Latest / Making Medicine / Addressing The Overlooked AMR Problem w/ Dr. Henry Skinner

Transcript

Addressing The Overlooked AMR Problem w/ Dr. Henry Skinner · Making Medicine

0:01
You're listening to Making Medicine Stories from the Early Stage Life Sciences Ecosystem, a
0:07
podcast that explores the people and deals that have led to the medicines, devices,
0:11
and technologies that keep us healthy. Let's get into the show. Hello,
0:16
this is John Stanford, your host of the Making Medicine podcast. We're
0:20
thrilled to have doctor Henry Skinner, CEO of the AMR Action Fund, with
0:25
us today to talk about what else mr antimicrobial resistance and the great work the
0:31
fund is doing to solve one of the great healthcare challenges of the twenty first
0:35
century. Doctor Skinner was an obvious choice to lead the fund and a fit
0:39
far investor focused podcast, given his tenure at Tecla Capital Management as well as
0:44
managing director of Novartis's Venture Fund. Doctor Skinner, welcome to the show.
0:50
Thank you, Johnnn. Thank you for having me and putting on. These
0:53
podcasts are a great compliment and allow all of us to gain a little more
0:58
knowledge along the way. Well, and I think a lot of folks will
1:00
benefit from today's conversation, and so let's level set for everyone in the audience.
1:06
We're going to be talking about an acronym all day wouldn't be Washington if
1:10
there weren't an acronym. So AMR or antimicrobial resistance. Can you give everyone
1:15
out there quick one oh one primer of what is MR and why is it
1:19
so relevant today? Absolutely? AMR is incredibly irrelevant today. But at the
1:26
simplest into microber resistance is a natural process by which pathogens develop resistance to antibiotics
1:34
that we've developed in the past. We need to remember bacteria and fungi have
1:38
been fighting with each other for over four billion years, and our antibiotics have
1:45
been derived from natural products, in other words, the ability of bacteria to
1:48
fight each other. So this tension has been in nature for billions of years
1:53
and it's only been the last hundred years or so that we've tapped nature to
1:57
develop antibiotics. And start in the nineteen twenties with the discovery of penicillin by
2:04
Fleming. You know, we had a golden age of antibiotics with many tens
2:07
of them developed amongst a number of classes. But each time we develop into
2:13
antibiotics, the bacteria are exposed to it and through natural selection develop resistance,
2:19
and we need to develop in use a different antibiotic for resistant bacteria. Or
2:23
fungi, and this is amar at as core. So since the nineteen twenties,
2:29
as we brought penicillin to the market during World War Two and save countless
2:34
millions of lives, resistance is developed to that imanoglycosides, carbopanams, and other
2:39
classes of antibiotics, and over time, although the antibiotics work well most of
2:46
the time, some of these pathogens that are resistant become increasingly difficult to treat,
2:51
sometimes impossible to treat if they're resistant to all antibiotics. And that's the
2:57
situation we find ourselves today. So when we talk about amar it could be
3:00
a pathogen resistant to one antibiotic or in the worst case, to all antibiotics,
3:07
which means a simple infection becomes life threatening again as it was in the
3:12
early nineteen hundreds and before. I think that's really kind of makes you feel
3:17
humanity's roll a little small. These things have been battling for, like you
3:22
said, billions of years, enter us only a hundred years ago using science
3:27
to come about this, And a theme that seems to come out of it
3:30
is we're going to need constant innovation. We don't just say, oh,
3:35
we've figured this out. And I think a lot of us on the lay
3:38
side as patients when we take these antibiotics, you know, we just are
3:43
We're glad to have them. A box of syllin or whatever. The bacteria
3:46
is going to go away. I'm going to be great. And I think
3:49
that's why we have to get the word out that it's great when it works.
3:53
But we have an enemy that we are constantly battling and it is constantly
3:57
adapting. So we have this great threat, and it certainly is a great
4:01
threat. I've heard a lot of folks, yourself included, really declare it
4:04
as one of the great threats to the health of humanity in the twenty first
4:09
century. So enter the Mur Action Fund, which you lead. Can you
4:13
tell us a little bit about what it is, what it's doing, and
4:16
why it was a necessary step in addressing this problem that you sort of describe.
4:23
Absolutely. So the Amur Action Fund came about through a collaboration between the
4:29
World Health Organization IFPMA, biopharma, pharmaceutica companies to welcome trust and others who
4:36
recognize that there was a decline in the investment in innovation in antibiotics and that
4:45
biotechnology companies, which as we know across healthcare drive innovation, and I don't
4:54
know, maybe eighty percent of it, and certainly in the antibiotic space,
4:57
the vast majority of the innovation is driven by small, all and medium sized
5:00
companies. But the absence of funding going into that that has accelerated or decelery
5:08
depend on how you want to look at it. The dearth of funding has
5:11
created fundamental gaps and moving that innovation forward and bringing new products to market.
5:17
Recognizing that gap, this group came about and said we need to do something
5:21
about that, and so a billion dollars was dedicated to the fund and pledged
5:28
to it that we will invest over the next ten years, so one hundred
5:31
plus million a year over that period of time, to drive the innovation forward,
5:35
to maintain the pipeline and bring two to four new antibotics to the marketplace
5:41
to treat the most urgent drug resistant infections across the world. So that's the
5:46
genesis of the fund. Now, the reason why we have to have the
5:50
fund unlike other areas of healthcare, because if you look at investment into healthcare
5:57
over the last twenty years, we've really seen an enormous amount of capital made
6:01
available through private and public markets, venture capital firms, hedge funds, pe
6:06
and the public markets. Over the last decade or two that has driven enormous
6:13
investment, an enormous patient benefit through a remarkable set of products that are helping
6:18
patients across the spectrum. Right from cancer, we've seen dramatic innovation and patient
6:25
benefit to genetic diseases, ophthalmology, arthritis, you name it, right,
6:30
We've seen really what the power of innovation and scientists can do when they have
6:35
the capital freed up to do it. But while investments has come into the
6:41
field, generally it's been starved in the field of AMAR or new antibiotics.
6:46
And if you look over I don't think that the last numbers I've seen,
6:50
maybe these are nineteen eighteen nineteen numbers. Over the last decade, we had
6:56
roughly twenty six twenty seven billion dollars invested into innovations and oncology by small companies.
7:04
The amount invested in AMAR about one hundred and sixty million or so a
7:09
year, so you know, we're talking maybe one fortieth you so maybe two
7:14
and a half two percent of what's been invested just in oncology in this yet
7:18
antibiotics is probably the most successful class of drugs from the standpoint of patient benefit
7:26
and improving outcomes of any class, and frankly, it enables our healthcare system
7:31
overall. So if we go back to where we were in the nineteen twenties
7:35
and tens, you know, the simplest of surgery and a simple infection killed
7:41
millions of people. I've seen quotes of estimates that the development of antibiotics starting
7:46
in nineteen twenties and thirties has added approximately ten years to the life expectancy of
7:53
people, right, so a huge benefit to society, and yet it has
7:59
so little investment now. And the fundament the reason for that is antibiotics are
8:03
a very unique class of molecules. From the standpoint of how we use them
8:07
in the clinic, they're incredibly effective. We typically give them from anywhere from
8:11
seven to fourteen days, so you treat, you cure the infection. And
8:16
I'm sure we've all had scripts for ten days or so, and you're cured,
8:20
right, and you go on to have a productive life, and you
8:24
don't even think twice about it. We've taken this for granted, unlike other
8:28
chronic diseases, where you have to take that medicine for the rest of your
8:31
life. Sometimes I think insolent, for example. So that's one dimension,
8:35
which means that these drugs are used for a short amount of time. And
8:39
in our system, we tend to put value on drugs that is intimately tied
8:46
with the volume of the drug that's used. Right, So we want to
8:50
bring benefit to all patients, and the more of the drug that's used,
8:54
the more patients that benefit, and the more revenue that comes from that innovation
8:58
to reward the invaders and the companies that have invested in that development. In
9:03
antibiotics, it's really a different different mix. We want to use these drugs
9:09
sparingly. We've got a number of them, and we want to give the
9:11
right antibiotic to each and every patient each and every time. But we don't
9:16
want to misuse these The more we use antibiotics, the more resistance develops,
9:20
and therefore that drug becomes of limited use. Furthermore, as resistance develops,
9:26
it spread so unlike resistance that you might find an oncology and then you move
9:31
on to your second line therapy. In antibiotics, right, this resistant pathogen
9:35
and then spread to other people and actually exacerbate the problem more generally, And
9:41
so you put all these things together, and it really means that the market
9:46
for antibiotics needs to be different than a volume driven reward, because we don't
9:50
want to abuse and overuse these new antibiotics and then limit their utility in the
9:56
long run. So, because of these things and a few other things with
10:00
DRGs and how antibotics are actually paid for in the system, the new antibotics
10:05
we've developed over the last decade or so have not received the same type of
10:11
remuneration as other therapies have. And we've seen a number of bankruptcies of companies
10:16
that have successfully developed antibiotics. Companies such as a Kayagin and Melina and Melina
10:22
had four approved antibiotics they were commercializing and yet they went bankrupt. And so
10:28
you bring these things together. And investors are very logical people. They have
10:33
duties to there to the people who give them the money to invest and expect
10:37
a return, to invest in things that are going to give a return.
10:41
And you can't invest in a company take all the scientific risk, in the
10:45
clinical risk success. We develop an antibiotic, only to have the company go
10:50
bankrupt and not reward both the entrepreneurs, the scientists, and the investors for
10:56
that risk. Because of that, we have too little investment too and investment
11:01
the pipelines too thin. So the fund was put in place to try to
11:05
change that. Now we have a billion dollars roughly to invest. But let's
11:09
be frank, we know it's expensive to develop new drugs. I think we're
11:13
optimistic we can help bring two to four new antibotics to market over the next
11:18
decade. This isn't enough. You know. We have between the CDC and
11:22
who I think over eighteen identified priority pathogens that are drug resistant that we need
11:28
to find treatments for antibiotics, treats any one antibotic we treat some of these
11:35
infections. We have infections of bone, urinary tract, skin, inter abdominal
11:41
lungs with half vap, etc. You know, we need a mix of
11:46
drugs that are going to be addressing these various problems. And two to four
11:50
is not enough. The pipeline is not rich enough. Where we are.
11:52
The fund will contribute to keeping things going, to keeping that pipeline moving forward.
11:58
We'll try to invest in the best and most meaningful of those drugs.
12:01
But we're a placeholder, right We're really going to give function to keep the
12:07
pipeline going, people engaged here and that buys us some time as a society
12:11
right to have our policymakers make some changes to the marketplace that brings the natural
12:16
flow of capital back into this critically important area for healthcare. So that's the
12:22
fund, and then just a couple of words about how we operate. We
12:28
operate like a typical VC. We are very heavy into diligence of the underlying
12:33
scientific merits of the programs of the company, the clinical strategy going forward,
12:39
marrying the product to where the greatest clinical needs are around the world, and
12:43
then how to prove that. And as most funds, we look at the
12:48
management team and so forth, and we hope to catalyze other investors coming back
12:52
into this field by being in it. And I think we've had some success
12:56
in our first two investments there. But first we will keep the pipeline moving.
13:01
We'll try to keep the best of this going. It's not enough.
13:05
We need others to come in. We need to fix the broken market to
13:07
have that happen. Yeah, you, first of all, that was tremendous.
13:13
I think you not just outlined what the Action Fund's role is, but
13:18
this broader concept and you know, we had a vcon earlier last year that
13:24
talked about this market failure, and you know, you talked about the natural
13:28
flow of capital. On this show. We always talk about capital flows like
13:31
water, and it seems in the MR space we got a big rock right
13:35
in the middle of the stream that is diverting this capital and that is this
13:41
market failure, this reality that in our market system, volume and value do
13:48
go hand in hand, and yet where we need people to develop drugs to
13:52
be used, as you said sparingly, and so I want to keep pulling
13:56
at this sort of addressing this market failure because your work is great, and
14:01
a billion is a lot, but it's also a little and I think everyone
14:05
should be concerned hearing if you have eighteen targets and possibly two and four in
14:11
the pipeline. So I know there's some discussion about other needed actions and needed
14:18
actors, and one of the big ones is government Incubate has been active in
14:22
supporting something called the Pasteur Act that I know you had a hand in conversation
14:26
discussing you know, why is government engagement law and sort of these poll incentives
14:35
so critical to addressing this challenge. Yeah, it is probably the most important
14:41
thing that we need to address collectively. Again, the marketplace that is broken.
14:48
So if you have a new antibiotic, and let's frame the discussion.
14:50
So you know, somewhere between thirty five and fifty thousand people in the US
14:54
die every year from MR right, So this is not trivial, right,
15:01
This is a really significant problem. Amar probably cost the healthcare system, you
15:07
know, twenty billion in direct costs, another thirty and indirect already. Right,
15:13
So the cost is significant. But the challenge is that we live in
15:16
a system where historically we value drugs based on volume, as you said,
15:22
whereas antibiotics we really need to think of the valuing them in a much broader
15:26
sense. So treating a person that has a drug distance infection with the right
15:33
drug that does several things. Right. It cures the infection in that patient
15:37
and so there's enormous benefit to that patient and their family. It also limits
15:41
the spread of that bacterium. Right. We've seen the spread of drug dissistance
15:46
infections and hospitals around the world. I was just reading of a facility in
15:52
Michigan that had to shut down because they had a Candida infection. I think
15:56
this is a couple of weeks ago, right, So these are real consequences,
16:00
and you get these infections spreading within the hospital that you can't treat.
16:04
Not only do those patients suffer in their families, but you need to shut
16:08
down the ward, you need to sterilize things. And this is just an
16:11
example of the impact this has. And we've seen with COVID just how perilous
16:17
our system is right where we've saturated the system with patients, We've run out
16:22
of beds and ventilators and the like, and having trusts an infection that limits
16:26
that further offers a risk to the system. So having the antibotic that can
16:32
treat these things prevents all that, right, It keeps our system running efficiently.
16:36
It allows us to treat patients with chemotherapies that make us more vulnerable to
16:42
infection, allows us to treat an aging population. And we know as we
16:48
age, our immune system becomes less effective, vaccines become less effective or more
16:52
susceptible, and so having the right drug to treat this infections benefit society as
16:57
a whole. The patients were treating the patients we don't have to treat because
17:02
we've treat it successfully these infections, and that propagates over time, so the
17:07
value antibiotics bring transcends the initial patient that benefits and benefits the system overall.
17:15
Again, antibos have added perhaps ten years to life expectancy. There's huge value
17:21
in these treatments. So we need to break out of this mindset that fits
17:25
other forms of pharmaceuticals. Right, if you have a new arthritis drug,
17:29
you want to give that to everyone who can benefit with an antibiotic, you
17:33
don't want to give it to someone who might benefit. Right, So if
17:36
you come in with sinusitis or running nose that's probably viral. Truth is,
17:41
you should not get an antibiotic unless you know this a bacterial infection because that
17:45
drives resistance. If you have a bacterial infection, let's give an antibiotic that
17:49
will treat that effectively. So we end up in this situation that the world
17:56
of yesterday of how we looked at value doesn't apply to this unit field,
18:00
and we need another way to do it. So the other aspect is,
18:03
if you think about antibiotics, think about penicillin. Right, discovered in nineteen
18:07
twenty eight, they figured out how to manufacture it during World War Two,
18:11
and it saved countless millions of lives. We still use penicilla today and it
18:17
is from that right, so we've had now approaching one hundred years of benefit
18:21
to humanity from that invention. Right then, we all know that the cost
18:26
that we pay for an antibiotic at the pharmacy is usually pretty darn low,
18:30
which is fantastic, right, This is in the long run what we want.
18:34
We just need the right set of arrows in the quiverent to be able
18:37
to treat all these infections and benefit humanity for the next two hundred years or
18:44
more. So what the punicentives do is they begin to provide that separation the
18:49
things such as the pasteur Act. At the United Kingdom has done something similar
18:55
where they have a subscription model where they will say, a few develop a
19:00
drug that meets these critical clinical needs, we will promise to buy access to
19:08
that drug, and we'll pay you up to ten million pounds and for that
19:14
England gets access to the drug for all the patients who need it. Now
19:18
you reserve it to just those patients who need it, but you guarantee its
19:21
availability. If we think about extending that concept which I pastor or similar in
19:26
the US, to the world broadly, the G seven, the G twenty.
19:30
We do several things, right. We ensure a pipeline of these drugs
19:34
that we need that takes ten to twelve fifteen years to develop, and we
19:40
make them available to patients. And we give physicians the choice based on their
19:45
clinical guidance and what they need to do to treat the patients to treat them
19:48
with the right antibiotic that is separated from other considerations and only focused on the
19:55
best interest of the patient. So past your the UK subscription, Adele and
20:00
things like that accomplish that they recognize the value that antibotics bring to the system
20:06
that enable chemotherapy, organ transplantation, basic surgery to be recognized, and to
20:14
make sure we have the tools so physicians can treat these infections. And you
20:18
know, the thirty five fifty thousand deaths in the US can can be reduced.
20:22
You know, it's about one point two seven million people die from AMAR
20:27
around the world. That numbers projected to grow to ten million by twenty fifty,
20:32
which is less than thirty years away. So we're talking you know,
20:37
significant consequences if we don't stay ahead of resistance, which is always building and
20:42
the bacteria are always looking for a way around our treatments. So if when
20:48
we get these things accomplished, now we have a marketplace pasteur at least as
20:56
this drafted now, would provide somewhere between one hundred and fifty million to three
21:00
billion, depending on the qualities of the drug that's brought forward to guarantee access.
21:07
And that's over ten years. And the beauty of this to me is
21:11
the polar centers. You pay for success, right, You let the market
21:14
do what the market does so well so efficiently, which is figure out where
21:18
to put the capital to optimize the chances for success. And when it's successful,
21:25
you guarantee there's a market which keeps investment coming in. So now you
21:29
have a positive feedback loop and we keep the pipeline alive. The other thing
21:33
we remember with some of these proposals is that if we don't do it,
21:38
where will we be in ten years or twenty years. And you know,
21:41
we have been so fortunate, you know with the mr Anda vaccines coming after
21:48
covid, that we had a vaccine less than a year after COVID was discovered.
21:53
We would not have had that. Have we not invested over decades into
21:59
the underlying technologies that were ready at that moment in time, right. So
22:04
it takes a lot of investment, a lot of time, a lot of
22:07
risk taken to be in the position to take advantage of it. It takes
22:11
a decade twelve fifteen years to develop a new antibiotic. If we don't keep
22:15
ahead of it, right, that this wave or the tide that's been coming
22:19
to shore, much like global warming, right, is going to hit the
22:26
shore and it's going to begin flooding the coastline, so to speak. We
22:29
need to stay ahead of it. We need to build on the infrastructure we
22:33
have, and frankly, we need to leverage that the great scientific talent,
22:36
the innovation we have in healthcare, and the scientists we have, and the
22:41
knowledge we have to continue to invest in the space to have that robust pipeline
22:45
that allows us to have a continuation of new antibiotics available to treat these incredibly
22:52
difficult to treat infections. I was having a conversation the other day with a
22:56
body of mind you found himself at the Department of Defense, and there is
23:02
our bionational security is an element of this as well, is that these pervasive
23:07
threats need to be addressed or sort of to preserve the American life. I
23:14
mean, it's tragic that we lose the thirty five to fifty thousand Americans a
23:18
year and a million people worldwide, but as you said, those numbers are
23:22
only going to grow. We call this to the Hill a no brainer in
23:26
terms of our support for the Past Door Act. It seems so common sense,
23:32
and so we'll be working with Congress and hope the policymakers that listen to
23:36
our show are adding their names to the legislation and that we can find it
23:41
it's way through Congress, because it's a seed that needs to be planted now
23:45
so that we can yield those returns in the coming years in a decade.
23:48
I want to pause the mur discussion. I want to come back in a
23:52
second to talk about some of the exciting news out of the Action Fund.
23:56
But one of the questions we get most from listeners is to hear more about
24:00
how people in this fairly niche industry of life science innovation got to where they
24:06
are. So, you know, could you I didn't really give much of
24:10
your background when we kick us off, could you walk us through a little
24:12
bit your journey to find yourself leading the Action Fund and the incredible work you're
24:18
doing. So would love to how do you get where you are today?
24:23
Yeah, now it's interesting. I wish I could claim some some sort of
24:27
prescient knowledge about how to get there or some grand strategy. I've been awfully
24:33
fortunate through my career, and frankly, I think all of us in life
24:37
science and healthcare today, I have to look at it that way. If
24:41
I go back to, you know, when I was younger, looking at
24:45
the healthcare system and where we were and where we are today, the amount
24:48
of innovation it is just incredible. When I started my PhD, you know,
24:55
I was doing sequencing the old fashioned way. If I got sixty bases,
24:59
I felt I'd really accomplished something. And now we can seequence of genomen
25:03
in hours and so that the transcendent innovation that has really driven so much benefit
25:08
has been remarkable. So I consider myself fortunate just to live in the time
25:12
we are to be part of this um but scientists by training. I got
25:18
a PhD microbiology. I've always been fascinated by microbes, antibiotics, you know
25:25
the story of fleming and that development, and frankly seeing the benefit that came
25:30
from that right as it really opened the healthcare system to what we think of
25:36
today. It's very simple things and take for granted, right the ability to
25:40
to have some complex surgeries, to have physicians be able to go in and
25:45
fix people that that need it, be that a broken bone that's gone through
25:51
the skin, chemotherapy, taking out tumors, etc. If you don't have
25:56
antibiotics, you know, these things were impossible, you know, much like
26:00
if we didn't have anesthesia, these thinks would be impossible. But they go
26:03
hand in hand and that enablement really has allowed the expansion of healthcare to so
26:08
much much benefit. But coming out of my scientific training, I did a
26:14
post Docabilla College Medicine in oncology and then you know, again, you know,
26:18
one of those being in the right place at the right time. The
26:22
laboratory I was in decided to spend out a company called Lexicon Genetics in Houston,
26:27
and we wanted to knock out every gene in the mouse and understand what
26:33
it did phenotypically, and then from that we would understand new targets for human
26:37
therapeutics and the like. So this is beginning of genomics. This is before
26:41
the genome was sequenced and we really had that vision of boy, if only
26:47
we knew these things, think of what we could do. And I think
26:49
in a lot of ways that's come to bear. But I started the company
26:53
and I was given a choice to be a scientist to move into business development,
26:56
and I so I did to dive in the deep end and new business
27:00
development, even though I don't I knew how to spell it. That was
27:03
about it, But I love that that interface between business and science. How
27:08
you think about growing a company, creating value, developing interactions with big companies,
27:18
academia, and really thinking of that continuum of innovation and how to apply
27:23
it ultimately to patient benefit. From there, I was recruited to a company
27:29
Pharmacy and up John based in New Jersey. Ultimately that became Pharmacy as they
27:33
bought Montanto Sarlily got bought by Fiser, But I did business development for them.
27:38
I covered all their therapeutic areas, so I got to see that drug
27:41
discovery and early development across the spectrum. They've developed Zyvox while I was there,
27:49
which is a great antibiotic. I covered neuroscience and cancer, and so
27:55
I was really able to see a breath of what it takes to develop drug
28:00
and how pharma thinks about it. From there, I went to a couple
28:03
of young biotechs. Aftervice the Bottom, I ran a couple of companies as
28:07
CEO up here in Massachusetts, sold one of them to share in PLOW,
28:11
so I got to see that side of it. And this was a chemistry
28:15
company, and I'm a biologist, not a chemist, so I think I
28:18
believe that the smarter people than me, but I'd look to see what the
28:22
compounds do and in animals and man. Ultimately, then I ran an anti
28:26
effective company, and I saw firsthand the challenge of trying to finance a company
28:33
in the space, even back twenty plus years ago, just how difficult it
28:37
was and what you needed to do to convince people that not that we didn't
28:41
need the drugs, but that the market would be there from them. I
28:45
then spent ten plus years at Novartists, most of that in their venture fund,
28:49
investing in early stage companies, helping to seed companies and take things out
28:53
of academia. Three years to Technic Capital Management, which is a mutual fund
28:59
so late stage investment crossover IPO to public. During that time I also picked
29:04
up a master's of jurisprudence, and healthcare law and policy. As I was
29:10
intrigued and very interested in the policy side of what we do, not just
29:14
at the scientific and business side. Then the fund was formed and I can't
29:18
think of a better place for me to spend the next decade, in a
29:22
more important place. So, you know, a lot of serendipity. You
29:26
know, started things and learned things along the way, not knowing where it
29:30
would take me. But you know, I think the last twenty or thirty
29:34
years and life sciences has been that way. There's so much opportunity for us
29:38
and a chance to grab and do some great things to benefit patients. Well,
29:45
I think you are representative of probably the dozens of folks who've been on
29:51
the show one in that serendipity plays a big role, but it is this
29:56
symbiotic and interrelate did role of science business and now as you've discovered policy,
30:03
and sometimes when I have conversations with policymakers, you know, they don't quite
30:10
grasp that we have to have all of it. We have to have a
30:12
suitable policy environment. You know, we happen to be recording this on World
30:17
ip Day, and so we're having an opportunity to celebrate you know by Dole
30:22
and the world that that created in terms of ip that generates investment. But
30:26
then it can't just be pure science either. At the end of the day,
30:30
we live in a world, in an economy where we have to justify
30:34
innovation, and so that blending of scientific minds and business minds. I get
30:40
asked every once in a while, what's especially when we're abroad, are what's
30:44
the secret sauce that America has? And it's the blending of those three And
30:48
I worry when I worry about the unraveling of those three threads, because it
30:53
really takes a strong business environment, it takes a strong policy environment, and
30:59
of course it's it's great science. And I think it's fascinating that you've been
31:03
emblematic of all that. And you know, as we wrap up speaking out
31:07
of great science, I just saw some recent good news out of the fund
31:11
and saw that you executed your first two deals. Can you share a little
31:15
bit congratulations, by the way, you can share a little bit about those
31:19
and anything else in the pipeline that you could talk about. Yeah, thanks,
31:25
John, And I think those first two investments are really emblematic of what
31:29
we're trying to do. Both happen to be US companies that just happened to
31:33
be how it is. But we are looking globally for innovation wherever that might
31:37
be, and we've certainly seen great innovation out of Europe and Asia over the
31:41
last couple of decades as well. One of the investments is a company caned
31:45
Venatorics. It's been around quite a while. It's what I would call,
31:51
I mean, it's an interesting company and that it started as a platform.
31:52
It's got a great chemistry platform focused on antibiotics and has a rich pipeline,
31:59
the most advanced of which just completed this phase three studies and showed superiority to
32:05
comparator, which is really tough to do, especially in this space. It's
32:09
got a great spectrum of activity. It allows us to treat some drugs assistant
32:14
infections that are extremely difficult to treat with anything else. So this is a
32:19
drug that's going to matter to patients, so very classic approach. This is
32:22
a beta lactim beta lactomace inhibitor, of which is a well proven class,
32:28
you know, probably the single most important class that we have in our armamentarium,
32:35
and this is an extension of that history going back to augment and other
32:39
things. So tried and true through Phase three, so late stage. It
32:44
has a Phase two program and some earlier things, great chemistry platform. Just
32:47
a really solid company, been around the while, and this looks like it
32:52
should be its first approval. Right, So to my point earlier, it
32:55
takes about ten years to you know, get up and running and to maybe
33:00
get a product to patients. And congratulations to the team there for that success.
33:06
It's tough to do and they've done a great job. Classic approach.
33:10
The other company we invested in is Adaptive Phage Therapeutics. This is a very
33:15
different approach that This is using bacteria phages or viruses that infect bacteria, not
33:22
classic small molecule approach. We have never had a bacteria phage approved. There's
33:29
lots of challenges from a regulatory manufacturing standpoint, and the approach this company is
33:34
taken is almost poor opposite of what Venatorics is, which is here's some great
33:38
drug, we use it as we've always used antibiotics. Adaptive Phage is taken
33:44
what I would characterize as a personalized medicine approach. So you have an infection,
33:47
we test that pathogen against a bank of bacteria phages and find one,
33:54
two or three that are going to be effective, and now we have a
34:00
potent drug to give that patient that should be highly efficacious for that patient.
34:07
Is different from all the other mechanisms. So we shouldn't drive cross resistance and
34:10
resistance. We shouldn't amplify the problems we have. And we're going to treat
34:15
some very difficult infections there, and they have ongoing studies and prosthetic joint infections,
34:21
which is a abilitating chronic infection, extremely difficult to treat of indwelling devices
34:28
and knee replacements, ere replacement shoulders and the like. So this is what
34:34
I would call in some ways extremely novel approach. Right, this sort of
34:37
approach has never been approved, but we think as a fantastic approach, compliments
34:44
everything else in the antibiotic space and gives us another dimension to treating these infections
34:52
going forward. And I'd say that probably bookends what we're looking to do,
34:55
you know, extremely you know, you can debate how risky it is,
34:59
but highly innovation of approaches that have not yet been proven to tried and true
35:04
approaches, and improvement on the chemistries and other things in the areas that we've
35:08
have successful products before, so we are taking a holistic view of how to
35:14
approach the problem, looking for innovation be at chemistry or be at brand new
35:21
modalities, and working with the companies to drive them forward. So this happened
35:24
to be our first two. We are very active in diligence on others.
35:30
We are clinically focused, so we're still trying to primarily look at companies that
35:34
are already in the clinic, but we are engaging and talking with companies that
35:38
are preclinical. We want to give our advice as to where the need is,
35:43
as to what we would like to see developed, and be an ideal
35:49
candidate for future investment in US. So we're looking to do all of that.
35:53
In addition, we've developed a really taught, not scientific advice aboard from
35:59
around the world of regulatory experts, ID physicians, chemists and so forth to
36:07
help us both understand what we're looking at better, but also to help the
36:10
companies as they think about how to develop their products. So where is the
36:15
ideal setting? How do they think about their product profile and optimize it to
36:19
where the clinical need is? You know, and that discussion could be as
36:22
detailed as you know, how do you think about your phase three study or
36:25
phase two studies. Should it be single arm? You know two dose is
36:30
high, low, etc. So we are looking to be active and only
36:32
bring capital in, but really helping companies think through their strategy and develop that
36:38
looking at the marketplace and beyond well, I think that's I mean, that
36:43
leads it on an optimistic and innovative note. I think, you know,
36:47
touching on that technical expertise that they need beyond just capital is something we talk
36:52
a lot about on this show. I love the all of the above approach,
36:57
and I don't you know, we recently had someone who does a lot
37:00
of oncology investment on and they talked about, yes, io is in vogue,
37:06
but small molecules coming back in vogue, and that, I think something
37:10
we all forget is just how why the spectrum of possible treatment? And so
37:16
it's really exciting to hear that your first two investments are at both ends of
37:21
the spectrum. One thing I know I'm taking away from this is something you
37:24
said that our ability to combat bacterial infection is an underpinning that, as you
37:31
said, enables the entire healthcare system. I had in fifth grade a bunch
37:37
of broken arms, they ended up putting a pin in my system or in
37:39
my arm. And not until now am I realizing that that very basic surgery
37:45
that let my arm deal would never have happened if we weren't prepared to address
37:50
any bacterial infection I may have gotten. And that you know, we all
37:53
have that story, and we've all taken and I nabiotic all close since I
37:59
have you, because I can't have a section on antibiotics without maybe raising one
38:04
of everything we hear. If you're if you're prescribed in antibiotic, you're told
38:09
to take it all the way to the end, not just till you feel
38:13
better, Take the antibiotic for the full seven days ten days. Since we
38:16
have a captive audience, can you maybe just say a couple of words of
38:20
why that is? Because we're all dubious when we feel better after day three
38:22
of the antibiotic, it sits in the frage or it sits on the shelf.
38:27
Is it's so critical that we take the take the full seven day,
38:30
ten day regiment. It is? And the reasons simple, So you know
38:34
the beauty is and I know when when my children were young and had an
38:37
air infection caused by bacteria, you get a moxycylin or what have you,
38:43
and they're feeling better within twenty four hours, right, which is just incredible,
38:46
right, because how many drugs really really make you, you know,
38:51
from lying on the bed too to running around that quickly. But we need
38:53
to remember, you know, we need to clear that infection, right,
38:57
We need to wipe out those bacteria that are causing the problem. We feel
39:01
bread pretty quickly because the inflammation is down. We're killing most of the bacteria,
39:07
but we need to wipe them all out and let our immune system clean
39:09
it out completely. So if we take a partial course, we've done you
39:15
know, sixty seventy percent of the battle against them. But within that mix,
39:20
if the body can't clear the infection, we've also set ourselves up for
39:24
drug resistant infection. So every time we give an antibiotic, the bacteria or
39:30
trying to find a way around it, and if we don't take the full
39:32
course, we give them a chance to find that way around, and taking
39:37
half the course we feel better and then boom the infections back or the inflammations
39:43
back, so it's painful again the infection was never cleared. Now we need
39:46
to take the antibiotic again. But now it doesn't work because the bacteria learn
39:52
from that treatment how to get around it. Now we're in trouble, right,
39:55
so now we have to hope there's another one. You go back to
39:59
the physician and you get you know, something else instead of the one you
40:01
had, and hopefully that works. But you know, it's a bit of
40:06
Russian roulette. It's a tough thing. And at some point you become effective
40:12
with the pan resistant and there is nothing left. And we're seeing that today
40:15
in the system. Right there are our patients today dying because we do not
40:20
have an antibiotic left to treat them. Right, We're back to nineteen twenties
40:24
where all the physicians can do is watch, and that's not the place to
40:30
be. But let's also extrapolate that. I mean, so that's taken what
40:32
you have and we have the benefit here of having great quality drugs, great
40:37
quality control in our system. As we look around the world that there's problems
40:43
with counterfeit drugs, adulterated drugs, drugs that have expired, or if their
40:50
counterfeit, who knows what it is, it's certainly not what it's supposed to
40:52
be. And this problem is if you think about around the world is even
40:58
much broader then taking your full course. You may think you are, but
41:02
if it's only half active, we're not so. But it's absolutely essential the
41:07
right drug to the right page for the right amount of time, and that
41:13
will be an almost all instance to secure the infection. And that's what it's
41:15
all about. Well, I appreciate you indulge in me. I think this
41:20
is as close as we'll ever get to a healthcare PSA on this show.
41:24
Thank you to doctor Skinner the entire team at m Our Action Fund for the
41:29
great work. If you didn't take away from the show that this is a
41:32
grave threat, a real threat, and something of consequence to all of us,
41:37
I encourage you to listen again because that was so clear. Appreciate all
41:40
of our audience for listening and sharing feedback. More from Incubate and more on
41:45
AMAR more Broadly is available at www dot Incubate Coalition dot org. Special thanks
41:51
as always to my colleagues Aston Roberts and Olivia Lukhani in the making of today's
41:55
podcast. I think this was a great episode, so thank you again,
41:59
Doctor Dinner and as always keep damp. Thank you very much, John,
42:04
You've been listening to making Medicine. To ensure that you never miss an episode,
42:08
subscribe to the show in your favorite podcast player. If you're listening in
42:13
Apple podcasts, we'd love for you to leave a quick rating of the show.
42:16
Just tap the number of stars you think the podcast deserves.