Why Medical Knowledge Isn’t Reaching Patients with Dr. Simon Chowdhury

1 00:00:01,919 - > 00:00:04,320 SPEAKER_00: I can remember in November 2019, I was chatting to 2 00:00:04,320 - > 00:00:06,879 a guy called Mark Wildgust, who's a pretty senior guy at 3 00:00:06,879 - > 00:00:08,800 Jansen, the super, super, super person. 4 00:00:08,960 - > 00:00:12,240 And we were talking about how one implemented some of the 5 00:00:12,240 - > 00:00:14,640 novel therapies in prostate cancer and what was the 6 00:00:14,640 - > 00:00:15,279 comparator. 7 00:00:15,359 - > 00:00:17,039 And I said, Well, I was talking about chemotherapy. 8 00:00:17,199 - > 00:00:19,199 He sort of said, Simon, no one gets chemotherapy. 9 00:00:19,280 - > 00:00:20,879 And I was like, No, they do, Mark, they do. 10 00:00:20,960 - > 00:00:22,320 We did these studies, they showed whatever. 11 00:00:22,399 - > 00:00:23,600 And he was like, no one gets chother. 12 00:00:23,679 - > 00:00:26,320 And he then he showed me some market research, and no one got 13 00:00:26,320 - > 00:00:27,039 chemotherapy. 14 00:00:27,120 - > 00:00:29,679 And I audited my own practice and it was very low. 15 00:00:29,920 - > 00:00:31,600 It was a real eureka moment for me. 16 00:00:31,679 - > 00:00:34,159 It was a moment where I realized that just because something's 17 00:00:34,159 - > 00:00:36,399 published in the New England Journal of Medicine doesn't mean 18 00:00:36,399 - > 00:00:39,200 it's going to make it into the clinic, even my own clinics. 19 00:00:39,280 - > 00:00:41,520 And then I said to people in my academic group, how many 20 00:00:41,520 - > 00:00:42,719 patients then get chemotherapy? 21 00:00:42,880 - > 00:00:44,240 And everyone said 70-80%. 22 00:01:40,879 - > 00:01:43,920 SPEAKER_01: On today's episode of Pharma Sessions, I am 23 00:01:43,920 - > 00:01:45,359 thrilled to welcome Dr. 24 00:01:45,439 - > 00:01:48,480 Simon Chowdhury, a medical oncologist and a leader in 25 00:01:48,480 - > 00:01:51,760 urological to cancer care, clinical research, and medical 26 00:01:51,760 - > 00:01:52,400 education. 27 00:01:52,640 - > 00:01:52,879 Dr. 28 00:01:53,040 - > 00:01:56,159 Chowdhury has spent his career at the intersection of the 29 00:01:56,159 - > 00:01:59,439 frontline oncology practice, clinical trials, translating 30 00:01:59,439 - > 00:02:01,760 complex science into better patient care. 31 00:02:01,920 - > 00:02:04,799 And what makes his perspective really compelling is his focus 32 00:02:04,799 - > 00:02:07,920 on a challenge that is affecting nearly every part of medicine 33 00:02:07,920 - > 00:02:08,400 today. 34 00:02:08,639 - > 00:02:10,719 How do we get the right knowledge to the right 35 00:02:10,719 - > 00:02:13,199 clinicians and patients in a form they can actually use? 36 00:02:13,439 - > 00:02:16,080 So we're going to talk a bit today about a project that 37 00:02:16,080 - > 00:02:18,400 Simon's working on that's really, really interesting 38 00:02:18,479 - > 00:02:21,680 called Open Medicine, which is attempting to bridge the gap 39 00:02:21,680 - > 00:02:25,840 between academic expertise, real world care, and provide trusted 40 00:02:26,080 - > 00:02:29,039 doctor-led education, really in a world that's absolutely 41 00:02:29,039 - > 00:02:30,560 flooded with misinformation. 42 00:02:30,719 - > 00:02:32,479 So misinformation, I should say. 43 00:02:32,639 - > 00:02:34,159 So I'm pretty excited about this. 44 00:02:34,240 - > 00:02:36,400 It's a topic that I have a lot of personal interest in. 45 00:02:36,560 - > 00:02:38,080 I think it'll be a great conversation. 46 00:02:38,319 - > 00:02:40,800 Simon, did I do an okay job introducing you? 47 00:02:41,280 - > 00:02:43,599 SPEAKER_00: You were far too kind, Jonathan, far too kind. 48 00:02:43,840 - > 00:02:44,719 But thank you very much. 49 00:02:44,879 - > 00:02:48,000 And uh I'm really excited to be here and really excited to chat 50 00:02:48,000 - > 00:02:51,199 to you about the new project and how that may well fit in and 51 00:02:51,199 - > 00:02:53,919 hopefully help shape medical education and improve the sheet. 52 00:02:54,159 - > 00:02:54,319 SPEAKER_01: All right. 53 00:02:54,400 - > 00:02:57,280 So before we get into all of that, I always like to do a 54 00:02:57,280 - > 00:02:58,400 quick get to know people. 55 00:02:58,479 - > 00:03:02,000 And lately I've been on this kick of uh asking as an 56 00:03:02,000 - > 00:03:07,840 icebreaker, what is your go-to or go-to's for karaoke when 57 00:03:07,840 - > 00:03:08,960 you're forced to perform? 58 00:03:09,120 - > 00:03:10,319 SPEAKER_00: Or maybe choose to perform. 59 00:03:10,800 - > 00:03:11,439 You come to London. 60 00:03:11,759 - > 00:03:13,599 I think Jonathan's actually a very talented musician. 61 00:03:13,680 - > 00:03:15,120 There's a guitar in the background. 62 00:03:15,280 - > 00:03:19,439 I'm a very enthusiastic uh mute karaoke singer, and I was once 63 00:03:19,439 - > 00:03:21,919 told when I was singing very much out of key that I should 64 00:03:21,919 - > 00:03:24,879 sing Daydream Believer by the monkeys because they were a 65 00:03:24,879 - > 00:03:27,840 manufactured band and it's got a very narrow vocal range. 66 00:03:27,919 - > 00:03:29,439 So probably that's one of my songs. 67 00:03:29,599 - > 00:03:32,639 And then my goddaughter Adele got me to learn the lyrics to 68 00:03:32,639 - > 00:03:35,759 super bass by Nicki Minaj, which is super difficult to learn. 69 00:03:36,080 - > 00:03:38,479 Took me four months of walking around London medical 70 00:03:38,479 - > 00:03:41,439 conferences doing this wonderful boys and boom system, top-down 71 00:03:41,520 - > 00:03:43,120 AC with the cooling system, etc. 72 00:03:43,360 - > 00:03:43,599 etc. 73 00:03:43,919 - > 00:03:46,400 So those are the ones we'll do, Jonathan, when we love it. 74 00:03:46,639 - > 00:03:48,400 SPEAKER_01: Unfortunately, I have a lot of enthusiasm for 75 00:03:48,400 - > 00:03:48,719 singing. 76 00:03:48,879 - > 00:03:52,560 I can play the guitar okay, but I know I'm not tone-deaf because 77 00:03:52,560 - > 00:03:55,599 I can hear my own singing and I can hear what it sounds like, 78 00:03:55,680 - > 00:03:59,520 but that is just a skill that uh unfortunately passed me by. 79 00:03:59,759 - > 00:04:02,240 But I will say that doesn't prevent me from trying to do a 80 00:04:02,240 - > 00:04:06,400 Chris Cornell impersonation at at any given moment in time. 81 00:04:07,439 - > 00:04:10,400 So, all right, let's start by looking back a bit. 82 00:04:10,479 - > 00:04:13,120 Why don't you I know you've done a lot in oncology and research 83 00:04:13,199 - > 00:04:14,639 and medical education? 84 00:04:15,039 - > 00:04:19,279 Maybe take us through a little bit of your career, but one 85 00:04:19,279 - > 00:04:21,920 thing that's always interesting is the motivation, right? 86 00:04:22,000 - > 00:04:25,120 What first drew you to this work and and what's kept you 87 00:04:25,120 - > 00:04:26,160 committed to it? 88 00:04:26,560 - > 00:04:28,959 SPEAKER_00: I think I was thinking about this, and what 89 00:04:28,959 - > 00:04:30,480 drew me to the work was the patients. 90 00:04:30,720 - > 00:04:33,839 So, age five, my dad wanted to be the doctor who wanted me to 91 00:04:33,839 - > 00:04:36,800 go to Cambridge University and be a doctor at Guy's Hospital. 92 00:04:36,879 - > 00:04:38,480 And and that's what I ended up doing. 93 00:04:38,720 - > 00:04:39,839 Which one of us more mad? 94 00:04:40,000 - > 00:04:40,639 Probably me. 95 00:04:40,800 - > 00:04:44,000 And as a very wet, behind the ears 24-year-old, I ended up on 96 00:04:44,000 - > 00:04:44,959 the wards at Guys and St. 97 00:04:45,120 - > 00:04:46,160 Thomas' Hospital. 98 00:04:46,319 - > 00:04:49,439 And the thing that I noticed was how amazing the patients were. 99 00:04:49,600 - > 00:04:51,360 You just saw the best of human nature. 100 00:04:51,439 - > 00:04:54,800 So I would be coming in on a Monday morning, often having 101 00:04:54,800 - > 00:04:57,279 maybe done some karaoke at the weekend, and the patients were 102 00:04:57,360 - > 00:04:58,560 like, Oh, it's lovely to see you, Dr. 103 00:04:58,639 - > 00:04:59,040 Cherry. 104 00:04:59,279 - > 00:04:59,839 How's your mum? 105 00:04:59,920 - > 00:05:00,480 How's your dad? 106 00:05:00,639 - > 00:05:02,079 How did Manchester United do? 107 00:05:02,160 - > 00:05:04,079 Or the Boston Celtics, maybe. 108 00:05:04,240 - > 00:05:07,680 And I was just amazed at that the you saw the best of human 109 00:05:07,680 - > 00:05:08,000 nature. 110 00:05:08,079 - > 00:05:12,240 So it really motivated me to work hard to try and help those 111 00:05:12,240 - > 00:05:12,399 people. 112 00:05:12,560 - > 00:05:16,480 And I think probably my parents came from very, very simple 113 00:05:16,480 - > 00:05:18,800 backgrounds, and they worked very hard, they were very 114 00:05:18,800 - > 00:05:21,279 determined, they were smart people, very kind people. 115 00:05:21,600 - > 00:05:24,639 And I think they gave me a real I had opportunities that they 116 00:05:24,639 - > 00:05:25,120 never had. 117 00:05:25,199 - > 00:05:27,920 And so I wanted to do something in an area where there was 118 00:05:27,920 - > 00:05:28,720 clearly need. 119 00:05:28,879 - > 00:05:32,720 And oncology has was the intersection of need and also 120 00:05:32,720 - > 00:05:33,839 just amazing patients. 121 00:05:33,920 - > 00:05:36,639 You just see the best of human nature, and you still do, and 122 00:05:36,639 - > 00:05:37,920 you see such fortitude. 123 00:05:38,000 - > 00:05:40,079 You see the best of human nature, the best of human 124 00:05:40,079 - > 00:05:40,399 spirit. 125 00:05:40,560 - > 00:05:44,399 So helping cancer patients is just a passion for me, and it's 126 00:05:44,399 - > 00:05:47,680 hard because a lot of cancer patients still don't do well, 127 00:05:47,920 - > 00:05:49,279 but they're amazing people. 128 00:05:49,519 - > 00:05:51,920 I'm very, very privileged to have many of them in my life. 129 00:05:52,000 - > 00:05:53,600 SPEAKER_01: So yeah, that's absolutely incredible. 130 00:05:53,680 - > 00:05:56,639 I mean, you're talking about seeing people going through what 131 00:05:56,639 - > 00:05:59,759 is oftentimes probably the hardest thing that they or they 132 00:05:59,920 - > 00:06:02,720 families will have to personally deal with. 133 00:06:02,879 - > 00:06:06,000 So there must be how do you I guess it's a question, just a 134 00:06:06,000 - > 00:06:08,079 personal question for me, but you've been doing this for quite 135 00:06:08,079 - > 00:06:08,399 some time. 136 00:06:08,639 - > 00:06:11,360 How do you deal with that emotionally, right? 137 00:06:11,439 - > 00:06:14,319 So that you're able to provide that support and be vested. 138 00:06:14,480 - > 00:06:17,279 But as you say, some of these prognoses are really pretty 139 00:06:17,279 - > 00:06:17,680 grim. 140 00:06:17,920 - > 00:06:19,680 SPEAKER_00: I think I'm probably the worst person to say how to 141 00:06:19,680 - > 00:06:20,000 deal with it. 142 00:06:20,079 - > 00:06:22,800 I'd probably deal with it a karaoke barn with I think great 143 00:06:22,800 - > 00:06:23,040 friends. 144 00:06:23,120 - > 00:06:24,480 I've got incredible friends. 145 00:06:24,639 - > 00:06:26,560 And I think now I recognize it a lot more. 146 00:06:26,639 - > 00:06:29,279 So one of the reasons why I've stepped away to a degree from 147 00:06:29,279 - > 00:06:31,759 clinical medicine is got too much for me, to be honest. 148 00:06:32,000 - > 00:06:35,680 Got to a point where I was just too emotionally engaged. 149 00:06:35,759 - > 00:06:38,160 Um, one of my bosses, who's sadly no longer with us, a guy 150 00:06:38,160 - > 00:06:41,120 called Martin Gore from the Boar Marsden, he said to me, You 151 00:06:41,120 - > 00:06:41,839 really care, don't you? 152 00:06:41,920 - > 00:06:42,959 And I said, Doesn't everyone? 153 00:06:43,040 - > 00:06:44,720 He said, No, not everyone does, Simon. 154 00:06:44,800 - > 00:06:47,279 And he said, You like me will run into compassion fatigue. 155 00:06:47,360 - > 00:06:48,160 And I think I did. 156 00:06:48,399 - > 00:06:51,920 And I think now with open medicine and just doing a little 157 00:06:51,920 - > 00:06:54,480 bit of clinical medicine, I've got a much better balance. 158 00:06:54,639 - > 00:06:57,439 I think the volume of patients I was seeing before was just too 159 00:06:57,439 - > 00:06:57,519 much. 160 00:06:57,759 - > 00:07:00,560 I look at a lot of my friends, colleagues, in awe of them. 161 00:07:00,639 - > 00:07:03,439 And I think one of the things that we're trying to do is to 162 00:07:03,439 - > 00:07:07,040 make life easier for doctors and patients, just so that the 163 00:07:07,040 - > 00:07:10,800 increasing complexity of science, medicine, therapies, 164 00:07:10,959 - > 00:07:12,560 it's really hard to stay on top of that. 165 00:07:12,639 - > 00:07:14,480 And I think people are burnt out. 166 00:07:14,639 - > 00:07:18,560 So I think if we can simplify things and make life a bit 167 00:07:18,560 - > 00:07:23,040 easier for everyone, that's so before we get into open medicine 168 00:07:23,040 - > 00:07:24,480 and what you're working on now. 169 00:07:24,560 - > 00:07:28,160 SPEAKER_01: Uh when you transitioned away from clinical 170 00:07:28,160 - > 00:07:31,120 practice or or somewhat, what are you transitioning into? 171 00:07:31,279 - > 00:07:32,879 What were you working on prior to this? 172 00:07:33,199 - > 00:07:36,079 SPEAKER_00: So I was working very much in an academic 173 00:07:36,079 - > 00:07:37,040 clinical centre. 174 00:07:37,199 - > 00:07:40,399 I was the head of the GU uh department there, which was 175 00:07:40,399 - > 00:07:40,720 great. 176 00:07:40,959 - > 00:07:43,519 In South London, which I love London. 177 00:07:43,600 - > 00:07:46,160 It's a brilliant city, it's got a great vibrancy. 178 00:07:46,240 - > 00:07:49,360 It's also got a huge amount of poverty immigrants. 179 00:07:49,519 - > 00:07:52,000 My dad was an immigrant to this country to the UK. 180 00:07:52,160 - > 00:07:53,600 So I actually really like the mix. 181 00:07:53,680 - > 00:07:55,040 I love the diversity of London. 182 00:07:55,279 - > 00:07:57,439 There's complex type of diversity for both of our 183 00:07:57,680 - > 00:07:58,079 countries. 184 00:07:58,319 - > 00:08:02,959 But for me, looking after people from India, Australia, the West 185 00:08:02,959 - > 00:08:06,800 Indies, Europe, as well as the indigenous South London 186 00:08:06,800 - > 00:08:09,519 population, there's a real authenticity there. 187 00:08:09,680 - > 00:08:12,480 I'm always sort of saying to people, I don't particularly 188 00:08:12,480 - > 00:08:15,040 want to look after people who don't have real problems. 189 00:08:15,120 - > 00:08:18,079 Now I now see that anyone coming to a doctor probably does have a 190 00:08:18,079 - > 00:08:18,560 real problem. 191 00:08:18,720 - > 00:08:20,959 But I think back in the 90s, I was probably a little bit 192 00:08:20,959 - > 00:08:24,480 dismissive of some of the more softer problems and some of some 193 00:08:24,560 - > 00:08:27,040 things around mental illness, such as I'd be much more attuned 194 00:08:27,040 - > 00:08:27,439 to now. 195 00:08:27,600 - > 00:08:30,800 But I think there's an authenticity in that population, 196 00:08:30,959 - > 00:08:34,799 and there's an authenticity in oncology that I think is just it 197 00:08:34,799 - > 00:08:36,559 really, it really speaks to me. 198 00:08:36,799 - > 00:08:40,720 So in the unit there, we built it from quite a small unit up 199 00:08:40,720 - > 00:08:43,759 into one of the world leading units, a lot of research. 200 00:08:43,919 - > 00:08:46,639 And then I realized that actually to get the research out 201 00:08:46,639 - > 00:08:49,120 there, we needed to get the education, and that became a 202 00:08:49,120 - > 00:08:49,840 passion for me. 203 00:08:50,080 - > 00:08:51,919 Working a lot with with pharma. 204 00:08:52,000 - > 00:08:54,480 I think there's a lot of some people are very dismissive of 205 00:08:54,480 - > 00:08:55,840 pharma, but I'm certainly not. 206 00:08:56,000 - > 00:08:59,039 It's very easy for doctors to make out that we're the that 207 00:08:59,039 - > 00:09:01,279 we're the uh we're the angels and they're the devils, 208 00:09:01,440 - > 00:09:03,519 whatever, the good guys, the bad guys and girls. 209 00:09:03,679 - > 00:09:04,720 It's definitely not like that. 210 00:09:04,799 - > 00:09:05,759 We're all on the same team. 211 00:09:05,840 - > 00:09:07,200 We we all want the same thing. 212 00:09:07,360 - > 00:09:10,159 And I've been so impressed with my pharma colleagues and friends 213 00:09:10,240 - > 00:09:12,320 who have a real passion to to improve things. 214 00:09:12,480 - > 00:09:15,200 SPEAKER_01: So I think we all need to work together and just 215 00:09:15,440 - > 00:09:18,080 do what we can to get the right therapies to the right people 216 00:09:18,080 - > 00:09:23,120 and make the that's been my experience working with pharma 217 00:09:23,360 - > 00:09:26,639 too, you know, particularly in medical affairs, is where I've 218 00:09:26,639 - > 00:09:27,919 spent a good deal of time. 219 00:09:28,000 - > 00:09:30,879 And those people are really just get the right patient to the 220 00:09:30,879 - > 00:09:32,240 right drug at the right time. 221 00:09:32,320 - > 00:09:35,600 But even, I mean, if we if we're being honest about it, there's a 222 00:09:35,600 - > 00:09:38,720 real need for commercial to move faster because at the end of the 223 00:09:38,720 - > 00:09:41,840 day, a medicine sitting in a lab doesn't help anybody, right? 224 00:09:41,919 - > 00:09:45,039 It needs to get into patients' bodies, and that means there's a 225 00:09:45,039 - > 00:09:47,840 lot of stuff that has to happen and it needs to get regulatory 226 00:09:47,840 - > 00:09:49,600 approval and all of that. 227 00:09:49,759 - > 00:09:52,720 So I think that it's it needs to be give and pull. 228 00:09:52,799 - > 00:09:54,000 This is or give and take. 229 00:09:54,080 - > 00:09:55,840 This is my personal 100%. 230 00:09:56,480 - > 00:09:58,240 SPEAKER_00: To be honest, without the commercial world, we 231 00:09:58,240 - > 00:10:00,639 wouldn't have the finances to develop these drugs. 232 00:10:00,720 - > 00:10:04,720 So I think we need to probably reassess some aspects of it, but 233 00:10:04,720 - > 00:10:07,840 I think far too many doctors are dismissive of that side of it. 234 00:10:07,919 - > 00:10:10,960 It's a commercial world, and actually, part of our role is to 235 00:10:10,960 - > 00:10:14,000 help get those therapies out there because the successful 236 00:10:14,000 - > 00:10:16,720 therapies will pay for the trials that lead to other 237 00:10:16,720 - > 00:10:17,759 therapies coming through. 238 00:10:17,919 - > 00:10:19,120 Uh, I strongly believe that. 239 00:10:19,200 - > 00:10:22,080 And, you know, as I say, I work a lot with people in pharma and 240 00:10:22,080 - > 00:10:24,159 they're often the smartest and most decent people. 241 00:10:24,240 - > 00:10:26,879 And then you have to look at the vaccine programs that happened, 242 00:10:26,960 - > 00:10:28,399 you know, that wasn't that long ago, you know. 243 00:10:28,480 - > 00:10:29,919 I suppose it's five years ago now. 244 00:10:30,080 - > 00:10:33,039 But the the pharma companies did such a brilliant job getting the 245 00:10:33,120 - > 00:10:35,519 giving the vaccines out there and doing along those lines. 246 00:10:35,679 - > 00:10:38,879 I love bringing patients along to meet colleagues in pharma. 247 00:10:38,960 - > 00:10:41,519 And the first thing the patients say is they say, Cyber Science 248 00:10:41,600 - > 00:10:43,600 should be thanking you because you're the real reason I'm 249 00:10:43,600 - > 00:10:43,840 alive. 250 00:10:43,919 - > 00:10:44,720 And it's true. 251 00:10:44,799 - > 00:10:47,600 I'm not the person making, you know, the clever therapies in 252 00:10:47,600 - > 00:10:49,360 prostate or kidney or bladder cancer. 253 00:10:49,440 - > 00:10:52,080 It's the guys and it's guys and girls in the in the pharma 254 00:10:52,080 - > 00:10:52,399 industry. 255 00:10:52,559 - > 00:10:53,919 So, you know, I think they need to be thought of it. 256 00:10:54,080 - > 00:10:54,480 SPEAKER_01: Well, that's great. 257 00:10:54,559 - > 00:10:57,440 And I feel like that is a whole conversation can be had about 258 00:10:57,440 - > 00:10:57,679 that. 259 00:10:57,759 - > 00:11:02,240 But I'm actually really interested in this knowledge 260 00:11:02,240 - > 00:11:02,720 gap, right? 261 00:11:02,799 - > 00:11:06,559 Because even as you are describing the patient 262 00:11:06,559 - > 00:11:11,039 populations that you're treating in South London, uh I would 263 00:11:11,039 - > 00:11:13,519 assume it's not just that there's an information gap. 264 00:11:13,600 - > 00:11:16,639 There's probably many different information gaps depending on 265 00:11:16,639 - > 00:11:21,039 who is in your audience and and what types of content they're 266 00:11:21,200 - > 00:11:23,759 they have accessible or that they're consuming, or be uh at 267 00:11:23,759 - > 00:11:26,720 some point in times being served up to them by the algorithms. 268 00:11:26,960 - > 00:11:30,559 So when did you first start to realize there was a big gap 269 00:11:30,559 - > 00:11:33,120 between cutting edge knowledge and what actually reaches 270 00:11:33,120 - > 00:11:33,759 patients? 271 00:11:50,230 - > 00:11:52,710 SPEAKER_00: I think it was slowly coming to me because I've 272 00:11:52,710 - > 00:11:56,149 got a lot of friends who work in the community and I realized 273 00:11:56,149 - > 00:11:59,110 that they were that they just didn't have the privilege that I 274 00:11:59,110 - > 00:11:59,269 had. 275 00:11:59,350 - > 00:12:02,629 They were seeing far many, many more patients without the 276 00:12:02,629 - > 00:12:06,230 infrastructure, nursing, pharmacy, doctors, community 277 00:12:06,310 - > 00:12:08,549 with regards to that, the community, academic community 278 00:12:08,629 - > 00:12:08,870 there. 279 00:12:09,110 - > 00:12:11,509 I was very fortunate I could go to all the meetings. 280 00:12:11,750 - > 00:12:15,029 I was invited to do these things, and a lot of stuff was 281 00:12:15,029 - > 00:12:16,070 pitched towards me. 282 00:12:16,230 - > 00:12:19,509 If there was one moment in time, I can remember in November 2019, 283 00:12:19,669 - > 00:12:22,310 I was chatting to a guy called Mark Wildgust, who's a pretty 284 00:12:22,310 - > 00:12:25,029 senior guy at Jansen, a super, super, super person. 285 00:12:25,269 - > 00:12:28,629 And we were talking about how one implemented some of the 286 00:12:28,629 - > 00:12:31,110 novel therapies in prostate cancer and what was the 287 00:12:31,110 - > 00:12:31,669 comparator. 288 00:12:31,750 - > 00:12:33,909 And I said, Well, I was talking about chemotherapy, and he sort 289 00:12:33,909 - > 00:12:35,750 of said, Simon, no one gets chemotherapy. 290 00:12:35,830 - > 00:12:37,509 And I said, No, they do, Mark, they do. 291 00:12:37,590 - > 00:12:39,430 We did these studies, they showed whatever, and he was 292 00:12:39,430 - > 00:12:42,549 like, No one gets and then he showed me some market research 293 00:12:42,629 - > 00:12:44,149 and no one got chemotherapy. 294 00:12:44,230 - > 00:12:46,789 And I audited my own practice and it was very low. 295 00:12:47,029 - > 00:12:48,629 It was a real Eureka moment for me. 296 00:12:48,710 - > 00:12:51,430 It was a moment where I realized that just because something's 297 00:12:51,430 - > 00:12:53,669 published in the New England Journal of Medicine doesn't mean 298 00:12:53,669 - > 00:12:56,629 it's going to make it into the clinic, even my own clinics. 299 00:12:56,789 - > 00:12:59,509 And then I said to people in my academic group, well, how much 300 00:12:59,509 - > 00:13:01,269 patient how many patients do you think get chemotherapy? 301 00:13:01,430 - > 00:13:02,789 And everyone said 70, 80%. 302 00:13:03,350 - > 00:13:05,669 And then we did a UK audit and it was 27%. 303 00:13:06,070 - > 00:13:07,110 It's a bit lower in the U. 304 00:13:07,190 - > 00:13:10,149 But the UK is fortunate and unfortunate in our national 305 00:13:10,149 - > 00:13:12,230 healthcare system, which I'm very proud of, but it's very 306 00:13:12,230 - > 00:13:12,870 joined up. 307 00:13:12,950 - > 00:13:15,750 But it means that implementation of therapies is much more 308 00:13:15,750 - > 00:13:17,350 straightforward than, say, in the US. 309 00:13:17,430 - > 00:13:18,870 And I go, I'm a big fan of the US. 310 00:13:19,029 - > 00:13:22,230 I trained at Dona Farbo, have lots of friends there, my 311 00:13:22,230 - > 00:13:23,110 cousin's still there. 312 00:13:23,269 - > 00:13:25,990 I'm not one of these Brits who thinks the US is awful, far 313 00:13:26,070 - > 00:13:26,310 from. 314 00:13:26,470 - > 00:13:29,269 I think we're actually, our healthcare systems could work 315 00:13:29,269 - > 00:13:30,389 much more closely together. 316 00:13:30,470 - > 00:13:33,750 But I think it's harder to it's harder to initiate and 317 00:13:33,750 - > 00:13:36,710 popularise and democratise the therapy in the US because it's a 318 00:13:36,710 - > 00:13:39,029 bit more broken down, I think, than the UK. 319 00:13:39,190 - > 00:13:41,430 But in the UK, the uptake was low. 320 00:13:41,590 - > 00:13:46,070 And so it made me really stop, pause, and focus some energies 321 00:13:46,070 - > 00:13:48,629 on how one changes that and how one. 322 00:13:48,710 - > 00:13:51,190 And it made me think most people are treated in the community. 323 00:13:51,350 - > 00:13:54,950 They're not treated in academic centres like my own or Barber, 324 00:13:55,029 - > 00:13:57,509 they're treated out in the community in the UK, the US, 325 00:13:57,669 - > 00:13:58,870 Germany, France, etc. 326 00:13:59,190 - > 00:14:01,430 Most countries, if not all countries, is like that. 327 00:14:01,590 - > 00:14:04,710 And I think, and patients want to be treated in the community. 328 00:14:04,789 - > 00:14:07,909 They don't want them, they don't want to come into travel three 329 00:14:07,909 - > 00:14:12,310 hours to come into a hot, dirty, sticky London, or traveling to 330 00:14:12,310 - > 00:14:16,310 Boston or New York or to Hamburg or Paris, just because those 331 00:14:16,310 - > 00:14:18,629 cities, you know, they want to stay close to home. 332 00:14:18,789 - > 00:14:22,870 Most of our patients are older, they trust the local doctors 333 00:14:22,950 - > 00:14:25,269 quite rightly who have looked after them for a long period of 334 00:14:25,269 - > 00:14:25,430 time. 335 00:14:25,590 - > 00:14:29,029 And we need to work with those doctors to make life a bit 336 00:14:29,029 - > 00:14:29,190 easier. 337 00:14:29,430 - > 00:14:30,230 SPEAKER_01: If that makes a ton of sense. 338 00:14:30,310 - > 00:14:33,590 I mean, that even mirrors in the US my own experience of I live 339 00:14:33,669 - > 00:14:35,990 uh a couple hours south of Philadelphia. 340 00:14:36,149 - > 00:14:40,710 And when people have serious things going on, they go north 341 00:14:40,789 - > 00:14:41,990 uh to Philly, right? 342 00:14:42,149 - > 00:14:44,950 They're going to Penn, they're going to CHOP, they're going to 343 00:14:44,950 - > 00:14:46,629 those real centers of excellence. 344 00:14:46,870 - > 00:14:48,870 This need that you've identified, right, to 345 00:14:48,870 - > 00:14:53,750 democratize or to essentially spread evidence-based clinical 346 00:14:53,750 - > 00:14:58,470 care from academic settings out to the broader clinical world. 347 00:14:58,710 - > 00:15:01,750 Tell me a bit about open medicine and motivation and kind 348 00:15:01,750 - > 00:15:04,870 of what made you go from that eureka moment to where we are 349 00:15:04,870 - > 00:15:05,110 now. 350 00:15:05,430 - > 00:15:07,110 SPEAKER_00: So I've been working a little bit in medical 351 00:15:07,110 - > 00:15:08,950 education, some of it with pharmaceuticals, some of it 352 00:15:08,950 - > 00:15:11,350 independently, trying to understand, trying to sort of 353 00:15:11,350 - > 00:15:14,950 read myself around about innovation, adoption, looking at 354 00:15:14,950 - > 00:15:18,870 things like tech, music, electronics, how they'd done 355 00:15:18,870 - > 00:15:21,430 things where people adopt a lot quicker than medicine. 356 00:15:21,590 - > 00:15:22,950 Medicine's very conservative. 357 00:15:23,029 - > 00:15:26,950 And I think the maxim of do no harm is something that we 358 00:15:26,950 - > 00:15:28,549 probably hide behind a little bit. 359 00:15:28,629 - > 00:15:30,629 And oncologists are not the best at this. 360 00:15:30,870 - > 00:15:35,029 The surgeons are and the hematologists are much better 361 00:15:35,029 - > 00:15:36,310 than the medical oncologists. 362 00:15:36,470 - > 00:15:39,029 So if you look at the implementation of robotic 363 00:15:39,029 - > 00:15:41,509 prostatectomy, that was incredible. 364 00:15:41,669 - > 00:15:44,870 And I think our surgical colleagues have to be thanked to 365 00:15:44,870 - > 00:15:45,509 a degree with that. 366 00:15:45,669 - > 00:15:46,789 The evidence base is low. 367 00:15:46,870 - > 00:15:49,269 There's no randomized trial showing that robotic surgery is 368 00:15:49,269 - > 00:15:50,629 better than open surgery. 369 00:15:50,870 - > 00:15:54,950 But I think they showed that with an energy and an education 370 00:15:54,950 - > 00:15:56,470 program, they were able to do that. 371 00:15:56,549 - > 00:15:59,350 And that's a tech which is different giving therapies. 372 00:15:59,590 - > 00:16:02,629 Open medicine came about from a passion project, really, for 373 00:16:02,629 - > 00:16:05,509 myself and one of my fellow founders of Eat Ghost, who's a 374 00:16:05,509 - > 00:16:09,990 super, super is our CEO, super intelligent guy, very, very 375 00:16:09,990 - > 00:16:10,629 thoughtful. 376 00:16:10,870 - > 00:16:12,310 We sort of the yin and the yang. 377 00:16:12,389 - > 00:16:15,830 I do a lot of uh, I speak a lot, he thinks a lot. 378 00:16:15,990 - > 00:16:18,549 So we're a good uh we're a good couple where that's concerned. 379 00:16:18,710 - > 00:16:22,789 But both of us are passionate about education, and we both 380 00:16:22,789 - > 00:16:26,230 wanted something that is going to it's a commercial operation, 381 00:16:26,310 - > 00:16:28,389 but we also wanted something that's going to benefit beyond 382 00:16:28,389 - > 00:16:28,629 that. 383 00:16:28,710 - > 00:16:32,230 And we wanted a platform that is completely open, is free at 384 00:16:32,230 - > 00:16:36,629 point of access, doesn't have adverts, doesn't have undue bias 385 00:16:36,629 - > 00:16:37,430 from anyone. 386 00:16:37,669 - > 00:16:40,070 Farmers, the obvious people, but as I said, they're not the 387 00:16:40,070 - > 00:16:40,470 enemy. 388 00:16:40,629 - > 00:16:43,750 And we wanted to get what's essentially what's in experts' 389 00:16:43,909 - > 00:16:44,149 minds. 390 00:16:44,230 - > 00:16:47,830 So let's take an expert at Memorial Sloan Care Strong, take 391 00:16:47,990 - > 00:16:52,070 what's in that expert's mind and cascade it into a way that is 392 00:16:52,070 - > 00:16:54,470 easily accessible on a mobile phone. 393 00:16:54,549 - > 00:16:58,230 So that someone in the community or a trainee, that UX 394 00:16:58,230 - > 00:17:00,389 experience, they can join the conversations. 395 00:17:00,789 - > 00:17:03,830 The one who runs mobile should know they're made possible by 396 00:17:03,830 - > 00:17:05,269 the team and see what we're doing. 397 00:17:05,669 - > 00:17:10,789 SPEAKER_01: Excent complex stuff into clear, actionable insight. 398 00:17:11,109 - > 00:17:14,470 For years, Xcent has made complicated data sets simple to 399 00:17:14,470 - > 00:17:17,669 help commercial, medical, and operations teams map what's 400 00:17:17,669 - > 00:17:21,349 happening, predict what's next, and make stronger decisions 401 00:17:21,349 - > 00:17:21,910 faster. 402 00:17:22,150 - > 00:17:25,190 And now there's an added AI layer that makes everything work 403 00:17:25,190 - > 00:17:25,829 so much better. 404 00:17:26,069 - > 00:17:28,870 I was actually pretty jaded about some of the AI approaches 405 00:17:28,870 - > 00:17:32,069 I'd seen, but when XSunt showed me theirs, I actually left my 406 00:17:32,069 - > 00:17:33,029 job to come work for them. 407 00:17:33,190 - > 00:17:33,990 It's really awesome. 408 00:17:34,150 - > 00:17:37,269 So if you want to understand your market, your customers, or 409 00:17:37,269 - > 00:17:39,670 your performance with more clarity than ever, check out 410 00:17:39,670 - > 00:17:41,109 xunt.com. 411 00:17:41,269 - > 00:17:44,549 That's xs-unt.com. 412 00:17:44,870 - > 00:17:47,589 Alright, let's jump back into the episode. 413 00:17:58,630 - > 00:18:00,870 It makes a tremendous amount of sense, and I love the idea of 414 00:18:00,870 - > 00:18:04,549 pulling parallels from the tech world, pulling parallels from 415 00:18:04,549 - > 00:18:07,349 other industries, because at the end of the day, sometimes 416 00:18:07,349 - > 00:18:09,349 people, as they're designing these programs, forget that 417 00:18:09,670 - > 00:18:11,190 doctors are fundamentally people, right? 418 00:18:11,430 - > 00:18:15,670 And if it is if they can see something in 15 seconds versus 419 00:18:15,670 - > 00:18:18,710 15 minutes, there's a massive benefit to that. 420 00:18:19,109 - > 00:18:24,630 Is your take that this simplification of taking the 421 00:18:24,630 - > 00:18:29,910 Uber expert in a field and putting their evidence-based 422 00:18:29,910 - > 00:18:34,630 guidelines essentially into this format is solving the access 423 00:18:34,630 - > 00:18:38,870 problem via faster access, more complete access? 424 00:18:38,950 - > 00:18:41,029 Like what is what is the ultimate goal here? 425 00:18:41,349 - > 00:18:44,069 SPEAKER_00: I think the ultimate goal is really to share 426 00:18:44,069 - > 00:18:47,430 knowledge in a way that is truly democratic. 427 00:18:47,670 - > 00:18:50,549 I think at the moment we have, I'm an academic or a 428 00:18:50,549 - > 00:18:51,349 pseudo-academic. 429 00:18:51,430 - > 00:18:52,789 I don't really think of myself as an academic. 430 00:18:52,870 - > 00:18:55,109 I like to think of myself as a pragmatic, but I work in 431 00:18:55,109 - > 00:18:56,230 academic centers. 432 00:18:56,390 - > 00:18:59,029 I'm, you know, have a role at the Medical Research Council in 433 00:18:59,029 - > 00:18:59,670 the UK. 434 00:18:59,829 - > 00:19:02,870 You know, I go and chat to people at Dana Farber, my 435 00:19:02,870 - > 00:19:05,750 cousin's the head of radiation biology there, very smart guy. 436 00:19:05,910 - > 00:19:07,990 So I mix with the great and the good. 437 00:19:08,150 - > 00:19:11,269 And I think the problem is that often we talk about stuff that 438 00:19:11,269 - > 00:19:12,950 is really fine detail. 439 00:19:13,109 - > 00:19:16,150 And sometimes, not really amongst my friends so much, but 440 00:19:16,150 - > 00:19:19,349 sometimes you see people showing off academically, making it more 441 00:19:19,349 - > 00:19:22,630 complicated, showing that they understand the genomic side of 442 00:19:22,630 - > 00:19:24,870 things and not making it more accessible. 443 00:19:24,950 - > 00:19:26,710 So for me, I want to strip it back. 444 00:19:26,950 - > 00:19:29,910 I really like the concept of simple Simon, of sort of saying, 445 00:19:30,309 - > 00:19:32,870 sort of saying to someone, if you understand something really 446 00:19:32,870 - > 00:19:35,349 well, explain it in a really simple way. 447 00:19:35,589 - > 00:19:37,990 When we go to the baseball, Jonathan, I don't understand 448 00:19:37,990 - > 00:19:38,789 baseball so well. 449 00:19:38,870 - > 00:19:39,829 And you'll strip it back. 450 00:19:39,910 - > 00:19:41,029 You are a very good communicator. 451 00:19:41,109 - > 00:19:42,710 You'll make it fun and easy. 452 00:19:42,870 - > 00:19:43,670 That's what we want to do. 453 00:19:43,750 - > 00:19:47,190 We want to make it fun and easy so that people actually enjoy 454 00:19:47,190 - > 00:19:47,430 it. 455 00:19:47,589 - > 00:19:50,710 I get a lot of my education from X, which surprises people more 456 00:19:50,789 - > 00:19:53,190 than more than journals, more than academic meetings. 457 00:19:53,349 - > 00:19:55,269 I get it on X and I interact that way. 458 00:19:55,349 - > 00:19:56,789 And that's easy for me as a man. 459 00:19:56,950 - > 00:19:59,349 I think it's much harder for women on X and much harder for 460 00:19:59,349 - > 00:20:00,549 people with more diversity. 461 00:20:00,630 - > 00:20:05,190 So we wanted a platform where it's open for everyone, but the 462 00:20:05,190 - > 00:20:06,710 content is verified. 463 00:20:06,870 - > 00:20:10,150 And also it's a safe place where people are abused, and we're 464 00:20:10,150 - > 00:20:11,990 gonna have very strict regulation there. 465 00:20:12,150 - > 00:20:13,670 Not regulation, we want debate. 466 00:20:13,750 - > 00:20:16,390 We want people to say I do it this way, or this is why I do it 467 00:20:16,390 - > 00:20:20,150 this way, but respectful, collegiate debate, not sort of 468 00:20:20,150 - > 00:20:21,190 calling people names and stuff. 469 00:20:21,269 - > 00:20:24,390 And I've seen a lot of my female friends come off X, and I feel 470 00:20:24,390 - > 00:20:28,390 very sad because A, they added a huge amount, and they're some of 471 00:20:28,390 - > 00:20:29,509 the smartest people I know. 472 00:20:29,750 - > 00:20:31,750 We want somewhere where they can go and feel safe. 473 00:20:32,069 - > 00:20:32,470 SPEAKER_01: It's great. 474 00:20:32,789 - > 00:20:35,430 And especially if you're trying to do this from a professional 475 00:20:35,430 - > 00:20:39,589 setting where you're hoping to further patient care, the last 476 00:20:39,589 - > 00:20:42,309 thing you want is heaps of abuse coming at you. 477 00:20:42,470 - > 00:20:45,349 So I at one point in my career I'd I had worked for this 478 00:20:45,349 - > 00:20:47,269 company in the US, it was called Cermo. 479 00:20:47,430 - > 00:20:54,309 And what we had was a network of physicians, and we had a pretty 480 00:20:54,309 - > 00:20:59,190 decent size chunk, at least at the time, of the US practicing 481 00:20:59,190 - > 00:21:00,230 physicians. 482 00:21:00,470 - > 00:21:04,950 And we were seeing some of this happening, and what what we 483 00:21:04,950 - > 00:21:08,470 ultimately found was that it did, it wasn't necessarily a 484 00:21:08,630 - > 00:21:09,269 censorship. 485 00:21:09,349 - > 00:21:12,549 Like I can't actually even remember a time where we had to 486 00:21:12,549 - > 00:21:14,309 tell people to rein it in. 487 00:21:14,549 - > 00:21:19,829 It was more about creating an environment where there were 488 00:21:19,829 - > 00:21:22,950 places to talk about clinical issues, there were places to 489 00:21:22,950 - > 00:21:26,390 talk about the business of running a small practice, 490 00:21:26,470 - > 00:21:28,630 essentially a small business in the US and dealing with 491 00:21:28,630 - > 00:21:31,190 insurance agencies and all of the like. 492 00:21:31,349 - > 00:21:33,109 So I've spent some time on open medicine. 493 00:21:33,269 - > 00:21:35,829 What I had seen was really flow charts, right? 494 00:21:35,910 - > 00:21:37,910 And this graphical simplified interface. 495 00:21:37,990 - > 00:21:41,190 I'd encourage people that are interested to check it out as a 496 00:21:41,190 - > 00:21:44,870 way to see how science can be communicated. 497 00:21:45,190 - > 00:21:49,589 Is your vision that this becomes a community environment for 498 00:21:49,589 - > 00:21:52,069 having back and forth discussions around the 499 00:21:52,069 - > 00:21:53,430 recommended treatment protocols? 500 00:21:53,750 - > 00:21:55,509 SPEAKER_00: I think ultimately what we've got at the moment, 501 00:21:55,670 - > 00:21:58,150 and you described it really well, is what we call living 502 00:21:58,150 - > 00:21:58,789 algorithms. 503 00:21:58,950 - > 00:22:02,870 So we found from our research that actually what people wanted 504 00:22:02,870 - > 00:22:06,230 was these flowcharts that would guide them through a clinical 505 00:22:06,230 - > 00:22:06,470 problem. 506 00:22:06,630 - > 00:22:10,150 So let's say something in my area, say advanced castrate 507 00:22:10,230 - > 00:22:11,750 sensitive prostate cancer. 508 00:22:11,910 - > 00:22:14,789 How does how does say Nearaj Agual, one of the world's 509 00:22:14,789 - > 00:22:15,750 leaders, address that? 510 00:22:16,150 - > 00:22:18,150 And Niraj is one of our thought leaders. 511 00:22:18,309 - > 00:22:21,190 He helped us to design an algorithm, and it's a 512 00:22:21,190 - > 00:22:22,150 click-through thing. 513 00:22:22,309 - > 00:22:24,549 What we noticed was these algorithms that were kind of 514 00:22:24,549 - > 00:22:27,109 like PowerPoint slides hadn't changed in the last 30 years. 515 00:22:27,190 - > 00:22:29,990 And I think that horrified my fellow founders who are 516 00:22:29,990 - > 00:22:33,509 brilliant at software, at website design, at AI, about 517 00:22:33,750 - > 00:22:35,349 search engine engine optimization. 518 00:22:35,509 - > 00:22:37,029 And I'm learning so much from them. 519 00:22:37,190 - > 00:22:39,430 The other founders are not doctors, thank goodness. 520 00:22:39,670 - > 00:22:43,349 So we wanted to build something that's interactive, has really 521 00:22:43,349 - > 00:22:48,309 great user experience, but takes the best expertise in a disease 522 00:22:48,309 - > 00:22:51,589 area, but puts it in a format that is user-friendly. 523 00:22:51,750 - > 00:22:54,710 And I think what we have at the moment is we're full of a world 524 00:22:54,710 - > 00:22:57,670 of PDFs, we're full of a world of that's text heavy. 525 00:22:57,829 - > 00:23:00,630 And I think as you will know, and as I will know from the 526 00:23:00,630 - > 00:23:03,990 younger people I work with, that isn't their world anymore. 527 00:23:04,150 - > 00:23:07,910 They've grown up on X, Instagram, Facebook, whatever. 528 00:23:07,990 - > 00:23:09,190 They want rolling content. 529 00:23:09,349 - > 00:23:13,190 They want content that is much more visual friendly and much 530 00:23:13,190 - > 00:23:16,789 more, much less more consumable, right? 531 00:23:16,950 - > 00:23:17,829 SPEAKER_01: More yes. 532 00:23:18,150 - > 00:23:19,910 SPEAKER_00: Well, sort of depth is more interactive. 533 00:23:20,069 - > 00:23:22,950 I think I now look at it, I read quite a lot of papers and things 534 00:23:23,029 - > 00:23:24,950 because I'm still interested, I still write them. 535 00:23:25,029 - > 00:23:27,589 But I sometimes, yeah, my heart sinks when someone sends me a 536 00:23:27,589 - > 00:23:30,870 30-page paper, I'm like, okay, that's gonna be three, four 537 00:23:30,870 - > 00:23:32,150 hours of my life I won't get back. 538 00:23:32,309 - > 00:23:35,990 And it's sort of, I would much rather have it in a in a in a 539 00:23:35,990 - > 00:23:37,029 short format. 540 00:23:37,269 - > 00:23:40,710 So it's sort of like an even on X, when someone does a tutorial 541 00:23:40,710 - > 00:23:43,589 that's like 20 tweets long, I don't really think that's they, 542 00:23:43,829 - > 00:23:45,029 I think they're missing the point. 543 00:23:45,190 - > 00:23:48,390 There was a brilliant one by uh Ashish, one of our foundation 544 00:23:48,390 - > 00:23:51,509 circle, is a leading bladder cancer, and he did it in three 545 00:23:51,509 - > 00:23:51,910 tweets. 546 00:23:51,990 - > 00:23:55,269 And I just said, oncologist, take note, because that's what I 547 00:23:55,269 - > 00:23:56,150 want us to have. 548 00:23:56,390 - > 00:23:59,029 To come back to your question, and sorry I didn't answer about 549 00:23:59,029 - > 00:23:59,430 community. 550 00:23:59,509 - > 00:24:02,069 I think ultimately we won't be there quite yet. 551 00:24:02,230 - > 00:24:04,789 To start off with, we'll have content that is more sort of 552 00:24:05,029 - > 00:24:07,509 where the interaction is from the user with the website. 553 00:24:07,589 - > 00:24:09,910 But ultimately, we really want people's comments, want people 554 00:24:09,910 - > 00:24:12,870 to say that I'm using and her to find out how do you find the 555 00:24:12,870 - > 00:24:14,150 interstitial lung disease? 556 00:24:14,309 - > 00:24:15,750 What's the what's the nuance? 557 00:24:15,990 - > 00:24:18,870 So I think when I'm taking what's in people's brains, I'm 558 00:24:18,870 - > 00:24:21,670 very lucky when I you know I trained a dip to my training at 559 00:24:21,670 - > 00:24:24,390 Dana Far, but some of the best GU people in the world were 560 00:24:24,390 - > 00:24:25,349 there and are still there. 561 00:24:25,430 - > 00:24:27,750 And I could phone up someone like Tony Schwery, who's the 562 00:24:27,750 - > 00:24:30,230 head of the unit, there, and say, Tony, I'm about to use 563 00:24:30,390 - > 00:24:31,990 Nirvolamab for the first time. 564 00:24:32,069 - > 00:24:33,269 What should I be looking out for? 565 00:24:33,349 - > 00:24:35,269 And Tony said, bring them back in two weeks' time, make sure 566 00:24:35,269 - > 00:24:37,430 you check their thyroid function, warn them about 567 00:24:37,430 - > 00:24:38,630 diarrhea, etc. 568 00:24:39,029 - > 00:24:41,349 And you can't necessarily get that from the paper. 569 00:24:41,509 - > 00:24:44,710 Reading a paper that's just got grading on there, it it sort of 570 00:24:44,710 - > 00:24:45,750 works, doesn't work. 571 00:24:45,829 - > 00:24:48,470 And I think sometimes some of the grade one, two toxicities 572 00:24:48,470 - > 00:24:49,269 are underplayed. 573 00:24:49,430 - > 00:24:52,630 So I think having someone who's got real wealth of experience 574 00:24:52,870 - > 00:24:55,269 take you through it, and ultimately we will embed 575 00:24:55,269 - > 00:24:57,990 diagrams, videos, etc., within the algorithms. 576 00:24:58,069 - > 00:25:00,470 So I think I think it's the equivalent of being able to 577 00:25:00,470 - > 00:25:03,109 phone up the best people in the world and get them to take you 578 00:25:03,109 - > 00:25:03,430 through it. 579 00:25:03,829 - > 00:25:06,549 SPEAKER_01: Yeah, and I think that is expertise and it's 580 00:25:06,549 - > 00:25:07,029 communication. 581 00:25:07,190 - > 00:25:09,589 I sometimes think of like I think a famous example of this 582 00:25:09,589 - > 00:25:12,309 is Steve Jobs on stage introducing the iPhone where 583 00:25:12,309 - > 00:25:14,630 it's like, it's your music on your phone. 584 00:25:14,789 - > 00:25:16,309 It's your music on your phone. 585 00:25:16,390 - > 00:25:17,349 He says it three or four times. 586 00:25:17,430 - > 00:25:18,390 He's like, Are you getting it? 587 00:25:18,470 - > 00:25:19,829 It's your music on your phone, right? 588 00:25:19,910 - > 00:25:23,029 Like this is one of the most successful product launches 589 00:25:23,029 - > 00:25:23,349 ever. 590 00:25:23,589 - > 00:25:25,750 And he boils it down to one sentence. 591 00:25:25,990 - > 00:25:29,509 So this is uh this is my segue because he's also the person 592 00:25:29,509 - > 00:25:33,670 that I think of when I think of some of the potential impacts of 593 00:25:33,670 - > 00:25:34,549 misinformation. 594 00:25:34,710 - > 00:25:37,349 And because this is something that we talked about going in, 595 00:25:37,430 - > 00:25:39,829 was one of the goals of this is to combat misinformation. 596 00:25:39,910 - > 00:25:43,430 And I think it's a an a very interesting example because I'm 597 00:25:43,430 - > 00:25:45,109 sure you know much more about this than I do. 598 00:25:45,190 - > 00:25:47,829 But my understanding of it is that he essentially had a 599 00:25:47,829 - > 00:25:51,589 treatable cancer that he was attempting to treat with like 600 00:25:51,589 - > 00:25:54,069 organic fruit juices, basically. 601 00:25:54,309 - > 00:25:57,589 And by the time he was ready for real treatment, uh it was too 602 00:25:57,589 - > 00:25:58,309 late and he died. 603 00:25:58,470 - > 00:26:00,470 And it has nothing to do with intelligence, right? 604 00:26:00,549 - > 00:26:03,269 Nobody would argue he's not a smart, brilliant guy and and 605 00:26:03,349 - > 00:26:06,470 well or connections or access or anything else. 606 00:26:06,710 - > 00:26:09,750 So tell me a bit about what you're seeing out there for in 607 00:26:10,069 - > 00:26:12,630 or misinformation and what you think that doctors' 608 00:26:12,789 - > 00:26:14,230 responsibilities are in this space. 609 00:26:14,630 - > 00:26:15,990 SPEAKER_00: I think that's a really good example. 610 00:26:16,069 - > 00:26:18,870 I don't know the details of his case too much, but that's my 611 00:26:18,870 - > 00:26:19,750 understanding of it. 612 00:26:19,910 - > 00:26:23,109 I think what we're seeing more and more of, and I think doctors 613 00:26:23,109 - > 00:26:24,549 have to look at themselves a bit here. 614 00:26:24,710 - > 00:26:27,349 It's very easy for us to criticize patients and say, oh, 615 00:26:27,430 - > 00:26:29,910 these people, they don't under, they don't get there's a reason 616 00:26:29,910 - > 00:26:32,630 they're not trusting doctors so much, and there's a reason 617 00:26:32,710 - > 00:26:34,470 they're looking for alternative sources. 618 00:26:34,630 - > 00:26:37,109 And some of, as you said, is some of the alternative sources 619 00:26:37,109 - > 00:26:40,950 are excellent communicators and also listeners, not my strongest 620 00:26:40,950 - > 00:26:41,190 point. 621 00:26:41,430 - > 00:26:44,549 So I think what we're hoping to do with open medicine is is 622 00:26:44,549 - > 00:26:47,349 listen, but also provide a trusted source. 623 00:26:47,509 - > 00:26:48,309 So it's interesting. 624 00:26:48,390 - > 00:26:49,670 I like generative AI. 625 00:26:49,750 - > 00:26:52,630 I think Chat GPT, etc., is actually a very good resource. 626 00:26:52,710 - > 00:26:55,190 But it's interesting, my friend's son that there's a 627 00:26:55,190 - > 00:26:57,990 meningitis outbreak in the UK where there was a couple of 628 00:26:57,990 - > 00:27:01,349 months ago, and lots of young kids were dying, which is very 629 00:27:01,349 - > 00:27:01,670 sad. 630 00:27:01,829 - > 00:27:05,029 And my friend, his son, who's in the sort of target age group, 631 00:27:05,109 - > 00:27:08,069 the kissing age group, 17-year-old boy, and he's in the 632 00:27:08,069 - > 00:27:10,470 area where there was the highest, the highest instance. 633 00:27:10,870 - > 00:27:11,349 What do you think? 634 00:27:11,430 - > 00:27:13,509 And I started looking on ChatGPT, and I thought I'm gonna 635 00:27:13,509 - > 00:27:15,670 phone someone up because I thought I'm not gonna take any 636 00:27:15,670 - > 00:27:17,589 chances with my godson Tom. 637 00:27:17,750 - > 00:27:20,870 So I think what we want to have is the best source of resource, 638 00:27:20,950 - > 00:27:23,829 but something so what that showed me is that I like 639 00:27:23,829 - > 00:27:26,710 generative I, but I was gonna trust my friend's son on with 640 00:27:26,710 - > 00:27:26,870 it. 641 00:27:27,029 - > 00:27:29,750 So we want to have something that's trustworthy, where you 642 00:27:29,750 - > 00:27:30,950 can get that voice. 643 00:27:31,109 - > 00:27:35,829 So our content is going to be high quality, but also both in 644 00:27:35,829 - > 00:27:39,589 terms of the spec, but also in terms of the actual knowledge on 645 00:27:39,589 - > 00:27:39,750 there. 646 00:27:39,910 - > 00:27:42,789 So I think that's the bit where we want to have a trusted 647 00:27:42,789 - > 00:27:43,349 resource. 648 00:27:43,509 - > 00:27:46,150 At the moment, our target audience is doctors, but by the 649 00:27:46,150 - > 00:27:49,109 end of the year, we hope to have patient-related resources. 650 00:27:49,269 - > 00:27:51,990 And I think there's going to be more empowerment of patients. 651 00:27:52,150 - > 00:27:55,349 I've always been someone that's never, never, never minded 652 00:27:55,349 - > 00:27:57,990 patients coming in with information and things like 653 00:27:57,990 - > 00:27:58,150 that. 654 00:27:58,309 - > 00:28:00,789 It's very hard when you've got a cancer, it's very scary. 655 00:28:00,950 - > 00:28:03,029 And there's a lot of very smart patients out there. 656 00:28:03,190 - > 00:28:05,750 I learn from my patients every day, if not every week. 657 00:28:05,990 - > 00:28:09,190 It's a question of harnessing what's out there. 658 00:28:09,349 - > 00:28:12,069 I'm very happy when patients come and they're educated and 659 00:28:12,069 - > 00:28:13,670 they've they've educated themselves. 660 00:28:13,910 - > 00:28:16,549 It's concerning what that there are a lot of people out there 661 00:28:16,549 - > 00:28:19,349 trying to make money from patients, and that I think is 662 00:28:19,349 - > 00:28:19,829 awful. 663 00:28:19,910 - > 00:28:21,829 And there's a lot of poor information out there. 664 00:28:21,910 - > 00:28:24,230 So I hope what we will be is a filter for good information. 665 00:28:24,309 - > 00:28:24,390 SPEAKER_01: Right. 666 00:28:24,710 - > 00:28:28,549 It's almost, you know, I think of it as you're in the States, 667 00:28:28,630 - > 00:28:33,029 you know, you could get your information from Instagram, you 668 00:28:33,029 - > 00:28:35,509 could get it from TikTok, you could get it from the Mayo 669 00:28:35,509 - > 00:28:38,630 Clinic, you can go and uh you could do a PubMed search, which 670 00:28:38,630 - > 00:28:41,029 I which is what I I'm not I'm not smart enough to read the 671 00:28:41,029 - > 00:28:43,910 actual papers, but I'll often look for a meta-analysis because 672 00:28:43,910 - > 00:28:46,630 that's kind of a nice, just give me the summary of all of the 673 00:28:46,630 - > 00:28:47,109 research. 674 00:28:47,269 - > 00:28:52,309 And I feel like creating that level of understanding, of 675 00:28:52,309 - > 00:28:57,269 recognizing what is a good and trusted source and and what 676 00:28:57,269 - > 00:28:58,069 might not be. 677 00:28:58,230 - > 00:29:01,750 I feel like that is a real challenge and opportunity for 678 00:29:01,910 - > 00:29:02,710 for you all. 679 00:29:02,870 - > 00:29:07,029 So, how how are you looking to build that brand of open 680 00:29:07,029 - > 00:29:10,549 medicine as, hey, these are not people trying to sell you a 681 00:29:10,549 - > 00:29:13,430 supplement or or whatever alternative cure. 682 00:29:13,509 - > 00:29:15,670 This is truly a trusted source of information. 683 00:29:15,990 - > 00:29:16,870 SPEAKER_00: That's a really good point. 684 00:29:16,950 - > 00:29:18,789 Let me just go back to something you said there, because you said 685 00:29:18,789 - > 00:29:19,670 you're not smart enough. 686 00:29:19,829 - > 00:29:21,109 You're plenty smart enough. 687 00:29:21,269 - > 00:29:24,549 And I think this is this is the way that academic academics, not 688 00:29:24,549 - > 00:29:28,870 just medicine, academic English graduates, we make it, we pitch 689 00:29:28,870 - > 00:29:31,269 it so we make you feel that you're not smart enough. 690 00:29:31,430 - > 00:29:34,069 The smart people would explain it in a way that made it 691 00:29:34,069 - > 00:29:36,789 explainable to our patients and to our trainees and to our 692 00:29:36,789 - > 00:29:37,190 colleagues. 693 00:29:37,269 - > 00:29:40,390 Because Einstein who said, if you really understand something, 694 00:29:40,470 - > 00:29:41,990 you can explain it simply. 695 00:29:42,150 - > 00:29:44,390 So it's not about you not being smart enough, Jonathan. 696 00:29:44,470 - > 00:29:47,670 It's about us creating a structure that is exclusive, not 697 00:29:47,670 - > 00:29:48,230 inclusive. 698 00:29:48,390 - > 00:29:50,630 So we want to do something that's really inclusive. 699 00:29:50,870 - > 00:29:53,910 To come back to what you were saying about a trusted source, I 700 00:29:53,910 - > 00:29:55,910 feel really, really very fortunate being the chief 701 00:29:55,910 - > 00:29:56,470 medical officer. 702 00:29:56,549 - > 00:29:57,910 I'd be able to go out and pick the team. 703 00:29:58,069 - > 00:30:00,789 So I've gone out, there's people that I know, I've got a big 704 00:30:00,789 - > 00:30:03,430 network, but there's also people I've thought, that person's 705 00:30:03,430 - > 00:30:04,950 brilliant at explaining stuff. 706 00:30:05,109 - > 00:30:08,230 So we've gone to some of the usual suspects, as it were, but 707 00:30:08,230 - > 00:30:10,950 we're really actually trying to get people, trainees, people in 708 00:30:10,950 - > 00:30:11,670 the community. 709 00:30:11,829 - > 00:30:14,870 I think community oncologists have been really talked about 710 00:30:14,870 - > 00:30:16,710 badly by a lot of buzz in academia. 711 00:30:16,870 - > 00:30:18,309 And I think these are good people. 712 00:30:18,470 - > 00:30:20,789 They're seeing the bulk of the patients, they're doing it under 713 00:30:20,789 - > 00:30:23,029 often less than ideal circumstances. 714 00:30:23,269 - > 00:30:26,789 We need to really make an effort to make sure that what we're the 715 00:30:26,789 - > 00:30:30,549 content we're providing, the way we're working, matches what they 716 00:30:30,549 - > 00:30:30,789 need. 717 00:30:30,950 - > 00:30:33,829 Not what we think they need, or not what we need, but the other 718 00:30:33,829 - > 00:30:34,309 way around. 719 00:30:34,390 - > 00:30:37,109 So exactly what you're saying on PubMed, I'm not X and Y. 720 00:30:37,190 - > 00:30:38,710 Well, it's PubMed's fault, it's not yours. 721 00:30:38,789 - > 00:30:39,990 And PubMed needs to change. 722 00:30:40,069 - > 00:30:42,150 Well, it is changing, isn't it, with most funding things. 723 00:30:42,230 - > 00:30:45,109 But so I think for us, it's about providing something that 724 00:30:45,109 - > 00:30:47,910 Jonathan can go to in six months' time and say, this is 725 00:30:47,910 - > 00:30:48,549 actually really good. 726 00:30:48,630 - > 00:30:50,309 And if you've got a friend who's going through something 727 00:30:50,309 - > 00:30:53,349 difficult, you can you feel comfortable signposting that 728 00:30:53,349 - > 00:30:53,589 way. 729 00:30:53,670 - > 00:30:56,870 So we're fortunate, we've got a foundation circle of some of the 730 00:30:56,870 - > 00:30:58,150 best people from around the world. 731 00:30:58,309 - > 00:31:00,870 Probably I think we almost hit 50 in oncology, and now we're 732 00:31:00,870 - > 00:31:02,309 going to metabolic medicine. 733 00:31:02,470 - > 00:31:07,589 So I think it's around that, but but I think we must never in our 734 00:31:07,589 - > 00:31:11,589 side make people feel that they're not smart enough or make 735 00:31:11,589 - > 00:31:13,829 them feel that they're that we're not providing stuff they 736 00:31:13,829 - > 00:31:14,870 can engage with. 737 00:31:15,109 - > 00:31:18,710 In my old hospital, we used to hand out 30-page written 738 00:31:18,710 - > 00:31:22,390 summaries of, say, dose of taxal and chemotherapy, prostate 739 00:31:22,390 - > 00:31:22,950 cancer. 740 00:31:23,190 - > 00:31:26,069 Almost half the people coming had a reading age less than 10. 741 00:31:26,150 - > 00:31:27,269 A lot of people couldn't read. 742 00:31:27,430 - > 00:31:29,509 That's not because they're stupid, it's just because they'd 743 00:31:29,509 - > 00:31:31,589 had less advantage than people and myself. 744 00:31:31,750 - > 00:31:33,910 But we carried on handing out the written information, the 745 00:31:33,910 - > 00:31:34,710 written information. 746 00:31:34,870 - > 00:31:36,150 We need to change that mentality. 747 00:31:36,710 - > 00:31:39,029 SPEAKER_01: I have a story along these lines that I think is kind 748 00:31:39,029 - > 00:31:39,829 of interesting, right? 749 00:31:39,910 - > 00:31:43,190 Where you had brought up the generative AI earlier, but I had 750 00:31:43,190 - > 00:31:45,509 previously worked at a company that was doing a lot of work 751 00:31:45,509 - > 00:31:48,950 around some of the documentation that goes along with getting all 752 00:31:49,029 - > 00:31:49,910 these drugs to market. 753 00:31:49,990 - > 00:31:54,150 So one of the projects we were proposing was using generative 754 00:31:54,150 - > 00:31:57,670 AI essentially to take a clinical trial protocol and turn 755 00:31:57,670 - > 00:32:00,950 it into an ICF, an informed consent form, which is a 756 00:32:00,950 - > 00:32:05,910 requirement to document that's meant to be at basically a fifth 757 00:32:05,910 - > 00:32:08,069 grade, fourth, fifth grade reading level. 758 00:32:08,309 - > 00:32:11,910 So for those in the UK, what is that, like 10, 11-year-old 759 00:32:11,910 - > 00:32:12,230 person? 760 00:32:12,390 - > 00:32:15,190 And that's meant to help people truly understand what they're 761 00:32:15,190 - > 00:32:17,670 signing up for if they volunteer for a clinical trial or want to 762 00:32:17,670 - > 00:32:18,789 participate in one. 763 00:32:18,950 - > 00:32:22,470 And we were running into all types of pushback with the legal 764 00:32:22,470 - > 00:32:26,230 review team about doing this from the pharma company, it was 765 00:32:26,390 - > 00:32:27,029 big pharma. 766 00:32:27,430 - > 00:32:30,950 And what ended up getting that one pushed forward was they 767 00:32:30,950 - > 00:32:34,549 found out that the nurses at the trial sites themselves were 768 00:32:34,549 - > 00:32:35,589 saying, This is ridiculous. 769 00:32:35,750 - > 00:32:37,910 I'm gonna just take this thing and I'm gonna put it into Chat 770 00:32:37,910 - > 00:32:41,509 GPT and I'm gonna have it generate my own ICF, something 771 00:32:41,509 - > 00:32:43,269 my patients can actually understand. 772 00:32:43,509 - > 00:32:47,589 So I think that that then gets into a whole nother set of some 773 00:32:47,589 - > 00:32:51,029 ways like the cat's out of the bag or the horses left the barn 774 00:32:51,109 - > 00:32:54,950 or whatever animal analogy you want to use, but is getting 775 00:32:54,950 - > 00:32:56,309 control of this, right? 776 00:32:56,470 - > 00:33:00,470 And and focus on simplification, focus on communication is 777 00:33:00,470 - > 00:33:04,789 actually a huge opportunity for doctors, for pharma, for anybody 778 00:33:04,789 - > 00:33:06,950 who's looking to really further medical care. 779 00:33:07,430 - > 00:33:08,230 SPEAKER_00: Yeah, no, absolutely. 780 00:33:08,309 - > 00:33:11,430 The the nurses get it, and and the patients go to the nurses 781 00:33:11,589 - > 00:33:13,589 because they're better communicators than the doctors, 782 00:33:13,750 - > 00:33:14,630 myself included. 783 00:33:14,789 - > 00:33:16,150 They're less intimidating. 784 00:33:16,309 - > 00:33:19,430 So we need to have something that is much more like that, 785 00:33:19,670 - > 00:33:21,829 less intimidating for everyone. 786 00:33:21,990 - > 00:33:24,710 You can make things my cousin I says, the head of genomics uh 787 00:33:24,789 - > 00:33:27,269 that Dana Farbuck, or the head of radiation bowlers, and 788 00:33:27,269 - > 00:33:29,990 genomic stability, he's a brilliant communicator because 789 00:33:29,990 - > 00:33:31,029 he strips it back. 790 00:33:31,190 - > 00:33:34,069 He takes it to a level for his audience, not for him. 791 00:33:34,230 - > 00:33:37,269 He can debate at a Nobel Prize level if he wants to, but 792 00:33:37,269 - > 00:33:40,630 actually he communicated, did a lot of work for refugee kids in 793 00:33:40,630 - > 00:33:42,150 in Syria, very, very proud of him. 794 00:33:42,309 - > 00:33:45,910 And you know, he was teaching 14-year-olds there who refugee 795 00:33:45,910 - > 00:33:47,029 kids, poor kids. 796 00:33:47,190 - > 00:33:50,789 And that takes a real talent to engage an audience like that. 797 00:33:50,950 - > 00:33:53,670 That's much harder than engage an audience at Harvard, in my 798 00:33:53,670 - > 00:33:53,910 opinion. 799 00:33:54,150 - > 00:33:54,309 SPEAKER_01: Absolutely. 800 00:33:54,549 - > 00:33:55,349 Uh very good story. 801 00:33:55,430 - > 00:33:59,029 So, all right, so let's end with a bit of a forward-looking 802 00:33:59,349 - > 00:33:59,829 question. 803 00:34:00,309 - > 00:34:05,990 So if this vision succeeds, what changes for the average patient? 804 00:34:06,150 - > 00:34:09,750 And what would you think the real world impact would look 805 00:34:09,750 - > 00:34:11,269 like a few years from now? 806 00:34:11,750 - > 00:34:14,549 SPEAKER_00: I think ultimately it's all about better improving 807 00:34:14,549 - > 00:34:15,190 patient care. 808 00:34:15,349 - > 00:34:19,029 So in cancer care, patients living longer and living better, 809 00:34:19,190 - > 00:34:22,710 so less side effects of treatment, better use of drugs, 810 00:34:23,109 - > 00:34:26,709 right dosing, so people get the right drug at the right time, at 811 00:34:26,709 - > 00:34:28,789 the right dose with the right supportive care. 812 00:34:29,029 - > 00:34:31,029 And it might be they don't need to have a therapy. 813 00:34:31,189 - > 00:34:33,189 We over-treat a lot in prostate cancer. 814 00:34:33,349 - > 00:34:35,829 So it might be someone with localized prostate cancer goes 815 00:34:35,829 - > 00:34:36,949 on to active surveillance. 816 00:34:37,109 - > 00:34:38,789 That would be a that would be a great win. 817 00:34:38,869 - > 00:34:42,549 They don't unnecessarily have a treatment, be it a drug 818 00:34:42,549 - > 00:34:45,829 treatment like I give that is the lowest testosterone or a 819 00:34:45,829 - > 00:34:48,949 surgical treatment that may cause incontinence or impotence 820 00:34:49,109 - > 00:34:52,389 or radiotherapy, which can cause bowel and bladder problems and 821 00:34:52,389 - > 00:34:53,269 potency problems. 822 00:34:53,509 - > 00:34:56,629 So I think ultimately, if open medicine works as we hope it 823 00:34:56,629 - > 00:35:00,149 will, it will be better patient care and improved quality and 824 00:35:00,149 - > 00:35:01,909 quantity of life for many, many patients. 825 00:35:02,069 - > 00:35:02,709 Global let. 826 00:35:03,029 - > 00:35:04,149 SPEAKER_01: All right, Simon, we'll leave it there. 827 00:35:04,229 - > 00:35:05,029 Hopefully, we'll next time. 828 00:35:12,789 - > 00:35:16,149 And that's a wrap on today's episode of Pharma Sessions with 829 00:35:16,149 - > 00:35:17,669 me, Jonathan Kaske. 830 00:35:17,829 - > 00:35:20,389 If you enjoyed today's conversation, don't forget to 831 00:35:20,389 - > 00:35:23,189 hit follow or subscribe and share it with someone else in 832 00:35:23,189 - > 00:35:25,829 the pharma world who might need to hear it. 833 00:35:26,069 - > 00:35:29,909 For more on pharma trends, career growth, and business 834 00:35:29,909 - > 00:35:33,909 strategies, connect with me, Jonathan Kaske, on LinkedIn. 835 00:35:34,229 - > 00:35:36,389 Until next time, thanks for listening.