Latest / StartUp Health NOW Podcast / Former Dexcom Exec Claudia Graham Joins StartUp Health’s New T1D Moonshot Impact Board

Transcript

Former Dexcom Exec Claudia Graham Joins StartUp Health’s New T1D Moonshot Impact Board · StartUp Health NOW Podcast

• 0:00
  [ on-hold music] You don't have to be a rocket scientist. You don't have to be some really smart person. The more you know, the better you're gonna be with diabetes.
• 0:14
  And so, getting your continuous glucose values tells you what you need to do. You're the one living with the disease.
• 0:23
  [ on-hold music] Welcome to StartUp Health NOW, the podcast where we celebrate the entrepreneurs and innovators reimagining the future of health. I'm your host, Logan Plaster.
• 0:35
  If you've followed StartUp Health at all recently, you would have seen headlines about our new Type 1 Diabetes Moonshot.
• 0:41
  To recap, we've launched an initiative designed to speed up innovation around Type 1 diabetes by bringing together a cross-disciplinary team of investors, entrepreneurs, philanthropists, researchers, and other experts.
• 0:53
  At the heart of the effort is an impact board, basically our T1D dream team, which brings together the top minds in the field for collaborative working sessions.
• 1:02
  We wanted to take some time on this podcast to introduce you to some of the inspiring folks on this board, and then invite you to get involved.
• 1:10
  On this episode, you'll meet Claudia Graham, former executive at Dexcom, the company that revolutionized the continuous glucose monitor. She served as VP of Marketing over there and SVP of Global Access.
• 1:21
  Now she's putting her decades of experience at Dexcom, and add 40 years as someone suffering from Type 1 diabetes, to work as an advisor and an investor.
• 1:30
  I caught up with Claudia over Zoom at her home in Idaho to learn more about the opportunities and challenges that she sees in the Type 1 Diabetes Moonshot, and how she thinks about leaving a legacy for the next generation.
• 1:42
  A quick note, if you're an entrepreneur or an investor, or really anyone passionate about innovating in Type 1 diabetes, we want to hear from you. Just email T1D@startuphealth.com. We'd love to connect.
• 1:55
  Now, onto the interview with Claudia Graham. [ on-hold music] I'm so glad we could connect, and I'm so excited that you're a part of this initiative. But you're so nice to say that. I'm thrilled to be part of it.
• 2:09
  I've been reading up and, you know, it's... Listen, we got to give it a shot if we can make a difference. Yeah. All right. So why do you care about Type 1 diabetes? Because I've had it for well over 40 years
• 2:22
  and, you know, um, and I've been working professionally in the field for probably 30 plus. So it's a disease that is complex and, you know, it's kind of like the more you know, the better you're going to be. Mm-hmm.
• 2:36
  And I'm afraid that, that that doesn't, that, that doesn't bode well for healthy quality. Mm. Right? Yeah.
• 2:44
  If you've got all the right access and all the right education, the right doctors, you're going to be fine, but there's so many people that don't have that. So it's a disease that I think can, can
• 2:55
  be modified and, and have a... You, you can have a, a huge impact on it. Yeah. Uh, how have you seen treatment and care improve over, over the 30 years that you've had... Well, I've had diabetes now, oh, probably 43
• 3:11
  years at least. Oh, you've been working in this space for 30 years, right? Oh, yes, right. Yes. For over 30 years. You know, uh, when I start...
• 3:17
  Well, they used to just have, um, urine testing for glucose, and then we went to blood glucose testing, and then insulin pumps came out.
• 3:25
  And I got involved in the mid-'90s and, um, I was working on some Type 2 drugs, but then I started working for a, a pump company at the time in the late '90s called MiniMed, and w- we made insulin pumps.
• 3:39
  Very, you know, good company, and we also started the first continuous glucose sensor.
• 3:44
  So we've gone from kind of nothing, from the dark ages, and then all the way to where we are today, which is the hybrid automated insulin pumps that talk to continuous glucose sensors.
• 3:55
  So I was at MiniMed for a while, uh, for, gosh, probably 12 years or so with... Maybe 10, I don't know, and Medtronic bought us. And then I went to Dexcom, which was a very small company.
• 4:06
  It was focused just on glucose sensing. Okay. And I stayed there until I retired. And here's the deal, it's all about your blood glucose. And, and once someone knows what their blood glucose is,
• 4:18
  then you decide how much insulin or what kind of medications or what your diet is. So it's been, it's been a fun challenge.
• 4:25
  The technology has really evolved, but it's really been more interesting to watch the patients and the doctors. Hmm. Because they're the ones that are benefiting so much. The technology's moving quickly, but, um,
• 4:38
  gosh, what it's meant to the patients. When you say watch them, what do you mean? Well, this is an interesting thing.
• 4:44
  So for example, when we first came out with our continuous glucose sensors, you know, 1999, 2000, um, the doc- people didn't embrace them. They weren't really user-friendly. They weren't as accurate as they are today.
• 4:59
  But then let's say, you know, fast-forward another 10 years, now we're 2008, and the devices are getting, you know, really accurate, and we've been able to show, the medical community has been able to show it really works.
• 5:11
  We had issues with a lot of physicians who thought that it was too much information for a patient- Hmm... to see. You know, why should they see their continual blood sugars?
• 5:20
  And the doctor said, "Well, that's too much information. You know, they're doing fine with just checking themselves three times a day." Hmm.
• 5:27
  Now, you see, that's like, you know, seeing a movie and seeing three minutes of a, of a 24-hour movie. Yeah. And you don't know where you are. So the continuous glucose sensor was an eye-opener.
• 5:37
  But we, we met a lot of resistance, surprisingly, from practitioners. Now, now, there's other areas of health that have had the same pushback where, okay, you can overload patients with data- Yes...
• 5:49
  and you do need doctors to be a filter at some point. So what made Type 1 different in that regard? Excellent question. You know, looks like you've done this before, I think, Logan, because that's an excellent question.
• 6:00
  Here's the deal. There's probably no other disease in the world that requires as much self-management- Hmm...
• 6:05
  as diabetesAnd so I go back to that first thing I said, which is the more you know, you don't have to be a rocket scientist, you don't have to be some really smart person.
• 6:15
  The more you know, the better you're gonna be with diabetes. And so getting your continuous glucose values tells you what you need to do. You're the one living with the disease. Got it.
• 6:27
  You know, not some nurse ed- nurse practitioner that you see 20 minutes twice a year. You see what I mean? Yeah.
• 6:34
  So the reason I think it's been so important is it's, it's enabled the patients, and that's a, you know, feeble saying, but there's, there's nothing more true in diabetes than empowering patients- Yeah...
• 6:44
  to take care of themselves. And, and that's what we see. It's, it's understanding what they're doing has made the difference. How, how would you describe, uh, generally the work you did at Dexcom?
• 6:53
  And, and what are you most proud of from that period? Yeah. I, I think bringing in, ushering in continuous glucose monitors and, you know, the hybrid closed loop systems.
• 7:02
  What I was tasked with, you know, I, I, I ran marketing and product development along the way at MiniMed and, and Dexcom, but the thing that most interested me was I was over w- what we call kind of access.
• 7:14
  So how do we get the payers? We started domestically in the US, how do we get them to cover it? And that included government as well as commercial payers.
• 7:24
  And then once we had the body of evidence, we could go outside of the US and really make some cost-effective arguments. So the things I'm most proud about is, is getting Medicare coverage for CGM
• 7:37
  and being able to use the apps, uh, you know, all the insurance coverage, and then working in, you know, Australia and in the UK and Germany.
• 7:46
  And it was, you know, the more advanced countries, of course, that started first, but now we're, you know, we've got... There's, there's no doubt that this technology
• 7:56
  i- is not a help, and there's no doubt, uh, that it is cost-effective for the right population, so. Yeah.
• 8:03
  Um, a big reason why we launched this Type 1 Diabetes Moonshot and created this impact board, of which you are an esteemed member, is this idea of lowering the barriers between institutions to speed up commercialization to, you know, research to commercialization, to- Absolutely...
• 8:22
  connect founders to startups, et cetera. So I wonder if you could speak to some of the, the, that challenge as you've seen it.
• 8:31
  Have you seen times when, boy, if we could just speak to each other, if we could just connect this group to this group to this group, how has that played out for you?
• 8:39
  You know what, in diabetes, the difference has been really the patient advocates. They're the ones that are stepping forward and saying, "Hey, wait a minute, I want that technology. Why can't I have that?
• 8:49
  I'm smart enough to figure out how to use it."
• 8:51
  So they've broken a lot of the barriers, and it's been those institutional barriers such as, you know, uh, "Well, we can't fund this because we don't think you're gonna make enough money," or, you know.
• 9:04
  I mean, y- you name it, and it's regulatory, and it's reimbursement, and it's this institutional behavior. So that's what excited me about StartUp Health, is that it's kind of bypassing that. Yeah.
• 9:15
  And if we can get some of these smaller companies that have got super ideas, and we can give them enough money to start this germinating, right?
• 9:24
  Then, then maybe somebody else can come in and buy it or help take it across the line, because so many things get developed and they never make it over that wall into the commercial world.
• 9:36
  Yeah, that valley of death they call it. That's the behavior. Yes. And that's where the excitement is. But you gotta try, and we've gotta get away from a lot of the institutional thinking. Yeah.
• 9:48
  Uh, do you f- And that's, StartUp Health is exciting. Do you follow, uh, new innovations in the space? Are there, are there startups that you're...
• 9:56
  or just products and services that you're excited about that are being developed? I do follow it. I'm, I'm very active in this area.
• 10:03
  Um, some of them are, are probably gonna get an idea and they're not gonna go anywhere unfortunately. Sure.
• 10:08
  What happens at the end of the day, it's a good idea, but when you start really testing it on enough patients, the truth is they might not be able to manufacture it, you know, and they can't reliably produce it.
• 10:18
  So stuff does fall by the wayside, but the technologies are good, uh, that are coming along. We've just got to get them through that testing phase. Yeah. And the same thing with new compounds.
• 10:29
  There's a lot of exciting work in Type 1 diabetes in terms of immunosuppressants and beta cell therapies, regenerative therapies. That is really burgeoning, and that, that's where a lot of money is being spent right now.
• 10:44
  Yeah, it's interesting to think that part of the entrepreneurial process is putting a lot of things out there, knowing that many of them will fail, you know?
• 10:52
  Really, you know, investing in entrepreneurs at scale, and not just trying to pick one winner and pray, you know. Like, hey, it might take investing in 10 of them to get the one, right?
• 11:04
  Uh, it, you know, and I, you're right because y- you know, the VCs, the smaller guys, some of these guys say, "Hey, you gotta invest in 10 companies."
• 11:09
  And I know I've invested in a few small ones and, you know, they really sounded good to me. They haven't made it. Yeah.
• 11:17
  But I'm glad, you know, I'm glad I could g- give my expertise and some of my, you know, money to see if we can get them over the, you know, finish line. Yeah. But it's hard. Yeah, it is hard.
• 11:29
  That's why I really like this model. Let's w- you know, the big boys have been in this area a long time, and we still don't have a cure, and we still don't have equal access for everybody.
• 11:43
  And so I think the stuff StartUp Health is doing is, is chipping away at some of these. And really the, the equality and the access issue is, that is bigger than people even realize. Hmm. It's huge.
• 11:57
  What makes, what makes you say that? Well, we can get these products developed.
• 12:03
  They might be able to make it through the, the FDA, but then payers might not embrace them, and they say, "No, it's, you know, it's experimental," or it'll only go to certain kind of treating physicians.
• 12:15
  So where the masses are going, they're not going to these high specialty clinics. Hmm.
• 12:20
  They're going to, you know, the regular docs, and the regular docs aren't specialized in diabetes.So that's, there's just, there's barriers. There's so many. Yeah. And, um, so I'm keen on chipping away at those. Yeah.
• 12:35
  I, I think it's really fascinating to bifurcate our thinking between scientific innovations and access innovations. Mm.
• 12:42
  'Cause like you, like you've said, and I've talked to other members of the board, you know, there's things that we already have that we just need to get into everyone's hands.
• 12:50
  And so if a startup can do that piece, then that's, that's a, a massive innovation. Right. Exactly. Exactly. Uh, so you've worked with startups. You've invested in some.
• 13:02
  Um, startups will read this blog post who are interested in this, uh, moonshot, this initiative. What's a piece of advice that you'd give to a founder who is early in the process of innovating around Type 1 diabetes?
• 13:16
  You know, uh, make sure your idea is sound. Have more money than you think you're gonna need. Mm. Uh, I would say talk to people that have been through it.
• 13:26
  People are really will- um, uh, other investors, I think they're quite willing to share their story and pass it on. Mm.
• 13:34
  And I know that, you know, the network with the, the StartUp Health is, is nice, and that's a nice benefit for these guys. Um, boy, keeping at it.
• 13:45
  But it, it, that's hard to say because the amount of money, it, it depends what the regulatory path is.
• 13:53
  You know, are they making a device that's gonna be sold by prescription and needs FDA approval, or is it gonna be some remote monitoring app? So there's a lot of different- Mm-hmm... things. Um, think it through.
• 14:03
  Think of everyth- all the worst that could happen, and it will. That your, your clinical trials will fail. Mm-hmm. You're not gonna meet the end point.
• 14:12
  You know, you're gonna have investors that wanna pull back and get their money back. You know, stuff like that. It, it all happens. It's, it's a long haul. It's takes a long time. I'm not saying don't do it. Yeah.
• 14:24
  Network. But you're, but, but you're, but you're a realist. Did Dexcom acquire businesses while you were there? We, we did. We made a small, um, acquisition of a, a small kind of diabetes device software.
• 14:38
  And, you know, o- once we got it, I think it was really great, but then did it stand up to the robustness that the platform really needed? Mm. You know?
• 14:48
  And that our business was growing so quickly, so I think we ended up having to put, you know, what we invested in it just went by the wayside.
• 14:55
  We ended up having to, you know, put of our, our own people, our own money, our own heavy- You might as well, you might as well have built it yourself. At the end of the day. Interesting.
• 15:05
  But, um, because a lot of these smaller companies haven't thought through the scalability, let's say. Mm. You know, they're kind of at, at proof of concept, and so they haven't thought through the scalability.
• 15:16
  And, um, so that's always a challenge. But they say, you know, "Listen, that's not gonna be my worry." Yeah. "That's gonna be who buys me." So that's your advice for founders.
• 15:26
  What about a sort of everyday health investor who says, "You know what? Maybe I want to be an impact investor. Maybe I want to put my money behind a portfolio of sp- targeted startups."
• 15:38
  What would be your message to an investor? Do the things that are most meaningful to you. Do your homework to find out where you think you can have the biggest impact. Mm.
• 15:49
  If I'm an investor, am I doing it because I really wanna get an ROI on my money? A lot of people don't anymore. I mean, they wanna, you know, they've made their money. They don't need more money.
• 16:01
  They wanna have an impact. So I like the idea of impact investing. I like that. Um, you know, you can't take it with you, and there are so many vehicles to make a meaningful, impactful investment. Research some of that.
• 16:16
  That's what, that's kind of what's exciting to me now. Yeah. Is, you know, how do you put your money out there so it's really gonna be put to good use? You said, what, you re- you retired recently from Dexcom?
• 16:28
  I retired from Dexcom three years ago, actually. Okay. Yeah. Well, Claudia, that's, those are the questions I have. That's it. Thank you so much for, uh, including me. Yeah. No, it's inspiring stuff. Okay, Logan.
• 16:40
  Thanks a lot. Okay. Thank you. Have a great day. [upbeat music] Thanks for listening to StartUp Health NOW.
• 16:48
  StartUp Health invest in health transformers around the world who are dedicated to achieving audacious health moonshots.
• 16:55
  If you want to learn how you can join this community of entrepreneurs, or if you want to connect with one of our 400 companies, go to startuphealth.com.
• 17:03
  If you'd like to learn how you can invest in our Health Moonshot Impact Fund, go to healthmoonshots.com. Thanks for listening to StartUp Health NOW. We'll be back again with another episode next week. [upbeat music]