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Biotech Boom, Drug Lag: Japan's Innovation Paradox · Making Medicine

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  Speaker 1: At Making Medicine, we're reporting on the headlines, not making
• 0:03
  Speaker 1: medical recommendations. For personal health questions, always ask your doctor.
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  Speaker 1: Nothing in this episode constitutes investment, financial, or legal advice.
• 0:13
  Speaker 1: Consult your own advisors before making decisions.
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  Speaker 2: You know, there's great science everywhere. There's not always great
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  Speaker 2: investments everywhere. What's important about this space, about AMED, is
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  Speaker 2: that the ecosystem is really trying to attract investors to
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  Speaker 2: come here and turbocharge their investments.
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  Speaker 3: Their efforts to build new, better drugs.
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  Speaker 1: Welcome back to the Making Medicine podcast, where science, policy,
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  Speaker 1: and innovation meet. I'm your host, John Stanford, coming to
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  Speaker 1: you live from Tokyo, Japan, where we're filming at BioLabs,
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  Speaker 1: a newly opened location incubating companies here in Japan. We've
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  Speaker 1: had an incredible week. We've been meeting with policymakers. We
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  Speaker 1: attended BioJapan and had a great panel. We've just been
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  Speaker 1: having conversations sizing up the ecosystem. And of course, we
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  Speaker 1: brought U.S. investors. And I'm thrilled that today's episode is
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  Speaker 1: going to sit down with Michael Gutbrode and Marion Nakata.
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  Speaker 1: They've been joined with RA Capital and Ventures. We've been
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  Speaker 1: having great conversations about the latest in biotech in Japan.
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  Speaker 1: Let's get into the show. Welcome to the Making Medicine Podcast.
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  Speaker 3: Thank you, John.
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  Speaker 4: Great. Thanks for having us.
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  Speaker 1: This is the furthest one away. This is our second
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  Speaker 1: Japanese podcast, but we can film this in the US
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  Speaker 1: and it'll be a little easier, but you've come eight, 10,000
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  Speaker 1: miles for what's culminating here in this conversation. I think
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  Speaker 1: it's fitting that we're sitting here at the brand new
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  Speaker 1: BioLab space. And I think after a week in the country,
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  Speaker 1: we hit BioJapan and we'll come back to that. We
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  Speaker 1: met with policymakers.
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  Speaker 3: Maybe.
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  Speaker 1: BioLabs is a good context to say what you saw
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  Speaker 1: this week. It's obviously a bullish bet by Johannes and
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  Speaker 1: the team of BioLabs that Japan is going in the
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  Speaker 1: right direction and opening up locations here. Is that what
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  Speaker 1: you saw this week?
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  Speaker 4: Definitely.
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  Speaker 1: Yeah.
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  Speaker 4: I mean, just with starting with bio, we were trying
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  Speaker 4: to guess how many people are going to be.
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  Speaker 3: At bio, right?
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  Speaker 1: This is embarrassing. Go on, Marion.
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  Speaker 4: I thought, well, maybe 5,000. And other people thought a
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  Speaker 4: couple hundred. And there were over 20,000 people at Bio. Unbelievable.
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  Speaker 4: So it was pretty remarkable from not just Japan, a
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  Speaker 4: lot of Japan, but from all over the world. So
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  Speaker 4: I think there is definitely the, you know, interest in
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  Speaker 4: having Japan be a vibrant, you know, startup ecosystem and biotech,
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  Speaker 4: you know– hub of sorts.
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  Speaker 1: You saw the same thing, Michael?
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  Speaker 3: Absolutely.
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  Speaker 2: I mean, yeah, this is exemplary of efforts that we're
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  Speaker 2: seeing across the stakeholders here. So we talked to government officials,
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  Speaker 2: other investors, CEOs of startups. I mean, everybody's excited about
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  Speaker 2: this new growth in Japan in biotech.
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  Speaker 1: Now, you're a busy guy, Michael. Sante Ventures is hot
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  Speaker 1: at work putting capital out there. And you took the
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  Speaker 1: time to be here What does it say about Sante
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  Speaker 1: that you're here? And how are you all thinking about
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  Speaker 1: the market?
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  Speaker 2: You know, I think it says that we will go
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  Speaker 2: anywhere to find the best science and the best opportunities
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  Speaker 2: for our investments. And Japan historically has been an incredible
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  Speaker 2: place for biology, chemistry. I mean, talk about the Nobel Prizes,
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  Speaker 2: all the fantastic publications here. And so I think what
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  Speaker 2: it really says is this is a place that we
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  Speaker 2: need to keep our eye on. We need to be
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  Speaker 2: aware of what's going on here. We need to make
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  Speaker 2: sure that we're able to invest here when there's the
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  Speaker 2: right opportunity for Sante.
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  Speaker 1: And I don't want to scoop Sante, but even more.
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  Speaker 1: One of the things that we've seen here is this
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  Speaker 1: incredible AMED program. And for those not familiar, about five
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  Speaker 1: years ago, it started as a reaction to COVID that
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  Speaker 1: they wanted to see more innovation and they were willing
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  Speaker 1: to create huge non-dilutive grants. I mean, someone's telling us
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  Speaker 1: 40 million in non-dilutive funding.
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  Speaker 4: So there's this- For one program.
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  Speaker 1: For one program. And that company, I think, is gonna
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  Speaker 1: try to double dip and go back for another program
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  Speaker 1: in the same company. So AMED, this really lucrative opportunity
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  Speaker 1: to invest in companies that are either in Japan or
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  Speaker 1: have a great tie to Japan.
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  Speaker 4: Is that something- And I believe clinical stage.
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  Speaker 1: Yeah, I think that's right. And so we saw it
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  Speaker 1: and I think it's great. And I think Sante's shown
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  Speaker 1: some interest.
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  Speaker 3: Absolutely.
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  Speaker 2: So the counter to, you know, there's great science everywhere
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  Speaker 2: is there's not always great investments everywhere, right? And so-
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  Speaker 2: What's important about this space, about AMED, is that the
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  Speaker 2: ecosystem is really trying to attract investors to come here
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  Speaker 2: and turbocharge their efforts to build new, better drugs. I
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  Speaker 2: think the AMED program is that extra kick that you
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  Speaker 2: need for investors who are looking globally And looking at
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  Speaker 2: other locales to say, oh, wait a minute, here my
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  Speaker 2: dollar can go that much farther. And at the early stage,
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  Speaker 2: that is critical. So, I mean, not only do you
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  Speaker 2: not have to kind of worry about fundraising, and you
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  Speaker 2: won't believe the amount of time CEOs spend fundraising.
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  Speaker 3: They literally never stop.
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  Speaker 1: And, you know, Marion, from your perspective, obviously incredible career
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  Speaker 1: at JJDC. You're doing boards now. You're doing advisory work.
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  Speaker 1: Do you agree that it's you're not going to come
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  Speaker 1: here just for the AMED, but it may be the
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  Speaker 1: sweetener that gets something that was a maybe invest over
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  Speaker 1: the finish line? Is that how you see it?
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  Speaker 4: Yeah. I mean, I think it's also a way of
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  Speaker 4: the government supporting de-risking. of the science through that non-dilutive funding.
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  Speaker 4: And in some instances, promoting specific areas like regenerative medicine,
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  Speaker 4: which I've heard from people when I'm in the US
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  Speaker 4: that they would consider coming and having a footprint in
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  Speaker 4: Japan just to be able to access that non-dilutive funding.
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  Speaker 4: So there's a buzz about regenerative medicine. So they have
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  Speaker 4: the potential to attract specific areas of interest to the country.
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  Speaker 4: For example, if they get interested in women's health, that
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  Speaker 4: could be something that would be a magnet for companies
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  Speaker 4: that can't get regular funding but would be willing to
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  Speaker 4: come here for AMET funding.
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  Speaker 1: And I mean, something that I feel like you called
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  Speaker 1: out in several of our meetings, I mean, there's so
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  Speaker 1: much strength there. You mentioned Nobel Prizes, and of course,
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  Speaker 1: they won more Nobel Prizes this week. And it seems
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  Speaker 1: like every time we come to Tokyo, they win a
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  Speaker 1: Nobel Prize. So I don't know if we're the cause,
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  Speaker 1: but that incredible science is there. But I love what
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  Speaker 1: you said. Incredible science does not a great investment make
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  Speaker 1: Did you see other things while you were here, whether
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  Speaker 1: cultural or business or others that are going right that
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  Speaker 1: do make them good investments? Or on the other hand,
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  Speaker 1: are things that you see would make it more challenging
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  Speaker 1: to see that good science into a good investment?
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  Speaker 4: I think that the culture of the Japanese, which tends
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  Speaker 4: to be very conservative and also having sort of consistent
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  Speaker 4: or harmonious policies interactions and not creating waves are potential
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  Speaker 4: issues if you're trying to create an entrepreneurial ecosystem. So
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  Speaker 4: for example, it's much more standard to have lifetime employment
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  Speaker 4: in the same company and to have that stability versus
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  Speaker 4: taking a risk and having a career in a startup
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  Speaker 4: that could blow up in two years if the science
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  Speaker 4: doesn't work. And by the same token, So it might
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  Speaker 4: be hard to find people that are willing to go
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  Speaker 4: into a startup. And so by the same token, I'd
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  Speaker 4: say from an investing perspective, it also creates an issue
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  Speaker 4: in terms of investing in something that is very nascent
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  Speaker 4: and early versus investing, let's say, in a big pharma.
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  Speaker 4: So those are some things that I see, which is
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  Speaker 4: sort of headwinds culturally. Yeah.
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  Speaker 2: And I think there's still some interesting tensions here.
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  Speaker 3: Overall.
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  Speaker 2: Historically, Japan has gone through periods of being very insular
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  Speaker 2: and not open to kind of foreign investment and foreign interaction.
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  Speaker 2: And I think that that does still play out a
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  Speaker 2: little bit in some of our interactions. There's this tension between, say,
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  Speaker 2: the AMED program really wanting to bring that activity and
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  Speaker 2: put those dollars to work in Japan and versus the
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  Speaker 2: trend in biomedical research and drug development right now and
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  Speaker 2: will only increase is it's a global activity, right? And
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  Speaker 2: so oftentimes, and we heard it this week, there are
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  Speaker 2: providers in other countries that these companies that are utilizing
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  Speaker 2: the AMED funding need to access, right? And so there's
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  Speaker 2: still a few wrinkles to be ironed out. And how
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  Speaker 2: can we grow the Japanese ecosystem by bringing foreign investment,
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  Speaker 2: but allow these startups to really succeed by giving them
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  Speaker 2: access to the global bevy of services they need?
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  Speaker 1: I think that's so well said because, yes, the emphasis
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  Speaker 1: is bring it to Japan. But also, I think one
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  Speaker 1: of the things we all tried to communicate is, don't
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  Speaker 1: make Japan fight with one arm tied behind its back.
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  Speaker 1: What makes U.S. biotech sometimes very successful is leveraging CRO services,
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  Speaker 1: CDMO services elsewhere or collaborating across borders. And this actually
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  Speaker 1: gets me to something else I wanted to bring up
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  Speaker 1: of siloing. And so I do think there's a focus
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  Speaker 1: here of like, do it all in Japan, soup to nuts.
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  Speaker 1: And we know that what it usually is more successful
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  Speaker 1: is that global attitude of specialization of labor, have a
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  Speaker 1: great idea, but use services around the world. And so,
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  Speaker 1: you know, I think I'd be curious, this concept of
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  Speaker 1: siloing that came up in academia and maybe mix in,
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  Speaker 1: I feel like we had to be the cheerleaders of failure.
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  Speaker 4: Yes.
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  Speaker 1: And say in all of these meetings, we fail so
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  Speaker 1: darn much. It's okay. And if you're not, if four,
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  Speaker 1: if they expect four out of five Amed companies to
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  Speaker 1: eventually put products in pharmacies, that would be wildly successful
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  Speaker 1: and frank, but also kind of say, maybe you didn't
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  Speaker 1: take big enough bets because failure is inherent. So Whether
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  Speaker 1: it's the siloing or failure, did either of those things
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  Speaker 1: resonate in the conversations with you guys?
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  Speaker 4: Failure, for sure. I mean, it's what we were saying.
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  Speaker 4: It's part of the business. And in Japan, failure is
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  Speaker 4: not very popular. And whereas for us in the entrepreneur
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  Speaker 4: ecosystem in the U.S., failure is celebrated in the sense
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  Speaker 4: that when a company shuts down like Caribou just did,
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  Speaker 4: you see people congratulating Rachel and saying, you had such
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  Speaker 4: a ride, you worked so hard and what's your next gig?
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  Speaker 4: Because everybody's excited about what's around the corner. And so
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  Speaker 4: I think that's one thing that is not part of
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  Speaker 4: the Japanese DNA, but it's an important aspect of our business, right?
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  Speaker 4: Of being able to accept those failures.
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  Speaker 2: Yeah, and I think also kind of tying in the
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  Speaker 2: ability to access global providers and collaborate across different companies
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  Speaker 2: and technologies, that's also reflected within academia as we talked about, right? Where,
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  Speaker 2: you know, I think looking at what Japan has done
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  Speaker 2: in academia, there's a pattern of siloed academic researcher who's
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  Speaker 2: incredibly good and incredibly productive in one area, and that's
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  Speaker 2: led to those Nobel Prizes. But as we're talking about,
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  Speaker 2: that doesn't necessarily lead to great translational research, right? And
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  Speaker 2: so as we've seen in the U.S., some of the
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  Speaker 2: most productive and important government-funded granting programs are those consortia
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  Speaker 2: that collaborative grants that really allow researchers to talk to
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  Speaker 2: each other and to push things, not only within their lab,
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  Speaker 2: but outside of the lab.
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  Speaker 1: Well, we got some homework from the cabinet office who
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  Speaker 1: was very clear. We need to bring them back a
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  Speaker 1: model that shows that. And so I think that consortium model,
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  Speaker 1: I think that's great to call out because that's what's
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  Speaker 1: missing here. And that is the model that we might
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  Speaker 1: end up recommending to the government is Look, you want
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  Speaker 1: your best labs not so competitive that they don't talk
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  Speaker 1: to each other. We've got to be comparing notes, mixing
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  Speaker 1: it up a little bit. So thank you for already
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  Speaker 1: doing the model homework that we're supposed to for some
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  Speaker 1: of the government meetings. And switching to some of those
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  Speaker 1: government meetings, what was your takeaway? I mean, at Incubate,
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  Speaker 1: we spend a lot of time sitting with policymakers. You
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  Speaker 1: spend a lot of time actually making medicines.
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  Speaker 4: What.
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  Speaker 1: What were your first reactions of any type to the
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  Speaker 1: government meetings?
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  Speaker 2: I mean, first of all, I was impressed across the
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  Speaker 2: board about the level of self-reflection within the country. And,
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  Speaker 2: you know, I don't interact with politicians very often, so
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  Speaker 2: I'm not, I can't gauge how consistent that is, but
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  Speaker 2: I have to say in almost every meeting that we
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  Speaker 2: were in, there was, you know, a real understanding of
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  Speaker 2: where Japan has been, where they think they are now,
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  Speaker 2: and where they wanna go. How to get there is
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  Speaker 2: really what a lot of our discussions were about. But
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  Speaker 2: to give an example, they wanna understand why is Kendall
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  Speaker 2: Square the way it is? And not to try and
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  Speaker 2: copy and replicate it, but at least understand what are
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  Speaker 2: the fundamental drivers of what makes a good ecosystem and
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  Speaker 2: how could policy potentially influence the way that they do
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  Speaker 2: that here.
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  Speaker 4: I was impressed by their commitment to biotech discovery, innovation,
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  Speaker 4: and also in terms of self-reflection, the recognition that there
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  Speaker 4: is a problem with drug pricing. And how it gets
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  Speaker 4: fixed is sort of a bit of a conundrum because
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  Speaker 4: it could be that it's at the expense of something else.
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  Speaker 4: And so that's the challenge they have. And also, I
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  Speaker 4: realized that the yen, which has been weak for a
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  Speaker 4: long time, which is why it's an excellent place to
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  Speaker 4: shop in Japan.
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  Speaker 1: Marion did some shopping.
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  Speaker 4: If you have U.S. currency, if you can only imagine
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  Speaker 4: the flip side about if drugs are expensive, if we
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  Speaker 4: believe they're expensive, let's say in the United States, for
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  Speaker 4: a country that has a currency that's devalued compared to
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  Speaker 4: the dollar, how that must feel for them in terms
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  Speaker 4: of affordability. So I had empathy to that. So it's
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  Speaker 4: not an easy problem for them to fix, but it
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  Speaker 4: is something that they recognize needs to be improved.
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  Speaker 1: And it seemed like, I mean, my takeaway from those meetings,
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  Speaker 1: and I think they were so self-reflective. I mean, it
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  Speaker 1: was almost a history lesson of the last 30 years.
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  Speaker 1: And the takeaway was between slow growth or no growth,
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  Speaker 1: deflationary state and a weak yen, they had to make
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  Speaker 1: tough choices. And in the greater context of healthcare, such
• 16:26
  Speaker 1: an emphasis here on hospitals, not even just as places
• 16:30
  Speaker 1: of improved health, but places of community gathering and the
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  Speaker 1: emphasis on doctors. I think they were very transparent that
• 16:37
  Speaker 1: the easy button to meet the struggling economy was these
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  Speaker 1: price cuts. And I think they were very transparent that
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  Speaker 1: I don't know why I'd go so far to say
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  Speaker 1: that they regret that, but they see the linkage between
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  Speaker 1: that and the drug lag, which is the first time
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  Speaker 1: I've said that right this whole trip. I've been mixing
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  Speaker 1: lag and loss and making glass. Drug glass. It's drug glass.
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  Speaker 4: Do you want to explain what that is to people?
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  Speaker 4: Because that was a revelation to me.
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  Speaker 1: Yeah, 70%. So a pervasive, but also we'll talk about
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  Speaker 1: in a second, maybe not that pervasive, but a growing
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  Speaker 1: awareness of, that 70% of the new medicines from the
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  Speaker 1: last five years aren't available in Japan. I mean, you
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  Speaker 1: look at even the room we're in, and you look
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  Speaker 1: at Tokyo, and you look at not just the innovation,
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  Speaker 1: but the wealth as a country, and you're shocked to
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  Speaker 1: hear 70% of new medicine's not available here. Three, four-year
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  Speaker 1: delays for even the most sort of middling medicines, let
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  Speaker 1: alone the most innovative ones.
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  Speaker 4: Because those launches aren't prioritized, right?
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  Speaker 2: Yeah.
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  Speaker 1: And you did a perfect job. So I kind of
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  Speaker 1: want to tag you in here because in the meetings,
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  Speaker 1: I feel like with policymakers, a lot of them said, well,
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  Speaker 1: look at AMED. We're going to have great drug discovery
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  Speaker 1: because of AMED and drug pricing is over here. And
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  Speaker 1: in the ecosystem model, they're very related. Can you walk
• 18:08
  Speaker 1: through in your own head how you see all these
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  Speaker 1: things linked? Because I feel like you really connected some dots.
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  Speaker 4: Yeah. I mean, when you think about... of funding things
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  Speaker 4: that are early clinical, which may not launch for over
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  Speaker 4: a decade, how does funding those things, how would they
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  Speaker 4: relate to drug pricing for things that are already launched?
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  Speaker 4: And so I think what happens when the pricing is
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  Speaker 4: not favorable, when farmers are doing their calculations about how
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  Speaker 4: much revenue they're gonna get in different countries and regions,
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  Speaker 4: et cetera, if a country has a very low number,
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  Speaker 4: it gets a lower priority in terms of timing of launch,
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  Speaker 4: et cetera. And so if it becomes a low priority,
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  Speaker 4: then there's like fewer employees in the country because there's
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  Speaker 4: a lot more focus on launches in countries where you're
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  Speaker 4: going to get like a decent amount of revenue. And
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  Speaker 4: so there's also the potential that you might not launch
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  Speaker 4: at all If you're one of those 30 percent that
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  Speaker 4: never makes it here. So if you're not even launching
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  Speaker 4: your drug here, then the question is, why would you invest,
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  Speaker 4: you know, in a startup ecosystem in that country? In
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  Speaker 4: other words, and I and when I say invest, I'm
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  Speaker 4: saying just, you know, I'd say not as like a
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  Speaker 4: corporate VC. but I'm just saying that the notion about
• 19:38
  Speaker 4: having a vibrant ecosystem that makes drugs and consumes drugs,
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  Speaker 4: it's not here if you're not potentially consuming the drug.
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  Speaker 4: So therefore, it sort of feeds back to where are
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  Speaker 4: these innovations being developed and it's more preferable in countries
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  Speaker 4: for which there is a vibrant ecosystem related to like
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  Speaker 4: pharma consumption of drugs and the creation of drugs and
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  Speaker 4: sort of this sort of flywheel of sorts. But so
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  Speaker 4: that's I think why the pricing issue has unintended consequences
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  Speaker 4: on the discovery side. And so just by putting AMED
• 20:21
  Speaker 4: dollars in isn't going to fix the pricing issues and
• 20:26
  Speaker 4: the access of medicines for the Japanese patients.
• 20:29
  Speaker 2: Yeah, and I just want to underscore Marion's excellent point
• 20:32
  Speaker 2: about the flywheel, right? And so if pharma is not
• 20:35
  Speaker 2: here because of pricing, pharma talent is not here because
• 20:38
  Speaker 2: of pricing. And we know, as I talked about, they're
• 20:41
  Speaker 2: curious about Kendall Square. What goes on in Kendall Square?
• 20:45
  Speaker 2: And what we know is you bump into anybody and
• 20:48
  Speaker 2: they're either in biotech, pharma, they're in biotech VC, they're
• 20:52
  Speaker 2: in academia. And it's that hyper concentration of talent. And
• 20:58
  Speaker 2: so when you have kind of the dearth of pharma,
• 21:01
  Speaker 2: they're one of the most important components. They have the
• 21:04
  Speaker 2: experience in drug development. They know what pharma companies want.
• 21:09
  Speaker 2: And they're able to mentor startups and entrepreneurs to be
• 21:14
  Speaker 2: more effective in producing new medicines. And so not having
• 21:17
  Speaker 2: that presence here is one of the other links, that
• 21:19
  Speaker 2: flywheel that Marion's talking about is you just don't have
• 21:22
  Speaker 2: it as much, right?
• 21:24
  Speaker 1: I feel like it... the points that you made in
• 21:27
  Speaker 1: those meetings did start to click. And I do think
• 21:30
  Speaker 1: there is a better appreciation for, oh, these things aren't
• 21:34
  Speaker 1: related to, okay, they're related. And if we're serious about,
• 21:39
  Speaker 1: and we know they're serious because there are 17 strategic goals.
• 21:42
  Speaker 1: And I would be, I think we could almost name
• 21:45
  Speaker 1: all 17 of them, but pharmaceuticals is in them. And
• 21:48
  Speaker 1: I do think, I think the prime minister has made
• 21:51
  Speaker 1: clear that she expects this. We met with several ministers
• 21:56
  Speaker 1: who I, to a word, said this is a priority
• 22:00
  Speaker 1: and we are pulling the levers. And the good news
• 22:02
  Speaker 1: is that in their political documents, their Honobuto, they made
• 22:08
  Speaker 1: good on that. They wanna start that flywheel up both
• 22:11
  Speaker 1: on the innovative side, on the early stage side, And
• 22:15
  Speaker 1: on the drug pricing side. And so that seemed to
• 22:18
  Speaker 1: figure it out. But then we talk about uncertainty and
• 22:21
  Speaker 1: policy predictability. Did you pick up on maybe, yeah, you're
• 22:26
  Speaker 1: going toward this goal, but are you really going to
• 22:29
  Speaker 1: this goal? We saw some other documents. What was your takeaway?
• 22:33
  Speaker 1: Do you think they're committed to this?
• 22:35
  Speaker 4: I think they'd like to be committed to it. But
• 22:39
  Speaker 4: I think that just reading between the lines, there's competing priorities.
• 22:45
  Speaker 4: and there's a finite amount of money. And I think
• 22:52
  Speaker 4: us being there and the work that Incubate does to
• 22:57
  Speaker 4: explain to them the consequences of that unpredictability. Because when
• 23:03
  Speaker 4: you are doing a calculation about the revenue in Japan
• 23:09
  Speaker 4: as a pharma, when you're doing your strat plan, you're
• 23:13
  Speaker 4: going to go to the lowest number. In other words,
• 23:16
  Speaker 4: if you're going to be assuming price cuts in Japan,
• 23:19
  Speaker 4: the number that they're going to project for you is
• 23:21
  Speaker 4: actually probably a low estimate, right? Because they have to
• 23:26
  Speaker 4: be realistic. So if there's things that they're promising that
• 23:31
  Speaker 4: there's a lack of clarity about implementation, people are just
• 23:35
  Speaker 4: going to almost have to assume that it's not going
• 23:37
  Speaker 4: to happen. So I feel as if.
• 23:42
  Speaker 4: Hopefully they're being educated that there are consequences and they
• 23:46
  Speaker 4: will stick to their promises.
• 23:49
  Speaker 2: Yeah, I think it's still early days in some cases, right?
• 23:55
  Speaker 2: There's a lot of promising signals, but we discussed a
• 23:58
  Speaker 2: lot of the kind of outstanding.
• 24:00
  Speaker 3: Barriers that still are our problems here.
• 24:04
  Speaker 2: You know, I think there's... often lack of transparency from
• 24:09
  Speaker 2: the outside, right, coming in, trying to understand maybe the
• 24:13
  Speaker 2: tax code or the labor laws. And can you effectively
• 24:17
  Speaker 2: run a startup company here, similar, you know, to the U.S.?
• 24:22
  Speaker 2: And that reflects, you know, again, on this question of
• 24:25
  Speaker 2: there's great science everywhere. You know, where is there an
• 24:29
  Speaker 2: environment for an investment?
• 24:31
  Speaker 1: Did you feel like Was there a specter of President Trump?
• 24:35
  Speaker 1: I mean, most favored nation came up in a couple
• 24:37
  Speaker 1: of the meetings. And, you know, I don't think anyone
• 24:42
  Speaker 1: drew the line, hey, we're thinking about increasing prices and
• 24:47
  Speaker 1: MFNs over here. I don't think. Do you think it
• 24:49
  Speaker 1: was a dotted line? I mean, how do you feel
• 24:51
  Speaker 1: like the specter of the U.S. and Trump played out,
• 24:56
  Speaker 1: if at all?
• 24:56
  Speaker 4: I mean, I think the tariffs in most favored nations are.
• 25:01
  Speaker 4: Things that they realize they have to negotiate. In other words,
• 25:05
  Speaker 4: it's just, it's not going to go away. And so it's,
• 25:09
  Speaker 4: and it's also, you know, it, it shines a light
• 25:12
  Speaker 4: a little bit on, on the fact that they are
• 25:17
  Speaker 4: trying to pay less.
• 25:19
  Speaker 3: Correct.
• 25:20
  Speaker 4: And, and so the, if, if they, if they, there's
• 25:24
  Speaker 4: a recognition that if they do cut a deal, it,
• 25:27
  Speaker 4: it has huge impact. of potentially reducing prices for other countries,
• 25:32
  Speaker 4: which is why there's almost leverage to not capitulate to
• 25:38
  Speaker 4: those price decreases. So I feel like that's a reality
• 25:43
  Speaker 4: that they have to face. And like I said, it's
• 25:46
  Speaker 4: just those two things, the MFN and the tariffs, shine
• 25:50
  Speaker 4: more of a light onto what's happening here in Japan
• 25:53
  Speaker 4: and what they're willing to pay.
• 25:54
  Speaker 1: Yeah, I mean, we can't talk about government meetings without
• 25:58
  Speaker 1: talking about the orchids. we had the pleasure of meeting
• 26:04
  Speaker 1: with several of the cabinet's newest ministers. And terrific.
• 26:07
  Speaker 4: Because they just started.
• 26:08
  Speaker 1: I mean, yeah, these are brand new ministers.
• 26:10
  Speaker 3: And you know. You know who the cabinet's newest ministers are.
• 26:14
  Speaker 1: Incubate is trademarking the Orchid Index as a relative measure
• 26:18
  Speaker 1: of power in Japanese diet offices. In your own words,
• 26:23
  Speaker 1: what is the Orchid Index?
• 26:26
  Speaker 3: Well, what you see.
• 26:28
  Speaker 2: is an incredible recognition of the new promotion, right? And
• 26:31
  Speaker 2: these are beautiful, beautiful orchids in perfect condition.
• 26:35
  Speaker 1: The most beautiful, perfect orchids you've ever seen.
• 26:38
  Speaker 4: I would say there were 40 blooms per single pot.
• 26:41
  Speaker 4: Like 10 times 4.
• 26:43
  Speaker 3: And we're talking about tens of pots.
• 26:46
  Speaker 1: There were a thousand orchid blooms in some of these.
• 26:50
  Speaker 1: I mean, we need to paint the picture. We're talking
• 26:51
  Speaker 1: about you walk in.
• 26:52
  Speaker 4: It's like a wall of orchids.
• 26:53
  Speaker 1: You see a wall.
• 26:54
  Speaker 3: Of white.
• 26:56
  Speaker 1: And the gifts, this must be the traditional gift. We
• 26:58
  Speaker 1: brought chocolates from the United States as our gifts. And
• 27:02
  Speaker 1: as at least one of them said, at least I
• 27:04
  Speaker 1: can eat this. I can't eat another orchid. And that
• 27:06
  Speaker 1: is the orchid index, is when you walk into these offices,
• 27:09
  Speaker 1: you can see who is newly anointed. And it was
• 27:13
  Speaker 1: just such a tangible, this is someone who clearly has anointing.
• 27:20
  Speaker 1: a say in where this government's heading. And I thought,
• 27:22
  Speaker 1: I mean, what an interesting thing.
• 27:25
  Speaker 3: We don't have an equivalent in the US, do we?
• 27:28
  Speaker 4: Yeah.
• 27:28
  Speaker 1: Imagine you could walk in and say, this representative, they're
• 27:33
  Speaker 1: in with the White House. We know this person is
• 27:36
  Speaker 1: carrying a lot of water. We don't have that. The
• 27:39
  Speaker 1: other thing they had, we had this incredible lunch. This
• 27:40
  Speaker 1: is probably one of the high points of the trip
• 27:43
  Speaker 1: was we were invited into the House of Councilors, or
• 27:47
  Speaker 1: now called the Senate, in the actual Diet building. So
• 27:50
  Speaker 1: just like the US, they have these office buildings right
• 27:53
  Speaker 1: next to the Capitol, the Diet building, but we were
• 27:57
  Speaker 1: very fortunate to have lunch in there. And as you
• 28:01
  Speaker 1: go in there, something we do not have but they
• 28:04
  Speaker 1: have is a screen that says, These are the senators
• 28:08
  Speaker 1: who are here in the building right now. And I
• 28:12
  Speaker 1: think for security reasons, we probably wouldn't do that in
• 28:14
  Speaker 1: the United States. But that was the other thing that
• 28:16
  Speaker 1: stood out to me. I was like, I've never seen that.
• 28:19
  Speaker 1: But I would love to know which senators are actually
• 28:21
  Speaker 1: truly in the building. So just a different experience.
• 28:25
  Speaker 3: Yeah, it was. A beautiful room, first of all. Yeah.
• 28:28
  Speaker 3: I mean, to have that be your cafeteria every day. Incredible.
• 28:32
  Speaker 2: And for us to be there amongst other representatives who
• 28:36
  Speaker 2: were not in sessions at that point, is that why
• 28:39
  Speaker 2: you were talking so loud about policy changes?
• 28:42
  Speaker 1: That's how you make change.
• 28:43
  Speaker 3: It's not in the meeting.
• 28:44
  Speaker 1: It's in the lunchroom. And you just say your issue
• 28:46
  Speaker 1: loud enough for people to hear. That's also probably why
• 28:49
  Speaker 1: they– encouraged me to leave quickly.
• 28:52
  Speaker 3: Yeah, maybe.
• 28:53
  Speaker 1: What were some high points of those meetings for you?
• 28:58
  Speaker 1: What stood out that you were like, wow, and I
• 29:01
  Speaker 1: didn't think my career journey would take me into this room?
• 29:04
  Speaker 4: I think being able to explain how innovation has to
• 29:12
  Speaker 4: be funded through what people and countries pay for drugs.
• 29:18
  Speaker 4: was something that I thought hopefully was useful because it's
• 29:23
  Speaker 4: not just about reimbursing pharma for the sunk cost for
• 29:28
  Speaker 4: the clinical development of one drug, right? It's about paying
• 29:33
  Speaker 4: for future innovation, right? That will help to create drugs
• 29:41
  Speaker 4: for significant new unmet needs and also for failures because
• 29:48
  Speaker 4: for every drug that's launched, so much research goes on
• 29:52
  Speaker 4: to try and find drugs that don't pan out. And
• 29:57
  Speaker 4: so to be able to articulate that and then to
• 30:02
  Speaker 4: have them say, what resources could you share with us
• 30:06
  Speaker 4: because we need to educate others in the government or
• 30:09
  Speaker 4: in the public was something that I thought was a
• 30:15
  Speaker 4: real privilege to be able to do that. And on
• 30:19
  Speaker 4: the drug loss, drug lag note, one of the things
• 30:24
  Speaker 4: we were wondering was why aren't the public up in
• 30:29
  Speaker 4: arms about this, right? Because, you know, if that's the case,
• 30:33
  Speaker 4: if you're getting substandard medical care because you don't have
• 30:37
  Speaker 4: access to drugs, why isn't there an outcry? And part
• 30:41
  Speaker 4: of it goes back to the cultural perspective, because Japanese
• 30:47
  Speaker 4: generally don't complain and don't want to stand out and
• 30:52
  Speaker 4: don't want to create waves. And I think that's you know,
• 30:57
  Speaker 4: potentially one reason. The other reason is there is not
• 31:00
  Speaker 4: necessarily the recognition about what exactly you're losing. It's one
• 31:05
  Speaker 4: thing if your clinic or hospital closes and you really
• 31:10
  Speaker 4: lose something tangible, right, because you can't go there, versus
• 31:14
  Speaker 4: if there's a drug, if you have some kind of
• 31:16
  Speaker 4: cancer and you don't have the latest KRAS drug, you
• 31:21
  Speaker 4: don't know because you don't know what you don't know.
• 31:24
  Speaker 4: So there isn't the outcry necessarily by patients. And by
• 31:27
  Speaker 4: the same token, there isn't necessarily the outcry by doctors
• 31:29
  Speaker 4: because they're the ones that might know. Yeah.
• 31:32
  Speaker 1: It's such a good point because the clinic, the hospital,
• 31:36
  Speaker 1: the room and the doctor are tangible. But what good
• 31:39
  Speaker 1: is a clinic if it is not stocked with the
• 31:42
  Speaker 1: best medicines to treat cancer? And one of the things
• 31:46
  Speaker 1: they seem to really want to focus on is real outcomes.
• 31:50
  Speaker 1: We spent a lot of time talking about cost effectiveness
• 31:52
  Speaker 1: and And I think we did make, I think we
• 31:55
  Speaker 1: gained ground on behalf of the whole industry and even
• 31:58
  Speaker 1: the whole health economic space of really having conversations about
• 32:03
  Speaker 1: thinking about cost effectiveness in different ways, because people can
• 32:07
  Speaker 1: go back to work after a cancer treatment that really works.
• 32:12
  Speaker 1: And so I think just that idea of they chose,
• 32:15
  Speaker 1: let's keep the clinics, let's keep the doctors, let's lose
• 32:18
  Speaker 1: the drugs. I think it is going to break through.
• 32:21
  Speaker 1: I think that outrage that we would expect, it seems
• 32:27
  Speaker 1: to be coming. And maybe the prime minister is front
• 32:29
  Speaker 1: running that by making this a strategic priority.
• 32:32
  Speaker 3: Yeah.
• 32:33
  Speaker 4: Yeah.
• 32:33
  Speaker 2: And you know, the other thing, I think that the,
• 32:37
  Speaker 2: you know, there's a lot of trends that are kind
• 32:39
  Speaker 2: of democratizing information and democratizing kind of awareness about what's.
• 32:44
  Speaker 3: Out there, such as AI.
• 32:47
  Speaker 1: SI.
• 32:47
  Speaker 4: Yeah.
• 32:48
  Speaker 2: I think I'm gonna stick with AI for now. And,
• 32:52
  Speaker 2: you know, I get a cold. I go to Claude
• 32:54
  Speaker 2: and I say, hey, how do I get rid of
• 32:55
  Speaker 2: this cold as quickly as possible?
• 32:56
  Speaker 3: Yeah.
• 32:57
  Speaker 4: Right.
• 32:57
  Speaker 2: And, you know, thankfully, that's my biggest health challenge sometimes.
• 33:01
  Speaker 2: But I think what we see in the U.S. is,
• 33:04
  Speaker 2: you know, if somebody gets a terrible diagnosis and they're
• 33:09
  Speaker 2: in an unfortunate situation, you know, they they want to
• 33:12
  Speaker 2: advocate for themselves. And I think that's quite reasonable.
• 33:15
  Speaker 3: Right.
• 33:16
  Speaker 2: Your doctor may not be aware of the latest and
• 33:19
  Speaker 2: the greatest treatments that are out there. And luckily for
• 33:22
  Speaker 2: us in the US, many of those are available and
• 33:24
  Speaker 2: you can get into a clinical trial if you want, right?
• 33:28
  Speaker 2: But I think that, you know, that type of availability
• 33:31
  Speaker 2: of information will make its way to Japan and maybe
• 33:35
  Speaker 2: the younger generation of people will become more aware of
• 33:38
  Speaker 2: what they have access to and what they don't.
• 33:41
  Speaker 1: I want to come back to the younger generation of
• 33:43
  Speaker 1: in a second. But I think that's such a great point.
• 33:46
  Speaker 1: And one of the things we don't talk about with
• 33:48
  Speaker 1: the advent of Claude and ChachiBT and Sakana AI.
• 33:52
  Speaker 2: Sakana AI is the Japanese pride here. Which they're very,
• 33:56
  Speaker 2: very proud of.
• 33:57
  Speaker 1: And we were very fortunate to meet with the new
• 34:00
  Speaker 1: state minister for AI, Shiozaki-san. And he was quick to say,
• 34:05
  Speaker 1: it is outpacing FrontierMod. I mean, that was... that was
• 34:08
  Speaker 1: right there. I mean, and the pride they're taking in,
• 34:11
  Speaker 1: in that space, I think is, is really interesting as
• 34:15
  Speaker 1: it gets adopted. I think you're right because it's WebMD
• 34:18
  Speaker 1: on steroids. And as it says, so sorry that you
• 34:23
  Speaker 1: have received this diagnosis. Here are the three best treatments
• 34:27
  Speaker 1: around the world, but none of them are available in Japan.
• 34:30
  Speaker 1: I think you're right. I think that could break the dam.
• 34:32
  Speaker 4: I related to the, um, Health economics. So Richard from
• 34:40
  Speaker 4: RA was very popular in some of our meetings.
• 34:43
  Speaker 3: He was.
• 34:44
  Speaker 4: Because he has created a model that has looked holistically
• 34:50
  Speaker 4: at what the costs are that you could potentially avoid
• 34:55
  Speaker 4: if you had effective drugs. So it's not just so
• 34:58
  Speaker 4: much about, let's say, you have Crohn's disease and what's
• 35:03
  Speaker 4: the cost to reduce your flares. It's about taking, like,
• 35:08
  Speaker 4: you know, can you go back to work? How many
• 35:12
  Speaker 4: hospital visits? How many surgeries have you avoided?
• 35:15
  Speaker 3: Yeah, the real societal value, right?
• 35:16
  Speaker 4: Yes, exactly. Because in Japan, there is this one insurance model, correct?
• 35:22
  Speaker 4: With a copay. So their insurance, if you have a
• 35:27
  Speaker 4: particular drug that you pay X for, could save multiples
• 35:32
  Speaker 4: of the cost of the drug holistically for that patient
• 35:35
  Speaker 4: over the course of their life. And they're not switching
• 35:37
  Speaker 4: insurances like we do, which makes it even easier to
• 35:41
  Speaker 4: have that argument. But how that cost avoidance could help
• 35:46
  Speaker 4: to justify what you pay for the drug is something
• 35:49
  Speaker 4: that they haven't been taking into account when they do
• 35:52
  Speaker 4: their pricing. So they were looking for those resources to
• 35:57
  Speaker 4: be able to advocate for why this makes sense from
• 36:03
  Speaker 4: the big picture and the long term.
• 36:06
  Speaker 1: And I think where that sort of cost effectiveness also,
• 36:10
  Speaker 1: you make such a good point about they do have
• 36:12
  Speaker 1: a centralized insurance system. We have to deal with in
• 36:14
  Speaker 1: the US. Anthem says that, oh, if you do it,
• 36:18
  Speaker 1: Anthem's going to pay, but Blue Cross is going to
• 36:19
  Speaker 1: realize all the benefit. They don't have that problem here,
• 36:22
  Speaker 1: which is an interesting strategic advantage. And also tying this
• 36:26
  Speaker 1: back to AI, they also have that data set. And
• 36:32
  Speaker 1: I do think in some of the meetings it came up,
• 36:34
  Speaker 1: a lot of the meetings they looked to us, I think,
• 36:37
  Speaker 1: to ask, where do you think our competitive edge is?
• 36:39
  Speaker 1: And I do think countries that centralize their healthcare data
• 36:43
  Speaker 1: sets are going to have a head start on the U.S.
• 36:46
  Speaker 1: because you could have a great frontier model, but good
• 36:51
  Speaker 1: luck getting the claims data out of UnitedHealthcare, especially as
• 36:54
  Speaker 1: a startup. So I think that is something they could
• 36:58
  Speaker 1: lean into.
• 36:59
  Speaker 2: Yeah, it's one of their obvious key advantages in this space, right?
• 37:03
  Speaker 2: And we've seen it play out well in the UK,
• 37:07
  Speaker 2: the NHS, as an incredible aggregation of all the clinical data.
• 37:14
  Speaker 2: And that's just so important in this day and age.
• 37:18
  Speaker 2: Not only having the data, but having it all in
• 37:20
  Speaker 2: the same format, all of the nuances to making that
• 37:24
  Speaker 2: data available to be trained on with AI models.
• 37:27
  Speaker 4: It is.
• 37:27
  Speaker 1: I think that could be one. So I haven't kept
• 37:30
  Speaker 1: up on nuclear medicine. So I will be honest that
• 37:33
  Speaker 1: that was a new one that popped up. But because
• 37:36
  Speaker 1: of their expertise, I mean, global expertise. And I guess
• 37:41
  Speaker 1: some sort of regionalism. Are either of you familiar enough
• 37:43
  Speaker 1: with nuclear medicine to take a stab at explaining this?
• 37:46
  Speaker 1: Because it came up in a meeting.
• 37:48
  Speaker 2: Yeah, you know, this is an area of interest for us.
• 37:51
  Speaker 2: We've looked into radiopharmaceuticals mostly, right? And It's an incredible
• 37:57
  Speaker 2: new modality where, you know, you combine a targeting agent
• 38:02
  Speaker 2: with a radionuclide with an isotope, you know, and you
• 38:05
  Speaker 2: can very specifically irradiate the tumor in a way that's
• 38:10
  Speaker 2: been proven quite effective by Pluvicto and other drugs, right?
• 38:13
  Speaker 3: And Japan has.
• 38:14
  Speaker 2: A history of expertise in this area. And the real
• 38:19
  Speaker 2: problem in this space is sourcing the isotopes, right? How
• 38:24
  Speaker 2: do you produce them? Because what actually happens is the
• 38:29
  Speaker 2: isotopes have a half-life. They have a very limited shelf life,
• 38:34
  Speaker 2: let's call it, right? And so you have to ship
• 38:38
  Speaker 2: the isotope.
• 38:39
  Speaker 3: To the patient.
• 38:40
  Speaker 4: From the cyclotron.
• 38:41
  Speaker 3: And it can only go in this radius of geography.
• 38:44
  Speaker 1: My vial of cesium needs to get to me before
• 38:48
  Speaker 1: it stops being cesium.
• 38:49
  Speaker 3: Before it's, yeah, no longer radioactive.
• 38:51
  Speaker 2: And so- having the ability to potentially make smaller nuclear reactors,
• 38:56
  Speaker 2: make cyclotrons in this country would really jumpstart their ability
• 39:01
  Speaker 2: to have access to this innovative new medicine.
• 39:04
  Speaker 3: It's very cool.
• 39:05
  Speaker 1: And it just seems like they should lean into their strength.
• 39:07
  Speaker 1: I mean, regenerative, clearly, they have such a lead.
• 39:11
  Speaker 4: IPSCs were discovered in Japan.
• 39:15
  Speaker 1: And so I think they have these strengths. I think
• 39:19
  Speaker 1: one of the One of the opportunities to think of
• 39:22
  Speaker 1: it as a strength is also this upcoming generation. And
• 39:26
  Speaker 1: I think a lot of people pointed to that the youth,
• 39:33
  Speaker 1: whatever we're going to define that as, will break some
• 39:36
  Speaker 1: of those cultural norms. Did you hear that while you
• 39:39
  Speaker 1: were here, that that's an opportunity for more entrepreneurship and
• 39:44
  Speaker 1: even for just different ways of thinking about themselves in healthcare?
• 39:47
  Speaker 4: I didn't hear it per se, but I think I
• 39:51
  Speaker 4: think it's something that could very well happen given the
• 39:57
  Speaker 4: way information is so accessible globally now with social media
• 40:04
  Speaker 4: and also traveling. There's a lot more foreigners that come
• 40:08
  Speaker 4: to the U.S. And so it goes both ways, that
• 40:12
  Speaker 4: people with entrepreneurial spirit can come here and infect the
• 40:15
  Speaker 4: young folks here. And they can go and get educated
• 40:19
  Speaker 4: in other countries and bring back those lessons they learned
• 40:25
  Speaker 4: in terms of how to do startups and things like that.
• 40:29
  Speaker 4: But what it really does is it will help with
• 40:32
  Speaker 4: the risk-taking. And the failure is part of innovation because
• 40:36
  Speaker 4: that's the part that they're going to learn and hopefully
• 40:38
  Speaker 4: bring back. So when they're... older and they are running businesses,
• 40:44
  Speaker 4: that is something that will sort of change, I'd say,
• 40:47
  Speaker 4: the culture of risk aversion here.
• 40:51
  Speaker 2: Yeah, I think we heard a couple anecdotes that indicate
• 40:55
  Speaker 2: maybe that's a trend. There's some cultural shifts that would
• 41:01
  Speaker 2: maybe make younger Japanese more suited to entrepreneurship or maybe
• 41:06
  Speaker 2: look at it as more of a viable path for
• 41:08
  Speaker 2: their lives and their careers. But it's hard to get
• 41:12
  Speaker 2: a sense in.
• 41:13
  Speaker 3: A week, right?
• 41:13
  Speaker 2: You know, I think, you know, I don't want to
• 41:15
  Speaker 2: draw too many conclusions from that. But it's good to
• 41:18
  Speaker 2: hear because it does address some of those more, I guess,
• 41:22
  Speaker 2: structural issues within the society that are often barriers to
• 41:27
  Speaker 2: starting new companies here.
• 41:28
  Speaker 4: I think also role models are really important.
• 41:31
  Speaker 1: And one.
• 41:32
  Speaker 4: that could become one is Typewriter Therapeutics.
• 41:36
  Speaker 1: So right.
• 41:36
  Speaker 4: Which was just announced a $ 56 million Series A led
• 41:41
  Speaker 4: by A & Ventures, which is a Japanese-based venture firm
• 41:44
  Speaker 4: and RA Capital. And so they have a footprint in
• 41:48
  Speaker 4: Cambridge and Tokyo. And if a company like that really
• 41:52
  Speaker 4: takes off and is successful, it could be something that
• 41:57
  Speaker 4: people will be starry-eyed about saying, how can I be
• 42:01
  Speaker 4: part of this kind of thing? And more and more
• 42:06
  Speaker 4: companies like that will be born. And I forgot the
• 42:08
  Speaker 4: most important part is that the foundational science is from Japan.
• 42:12
  Speaker 1: I mean, we were fortunate to have Mayu at dinner
• 42:14
  Speaker 1: last night and hear about Typewriter and also the great
• 42:17
  Speaker 1: work she's doing with Arch. And I just think that is,
• 42:22
  Speaker 1: they have a real success story and not a $ 5
• 42:24
  Speaker 1: million success story. I mean, they're well on their way to,
• 42:28
  Speaker 1: and you know, they'll need more capital to take things
• 42:31
  Speaker 1: and hopefully the data stays good. But I think you're
• 42:34
  Speaker 1: right to call out that success story and say, show
• 42:37
  Speaker 1: that it really is possible. It's not pie in the sky.
• 42:39
  Speaker 1: It is, if you can go on this path with typewriter,
• 42:42
  Speaker 1: if we can have 15 typewriters by the time we're here, transformational.
• 42:47
  Speaker 4: And by the way, it's super hot space. It's in
• 42:50
  Speaker 4: vivo car tea. Yeah. So in terms of the applicability
• 42:53
  Speaker 4: of the science to an unmet need, it could be enormous.
• 42:57
  Speaker 2: Getting back to that Boston Kendall ecosystem, you always hear
• 43:01
  Speaker 2: about Genzyme, Millennium, these companies that were the first, the pioneers,
• 43:06
  Speaker 2: and the number of incredible executives and CEOs that we
• 43:11
  Speaker 2: meet in Boston and Kendall who come from those two companies.
• 43:15
  Speaker 3: It's incredible.
• 43:18
  Speaker 2: You just need that kind of kick, it kickstarts the ecosystem, right?
• 43:21
  Speaker 2: When you have that success.
• 43:23
  Speaker 1: And you only actually need a handful. I mean, you
• 43:25
  Speaker 1: think about how many times someone says, I was at
• 43:27
  Speaker 1: Genzyme these years. And someone else was like, Oh, I
• 43:29
  Speaker 1: was there. Maybe we're, how cool is it to think
• 43:32
  Speaker 1: of like, maybe typewriter is not necessarily the first, but
• 43:35
  Speaker 1: one of many, I mean, Shinobi was this great, uh,
• 43:38
  Speaker 1: success story as well. And it was great to see
• 43:41
  Speaker 1: Hiroki and some of the team there. And so, you know,
• 43:45
  Speaker 1: a handful of people, maybe in 10 years are saying,
• 43:46
  Speaker 1: Oh yeah, I was, I was there. That's where I
• 43:48
  Speaker 1: all got started, but I'm now going to go off
• 43:50
  Speaker 1: and do my own thing. Or it was financially very lucrative.
• 43:55
  Speaker 1: And so now I want to get in the investing
• 43:57
  Speaker 1: side of the house and I'm going to bring the expertise, uh,
• 44:00
  Speaker 1: that I have. Um, I want to, I, I've got
• 44:03
  Speaker 1: one final question. You've been generous with your time all
• 44:06
  Speaker 1: week and a little.
• 44:07
  Speaker 4: Bit of surprise.
• 44:10
  Speaker 1: Um, we went to a, a shrine, um, in between
• 44:15
  Speaker 1: some of our meetings and, At these shrines, a popular
• 44:22
  Speaker 1: thing to do is to get an amulet or a
• 44:24
  Speaker 1: talisman for various things. Good health, strength, thoughts for loved ones.
• 44:34
  Speaker 1: One of them was safety in traffic, which I think speaks.
• 44:39
  Speaker 1: Clearly that is a priority for some people. I spotted
• 44:43
  Speaker 1: these two, and I want to give them to each
• 44:45
  Speaker 1: of you. Because these were the talismans for various wishes.
• 44:51
  Speaker 4: Oh, thank you.
• 44:52
  Speaker 1: And I thought a good way to end this was
• 44:58
  Speaker 1: by asking each of you, after your week here, what
• 45:02
  Speaker 1: is your wish for Japan, for the incredible people here,
• 45:06
  Speaker 1: the kind and amazing people we've met here, their biotech ecosystem?
• 45:11
  Speaker 1: What is a wish that you have that maybe can
• 45:14
  Speaker 1: be realized the next time we're all here? Marianne, I'll
• 45:17
  Speaker 1: start with you. Put you on the spot. There was
• 45:19
  Speaker 1: no prep for this question. With surprise gifts, you can't
• 45:22
  Speaker 1: tell them you're going to get this tough question.
• 45:25
  Speaker 4: I mean, my wish would be a company like Typewriter
• 45:29
  Speaker 4: at least once a year that pops up with financing,
• 45:34
  Speaker 4: with blue chip investors, with, you know, with Japanese science.
• 45:40
  Speaker 4: I mean, I think that would be my one wish
• 45:44
  Speaker 4: on the left side. And on the right side is
• 45:46
  Speaker 4: that the Honobuto lives into their commitment about sort of
• 45:52
  Speaker 4: loosening the drug pricing policy that they have now. So
• 45:58
  Speaker 4: it's sort of a twofer.
• 45:59
  Speaker 1: Because it's kind of like a barbell.
• 46:01
  Speaker 3: It's a barbell.
• 46:02
  Speaker 4: It's like one on either side, like early stage, late stage, yeah.
• 46:06
  Speaker 3: All right. my various wishes, one personal, that I come
• 46:11
  Speaker 3: back to Japan very soon. I have to say, I.
• 46:14
  Speaker 2: Mean, the warmth of the people and the welcoming nature
• 46:21
  Speaker 2: is just constant. Whether you're at the hotel, you're at
• 46:23
  Speaker 2: the restaurant, you're at the government buildings, right? I never
• 46:27
  Speaker 2: felt unwelcome. I always felt like they were so happy
• 46:30
  Speaker 2: that I was here, right? So selfishly, I can't wait
• 46:33
  Speaker 2: to come back. I can't wait to come back, hopefully,
• 46:37
  Speaker 2: for investment opportunities, right? And to really help spur this ecosystem.
• 46:42
  Speaker 2: So I think the other wish is that there's good
• 46:45
  Speaker 2: reason to come back.
• 46:46
  Speaker 1: Well, I think those are fitting sentiments to end on.
• 46:49
  Speaker 1: This is a particularly special episode. And thank you again
• 46:53
  Speaker 1: to BioLabs and the incredible team here. And I should
• 46:56
  Speaker 1: give also a shout out. Incubate is very fortunate to
• 46:59
  Speaker 1: work with an incredible team in Japan today. that helps
• 47:03
  Speaker 1: us engage with the government. And Tomasan, I don't know
• 47:07
  Speaker 1: where you are, but thank you to you and your
• 47:10
  Speaker 1: terrific team that were with us all week.
• 47:12
  Speaker 3: They were incredible.
• 47:13
  Speaker 1: Yeah, I mean, everything was great. Just the energy with
• 47:17
  Speaker 1: which policymakers wanted to get into the specifics of building
• 47:21
  Speaker 1: this ecosystem. That's it for this episode of the Making
• 47:25
  Speaker 1: Medicine podcast. A very special thank you to BioLabs Tokyo
• 47:29
  Speaker 1: for hosting us for this incredible conversation, to my guests,
• 47:33
  Speaker 1: Michael and Marion, the team at RA Capital and A
• 47:35
  Speaker 1: & Ventures who joined us this week in Japan, and
• 47:38
  Speaker 1: to all the policymakers in Japan who took their time
• 47:41
  Speaker 1: in their first week of their new diet session to
• 47:43
  Speaker 1: hear our thoughts on how Japanese biotech ecosystem can be strengthened.
• 47:47
  Speaker 1: You can find this episode and other conversations about Japan
• 47:51
  Speaker 1: and policy and biotech on our YouTube channel. Follow us
• 47:54
  Speaker 1: there and follow us on other channels to keep updated.
• 47:58
  Speaker 1: Thanks for listening. As always, keep innovating.