicare, and they all have different deductibles and different formularies as far as what drugs are going to be reimbursed. So as you go from one insurer to another, it's like starting a new world. So you have that, and then you have this poor physician who just wants to prescribe a therapy or order a test of some sort. And depending upon the individual, what insurance they have, you have to go in six or seven different directions to get reimbursed or get approved. So that creates an incredible amount of administrative burden. And that's a big portion of the cost in the US Is around that. And then the insurer typically has the ability to say, no, the symptoms that you have described does not warrant us to reimburse that test. And so now the physician or physician's assistant has got to call the insurer and say, no, no, no, you're misunderstanding it. And then insurer says, we'll think about that. And to the point where a relative of mine went to a hospital system here and had to spend time in the hospital, and then it actually was in a hospital at home program, and it was tens of thousands of dollars. And the insurer denied the whole thing. And the realtor said, what? This is tens of thousands of dollars and called the hospital and the hospital, oh, yeah, don't worry about it. That's the way this insurer starts. They always deny the whole thing. And then we have to go. And then they do little by little go through it and say, can you pay for this? Can you pay for that? Can you pay? But the insurer often will start off, as opposed to just looking at one piece to deny or question, they just deny the whole thing. And that doesn't happen all the time. But that is an example of what goes on. And that's before you get into the whole way, that therapies are actually distributed. There's multiple middlemen. So the pharmaceutical company will make the drug, sell it to a distributor, the distributor will sell it to what's called a, uh, pbm, Pharmacy benefit measurement. And that PBM could either be in a hospital, there's all different versions of PBMs. So there are so many levels, so many complications. But right now, what in the US Is being realized is a real problem is this. Insurance companies denying coverage, and then the provider or the physician and the insurers going like this for days or months. And one of the things I want to do with the boards that I sit on is try to get a provider and a payer to work together, to collaborate. And that can be done via technology. Right. There's no reason why when a physician puts in what they want done, and if the payer knows what they're going to cover, that that can't just be an automated fashion. And in minutes the physicians should hear that everything is covered or not without anybody picking up the phone. So that's another example of where I think technology can really make a difference in not having all this money wasted.

Speaker B: That's an incredible ambition to have, and as you've said, one that is so ubiquitously required within the US healthcare system. It sort of leads me to a very related question, which is whose job is it to keep people healthier for longer? And I say that because in a very fragmented system, everybody has their own incentives, everybody has a job to do, and they get paid in a certain way. And, um, the optimization of that process may involve better outcomes for the patient, but may not. It may only kick in when you actually get to treat somebody when they're sick in certain cases. So we're living in a world where, um, as I said, healthcare is becoming increasingly unsustainable in terms of the cost. The burden of disease is increasing. I think everybody is recognizing at a strategic level that we have to get better at preventing these diseases, but the incentives are not necessarily aligned. Here are the sort of programs that you're talking about addressing those kind of issues, as well as the pragmatic business of ensuring that people get the care that they need as quickly as possible and with as little friction as possible.

Speaker A: So right now, Steve, I don't think there is a lot of momentum behind that. Right now, the providers have the responsibility of helping their patient, but they don't have the time. They don't see them often enough. Patient doesn't always want to come in when they're supposed to. So it's Very difficult. The insurer is financially incentivized to keep their members healthy because if their members stay healthy then they're not going to end up in the emergency room with a very expensive process. But somehow that is not rising to the top. What's rising to the top is something more immediate. But if we decide not to reimburse this or that, we'll save money as an insurer as opposed to if we keep the member healthy. And the reason why insurers will be little less motivated to really worry about their members health is because if that person changes jobs next year, they're with a new insurance company. So the fact that you kept them um, healthy and out of the emergency room for the next two years, somebody else is going to benefit from it. And folks in the US go from insurer to insurer. So there isn't that sort of long term, let's keep the member healthy incentive that will rise to the top. Consequently in the US there's a big move now for everybody to just take control of their own healthcare.

Speaker B: I was going to go there because I think if, particularly if you're uh, I think the average cost of healthcare in the U.S. insurance in the U.S. is pushing $14,000 per person per year. If you're relatively young, which is usually when you're healthiest, you may well look at that and think, you know, if I'm not getting this through employment, if I'm not getting it through my job, that's a lot of money to be taken out. I'm trying to save for a home, I'm trying to bring a, you know, a new family up. Um, it's when you're earning least but you need that money perhaps the most. So how do you see healthcare going in terms of perhaps a change from uh, as you were alluding to that insurance led. Oh, I'm always going to be in a plan. It may be a different plan but I'm going to be in a plan to that management, that self management of health, perhaps with more direct to consumer, uh, perhaps working through pharmacies rather than with an insurance plan. Is that a trend that is prevalent in the US health system?

Speaker A: I would say that's probably the strongest trend right now in trying to improve health in the US because none of the other things have worked. The way the providers and insurers interact is very expensive and doesn't have the patient in the center. So I'd say over the last three to four years, relatively recent people are grabbing the responsibility themselves. And what's really Pushed it over the edge is a lot of subsidies. I talked to the marketplace where you can go and get your own insurance. Well, that was fairly heavily subsidized by the federal government. Those subsidies have been cut some completely, some to different degrees. So people who are paying $1,000 a month now have to pay $2,000 a month and their income may only be $30,000. So they're like, this is crazy. And it comes along with a high deductible. So you know, the first $5,000 you're paying yourself anyway before you get any of the benefits and insurance. So people are just saying, I will take that money, I will put it in the bank that I would have used to pay for insurance and that's what I'm going to use when I need it. And obviously that is a risky proposition, but less RISKY if you're 24, 28, 32 years old, where you're healthy and you haven't been, uh, in the hospital your whole life or you haven't had a medical condition. I mean, obviously if you have an ongoing medical condition, it's going to be different, but for somebody health. And the problem is when you take the healthy folks out of the pool, it makes healthcare so much more expensive for everybody else.

Speaker B: I was gonna say, you know, you're adding risk to that pool and you're adding probably a burden of some of the more expensive drugs in there as well. So, you know, we know that GLP1s have been very widely used. They're typically, I think in the data that we've seen, the average age, uh, a GLP1 patient is approaching 60. And obviously they're fairly high BMI, often diabetic at the same time. Those are your really expensive people. They're going to have a lot of other morbidity, they're going to have multiple chronic illnesses and perhaps be progressing to some of the more expensive complications. Is it inevitable that insurance companies are going to have to be serving that population or are there things that they can do to use benefits to long term health, perhaps to attract some of those younger members back in. What's the thinking around that? Are there things that can be done?

Speaker A: Yeah, I think so. I think the earlier we could diagnose patients with chronic conditions and get them on disease modifying therapies. That's got to be the answer in the long term because by the time you're 60 and you've been struggling with diabetes for 30 years or however long it's been, or 65 or 70 years old, your body's beaten down and something's gonna give. So the only way to really get in front of that is to go back and be able to diagnose people with these chronic diseases much earlier, be able to control those diseases with therapies much earlier and don't let the disease progress the way it will on its own. And at a certain point you lose control and now you're just fighting symptoms and then, you know, you essentially lost the battle. So I think that's the answer Steve. And luckily technologies are emerging to enable us to do that. And that's in everybody's interest. That's in the interest of the patient, of the insurer, in the physician. So I think that's going to be a big piece of the future.

Speaker B: Over the course of your career, you've seen other industries be utterly transformed. You know, you've been in fast uh, moving consumer goods, you've been in banking, the digitalization and um, the personalization of those industries was utterly profound. And it happened, it happened while you were working for them 20 odd, 30 years ago. Do you find that healthcare has been slower to adopt those that personalization, the use of data, the tracking of patients, and if so, why do you think that is?

Speaker A: I think it has a lot to do with leadership. You can go back to Citibank which was the first with ATMs under at the time, the leadership of John Reed, who was the CEO. John Reed was a technologist. He understood technology, he drove that. He said this is the future, this is what we have to do. And he led the whole industry and started the whole digitization, including the ATMs. If you look to fast moving consumer goods, it was driven by marketing. And marketing is all about data, about understanding people and what are their habits. So that leadership there was driven more and more by data which drove the technology. In healthcare you have, no offense to science, but in the pharma industry you often had a scientist leading the way. And back 20, 30 years ago technology played a role, but it wasn't a strategic role, it was an adjunct of sorts. And that's how technology, at least my experience was envisioned. It started to change a little bit. Oh, we could really use SAP for warehousing and logistics and so on, but it never made its way all the way back. And similar in the hospital systems. I mean it wasn't till five or 10 years ago that just the thought of an electronic medical record, how important that is. But now it's changing. As I mentioned a little earlier, five, six, seven years ago, like Eric Dixon 10 years ago, whatever it was when he made that, when he called me up and said, technology is the way to go. But it depends a lot on the leadership in the, a certain degree what drives the industry. Right. So if discovery via, uh, in vitro research is what was really leading the pharmaceutical industry, well, then that's what they're going to stick with. And maybe that, that wasn't a bad thing, but that's why they're, you know, lagging. But especially with the AI, bit of a craziness right now.

Speaker B: Well, I was going to ask about that. And do you see the pace of change accelerating? And is that to do with the general trend that we see personalization throughout our lives? The books that are recommended to us, the TV shows that are recommended to us, the music we listen to, the bank accounts we choose, the expectation is that everything is going to be tailored to one level or another. I think that's much less so, uh, I think it's changing a little bit, but I think it's much less so still in healthcare, do you think that it is accelerating or that AI is going to play a fundamental role in making health more personalized, or, uh, are we in for five more years of incremental change in the way that things have worked before?

Speaker A: I don't know if AI will drive that change. So first of all, I believe that the focus on personalized precision medicine is on the upswing, without a doubt largely thanks to the experiences with oncology. So we've made a real difference there on saying this oncology drug will work for you or not, or your mechanism of action in your particular type of cancer. This is why we don't have that anywhere else in chronic diseases. So without the underlying science underneath, how to stratify patients in a way that's going to make a difference. AI will certainly help, but I don't think on its own it's going to drive. I think AI is going to make a big difference in the administrative functions. Like, you know, there could be again, two AI bots of sorts talking to each other to say, yes, your therapy is reimbursed, go in 40 seconds. That's possible. But to put AI on top of science we don't understand can be helpful to a degree, but it's not going to get, get what people are expecting. They're going to expect to go to the doctor, and when they get a therapy, they're going to expect it to work and not have the doctor say to them, well, we've got four choices here. We're not sure. Which one of these therapies for your high blood pressure are going to work? Let's try this and this. And if that doesn't work, then we'll monitor you for six months. And if that doesn't work, that has to change and expectations are. It should change.

Speaker B: Yeah, I mean I think that's um, perhaps something that's underappreciated is very often your experience of disease going into a clinician is that you get sucked into, through a diagnosis, you get sucked into a single clinical care pathway. And it is, we're going to try certainly in the UK in social care system, we're going to try the cheap stuff first. Uh, and if that doesn't work, then you can go on to the next thing. And if that doesn't work then you can go on to the next thing. And if all else fails, we'll put you on something, an expensive biologic drug or something like that. The reasoning behind that is a framing that drug costs particularly are a very important part of healthcare expenditure and you uh, don't wanna pay more for drugs if you can avoid them, if there are generic versions of, of the same thing, or if you can treat a proportion of the patient population with something that's cheaper. Is that sort of care pathway perspective and particularly where you may feel comfortable going through multiple rounds of treatment with drugs just because that's what is recommended at that stage of treatment. Is that something that's actually being used changed in complex chronic diseases? You talked about oncology and it's absolutely been changed there. Uh, do you see the same willingness to build more adaptive and personalized care frameworks? And um, is the structure of, particularly of healthcare in the US helping or hindering that?

Speaker A: The structure as it exists today is hindering it. What's helping it is back to people taking control of their own healthcare. So people are now willing to, to pay for their own lab tests, they're willing to gallery that test. People are paying $1,000 for um, if they can get a more precise diagnosis, people are willing to pay for it. And with a more precise diagnosis and, or even an educated diagnosis, they go to their physician. And in the US at least you're allowed to say I want this drug. And when you go to a physician and say I want this drug, there's statistics out there of how often you actually get it and it's pretty. So the physician does not want to deny you what you research, what you want, and you usually get the drug you want. So I don't think it's going to be the physicians necessarily. I mean there are some very progressive and who, et cetera. But I think there's going to be a lot of folks like you and I going into the physician and saying, well, I took this test and this diagnosis maybe isn't an exact diagnosis, but it explains the mechanism and here's what I want. And I think once the patients or the population start doing that, then that'll shift healthcare to like, well, wait a minute, this is happening. Why don't we, the physician, why don't we as a payer start paying for these tests so we can get the people on the right drugs? So I think that'll probably drive it, Steve, more than the existing system.

Speaker B: Yeah, it's interesting, isn't it? I suspect that, that social care systems will kind of have a slightly different dynamic to them in the sense that you own the problem of patients from the moment of birth, uh, all the way to death, and you're amortizing your costs across a whole lifetime rather than not across one or two years on a particular plan. But equally, we've struggled outside of oncology for sure to establish the principle of that sort of personalization of care. Uh, it's really difficult to have multiple specialists coming together and, you know, and figuring out which therapy might be the most appropriate for you to go on ahead of trying two or three others. And I certainly don't think that we have the culture that you can particularly go in to your clinician and ask for a specific therapy and expect to be particularly successful at, uh, getting that unless it's, you know, something that's pretty close to the clinical care pathway anyway,

Speaker A: like many of these things just goes down to people. In the end, I think the provider system is going to have to realize the shift that's going on and as the science and the tools to better diagnose earlier diagnoses and more targeted treatments that they'll come along with it. But I think it's gonna start with the individual saying, I've had enough.

Speaker B: We've got a little bit of an epidemic of what are sometimes called lifestyle related diseases in the West. We've seen the length of a health healthy lifespan. So that period where a person is free of disease diminishing very rapidly in the US and less so, but still diminishing in the uk. We know that as you get older, when you have multiple of these conditions, you really start to become expensive to manage. So maybe five times more expensive to treat someone over the age of 65 on average than under. And we Also know that the number of people achieving that sort of age and living quite long but, but with multiple chronic diseases is increasing rapidly. Ten years on from now, when these problems are really starting to hit, what decisions do you think healthcare leaders could have made today that might result in them not looking back and saying, well, actually we had the tools. If only we had done this, if we'd only acted in this way, we could have avoided a lot of the, these kind of problems?

Speaker A: Yeah, no, it's, uh, a great question and I think it's so timely because when you think about it, folks our age, Steve, you know, when our parents were growing up, they were lucky to get through the 50s and 60s, of course, of heart conditions. And we've since handled that. And now. So people are living long enough to get cancer, and we've made a big impact on cancer. Long way to go, but a big impact. So now people are living longer and what's getting them, um, is chronic conditions, als, Alzheimer's, diabetes, you pick it. So I think if people were to look back 10 years and say what they could have done different is got more interested in chronic complex diseases and try to get underneath it earlier. Because 10 years from now that's gonna be the issue. That's where everybody's gonna be starting. It's already starting. And I think, think if the insurers could somehow get together and say, look, you're going to pass me a member and I'm m going to pass you a member. So it's in our collective interest to keep these people healthy. Why don't we try to work together and similarly with the providers? It's so expensive for the providers to have all this administrative system to talk to insurers. Why didn't we work on that sooner and why didn't the insurance community come together to, again, as we've said a few times, get an earlier diagnosis of these chronic diseases, get them on the right therapy sooner, don't let the disease progress. So by the time they're 70, maybe the disease is there, but it's much better managed. If not well managed. It'll probably be some combination of. We should have removed more administrative burden from the system so we could focus on the patient. And we should have gotten more interested in chronic complex diseases and getting underneath them sooner rather than later would be my guess.

Speaker B: And particularly I think, the prevention agenda and setting out incentives for maintaining health. We're seeing it sort of in some of the programs. I know that if I do more exercise, our, uh, private health insurer in The UK will pay for my Amazon prime subscription or they will buy me a coffee every week. I get rewards for the right kind of behavior. And I wonder if that may help nudge, um, people along a little bit as well.

Speaker A: I think it will. But so much is motivated, at least here in the States, by the almighty dollar. What I see happening is like with Amazon's one medical, right? So they're putting that in corporate settings, whether it's a corporate headquarters, a, uh, corporate park, paid for by the employers, because the employers want to get the most out of their people. And if they have early onset diabetes, they want it treated correctly. Women suffering from chronic pelvic pain don't just fight through it. Go downstairs. You don't have to go to your doctor. Go downstairs and they're gonna work with you. So I think a lot of it may get driven, or portions of it, I should say. I think portions of it will be driven from models that we don't know about yet. So it's models like that I, uh, wouldn't, I've thought of several years ago that are happening in a big way with the Amazons. And there's a lot of money to be funneled in this direction. And healthcare is for every company that I ever work with. Our industry that we're focused on selling our product to is healthcare, whether all the technology. So I think there's going to be models that emerge that can be a lot of tests for sure, like one medical, and then I'm sure a few of them will rise to the top.

Speaker B: So, um, okay, just to finish off, we've sort of started bright and, you know, coming in and doing transformation. We've got a little bit worried about the current trends. We're starting to come back to some of the things that are going on that may solve some of these problems. But before we let you go, what gives you the most optimism that we can overcome these challenges and we are going to be able to make a difference? You are going to see precision preventative medicine being a much more normal part of the maintenance of health in populations actually around the world, not just in the US or uk, but around the world.

Speaker A: I think what gives me the most optimism is the fact that technology has finally reached the healthcare industry and boards have ex CIO on them, almost all of them pharmaceutical companies. So it's no longer just something, uh, on the side, a necessary evil. It is now a strategic pillar in healthcare. And that gives me a lot of optimism because it's gotta be a huge part of the way we get out of this, which is leveraging new platforms, new science, new technologies, whether it's AI, and in the past it was, we gotta do more of the same, better to get out of this. And that mindset is changing. I sit on the board of a, uh, payer, and I remember one of the board members said those exact words, we're talking about how we're going to get through this. And he said, guys, doing more of the same, better is not the way out of here. We have to start looking at new technologies, new ways of treating the patients, new ways of diagnosing patients, better precision medicine. And for that conversation to be happening at the board says a lot to me versus a bunch of IT guys over coffee saying that, uh, not that that's a bad thing. And with the board giving that direction to a CEO. So that's what gives me optimism. I think the openness to doing things differently and coupled with the next generation of leaders have sort of grown up with technology now and they're ready to embrace it. Whether it's a physician or a physician moving up the ranks in a hospital, whether it's a payer, you name it, the folks coming in now have grown up with it, uh, and are more open to it. So that's going to be a big help as well.

Speaker B: Well, I really appreciate the chance to talk through some of these things. Your insights across all of those industries are fantastic. And I think it's made it very clear that there is an element of transformation that's required here. It's a, uh, combination of technology, culture, leadership that's actually going to be required. But the prize is well worth having. If we can improve health for people, if we can make medicine more precise and particularly more preventative, that is a very, very worthwhile goal indeed. So thank you very much, Ray, really appreciate your thoughts and sharing them with us. And, um, any last words for the listeners?

Speaker A: No, not really, other than, and thank you, Steve, for having me. And I guess my last thought will be, and it's a little bit negative, but we don't have much of a choice. We've got to change because we're running out of money. The whole world's running out of money. This is not sustainable. When that happens, boy, necessity to motherhood of invention shows up and I think that's where we are. So that, again, bit of a negative comment, but that's what gives me the optimism. There isn't a choice. And that really is somehow really helping us.

Speaker B: Yeah, I agree. Thank you.

Speaker C: If this episode changed the way you think about precision medicine and chronicles disease, share it with someone who should be part of the conversation. For more discussions on how a deeper understanding of disease biology is reshaping healthcare, follow Biology Matters wherever you listen. You can also learn more about precision life and the work that we're doing@PrecisionLife.com and remember, the better we understand disease, the better we can predict, treat and prevent it. Biology Matters. Until next time, Sam.