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Mar 2, 2016

The Next Moonshot in Healthcare

The end of cancer might happen sooner than we think

Dr. Patrick Soon-Shiong, surgeon, medical researcher, businessman, philanthropist and professor, sits down with StartUp Health CMO, Dr. Howard Krein, to discuss his ambitious undertakings.

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Key takeaways from this episode of StartUp Health NOW can be found here.

GUEST: Patrick Soon-Shiong, MD, NantWorks

HOST: Howard Krein, MD, StartUp Health

LOCATION: StartUp Health Festival, San Francisco, CA

IN THIS EPISODE:

A First in Our Nation: Whole Genome Sequencing
The Coalition of the Cancer Moonshot 2020
Using Relationships, Bringing People Together for a Common Good

Show Notes and Key Takeaways

(Access the full transcript here)

A First in Our Nation: Whole Genome Sequencing

[2:00] Dr. Patrick Soon-Shiong: Today we announced the reimbursement or insurance coverage by Independence Blue Cross of whole genome sequencing. It’s the nation’s first whole genome sequencing. But goes beyond whole genome sequencing. Quietly, we’ve been building a platform that does whole genome sequencing of the tumor-normal which is basically an entire three billion base pairs. But doing the whole genome sequencing of the gene is not enough. You need to understand what goes downstream of that, called RNA. So we also completed the RNA seek and doing that is just not enough. You need to go downstream after you understand which proteins express to quantitatively measure the proteins. That’s called proteomics. So it was hard for most people to believe that you can do a whole genome sequencing and the RNA seek and the quantitative proteomics which we call GPS Cancer. And we have CLIA/CAP certification for both in the pipeline that can do, now we have a capacity of 4,000 patients a month. And we just received full reimbursement today.

The Coalition of the Cancer Moonshot 2020

[3:20] Dr. Soon-Shiong: We announce that because that formed the genesis of us now being able to molecularly identify at the most infinite level what’s going on with a cancer patient. And then integrate that with the clinical findings and then drive that to the therapy.
[3:39] Dr. Soon-Shiong: So, that however requires a combination of therapy which requires then a coalition of all kinds of drugs in the world of immunotherapy. And we could talk a little bit about that. The trouble is, pharma is developing all these drugs in silos, so how do we get pharma and biotech for a common good to put their drugs into a single pool? And we were able to get them to put 60 drugs into a pool in development. And put them together so it could be analyzed. And then, the question is how do we get 20,000 patients into clinical trials within three years? The goal is to take 100,000 patients, put them into randomized phase one-two trials, 20,000 across all tumor types based on the biology. In order to do that, we needed to get the academic centers and the community oncologists to work together. And we got that done and so we’ll be having a press conference tomorrow. We call this the Coalition of the Cancer Moonshot 2020.

Using Relationships, Bringing People Together for a Common Good

[6:00] Dr. Soon-Shiong: By 2005 we got this drug Abraxane approved for breast cancer, nanoparticle drug. By then I began to realize we were seeing in our hands, patients who were surviving by giving low-dose chemotherapy… That was completely counter intuitive to everything we’ve been trained, including things we trained at all the major medical centers. And the concept there is that your body, you and I sitting here today, are generating about 10,000 cancer cells a day, sitting as you are. And the only thing protecting your human body right now is a cell called a natural killer cell. It’s floating around recognizing it and killing it. Which means it’s your immune system that’s protecting you from cancer. So when you think about that, then it doesn’t make sense that we’d give you high chemotherapy to wipe out the immune system. And so, we’ve been thinking about cancer in the wrong way. We’ve been thinking about it as a battle rather than a war. So, everybody gives high-dose chemotherapy and they see a reduction in tumor and everybody’s excited and happy. They won the battle but they’ve lost the war because as soon as that tumor shrinks, the mutations we’ve discovered, some are asleep, some are awake, thousands of them waken and spread so you’ve lost the war and you wiped out your immune system, you wiped out your protection and that’s why we’ve lost the war.
[7:27] Dr. Soon-Shiong: I recognized it 2005. So, to give low-dose chemotherapy, it’s called metronomic, is so counter to pharmacy, so counter to oncologists, who actually make money selling drugs, it’s so counter to the science community. I realized the only way for me to do this is to sell both of my companies, which I did in 2010. …One of the things, and some of you are technologists from a digital perspective, is that if I’m going to do the whole genome sequencing with just 20,000 genes, so let me tell you the mathematical problem here.
[8:58] Dr. Soon-Shiong: The generation of such amount of data for one patient’s a couple of terabytes. So, if you look at the math is 1.3 million cancer patients, it’s 10,000 cancer patients a day. You look at the math that’s petabytes of data a day. So, I took over the National LambdaRail. The National LambdaRail was running for the Large Hadron Collider. 10 gigabytes per second, thought to be the greatest and fastest and that’s in fact how God’s Particle was found. I realized what we’re trying to do, believe it or not, in all of you and every cancer patient is to find God’s Particle everyday.
[9:33] Dr. Soon-Shiong: What do we needed to do was first build a fiber infrastructure. I took over the National LambdaRail, we’ve now built fiber that runs around this country all the way to Japan, all through UK at eight terabytes a second. And that’s inter connecting all the hospitals and all the supercomputers. That took me four, five years. I then needed to build supercomputer platforms. Brought in astrophysicist, mathematics, mathematicians to look at modeling so that we can actually do the bioinformatics of three billion base pairs times 200,000 RNA times a protein pathway. i.e. GPS Cancer. Those papers are published in “Nature and Science,” so the science is completely validated.
[10:18] Dr. Soon-Shiong: Built that. Then said OK, now I’ve got that information, but how am I going to get the information of an Epic center or an Allscripts and all the medical records that don’t speak to each other. So, we then built a middleware software and then I brought in the company called Harris, which runs the air traffic control of our nation and the VA/DoD. We brought that in, so we’re agnostic to all. And just last week we brought in a company called NaviNet because I recognized, I always thought in my naivety, that what was important to a doctor was what is the best treatment to give to my patient? And how do I read up about that all the time. It turns out doctors are just too busy and can’t really keep up. The most important moment in time, the digital moment, was when the question arose, is this patient covered? Does this patient, drug, is it covered? So, NaviNet is the vehicle owned by the insurance companies that allows drug authorization and it’s the digital moment that is captured now by 90% of the capitalized in the United States. I said, “Ah ha, that’s the moment, that’s the organization I should, we should get,” and we just acquired them last week so that we can now capture the digital moment between patient and doctor.
[11:41] Dr. Soon-Shiong: On that, because it has a bi-directional portal, we can now drive the actionable information of complex genomics tried to clinical trials. The trouble is, there’s 10,000 clinical trials every day. So we built a program of 90 doctors to collate on a daily basis the 10,000 clinical trials. And integrate that on to the NaviNet portal.
[12:07] Dr. Soon-Shiong: I realized that nobody would build this infrastructure including the government. I tried. I went to the Institute of Medicine. I went to the National Academy of Science. And realized this is not an academic exercise. This is a public-private exercise and people like yourself should get involved in it. I also realized at the end of the day these digital moments will be down at the app level. The day will come when a doctor sees a patient and says, “Download, I’ll prescribe that app.” So, that app is what’s going to treat you.
[12:45] Dr. Soon-Shiong: I built an entire platform called NantMobile Health but not just as apps. I took the machinery inside that and we built a thing called machine vision in which you could take the camera that could actually recognize images in the real world. And we just released that at the hack-a-thon at CES this week. If you go to theIDAlliance.com or NantMobile.com. The idea was to take that app and actually make that app applicable, so what we did, we released Woundtech and I just got news from Woundtech, they’ve taken all of Puerto Rico, reduced the cost of diabetic ulcers, merely by actually recognizing the ulcers using our phone. And I actually have an algorithm that can predict what treatment to give in the remote fashion.
[13:36] Dr. Soon-Shiong: We’ve taken that app and created a natural language processing so that you can think Calio by iD that allows you to look at nutrition in real time. And then finally the machine vision app. Procter and Gamble used it for the kids, we have a game, and brush for two minutes, and it increased Procter and Gamble sales by 10% of their brushes. We opening this app free. We’ve not made a single penny so far on any of this, so that people like yourself could use it and I’m so glad you have a group here focused on healthcare.
[14:41] Dr. Soon-Shiong: Finally, in the final piece, in order to do that I realize that there’s 20,000 different medical devices with APIs. So we took the trouble of writing APIs to 20,000 medical devices. So that it actually all integrates directly into the cloud and integrate the data. We captured last year eight billion vital signs of data. I now have five years of continuous data of one and a half million lives.
[15:11] Dr. Soon-Shiong: So, I think the opportunity now for us to truly create machine learning, predictive modeling at this kind of level is here. I realize nobody would do this. I realize there’s no company would do this. I’ve had the incredible fortune as a physician and as a scientist to be able to sell my two companies and go underground. We are 15 acres in California, a quiet little Google complex so to speak. We have a thousand people working quietly from all walks of life, from physicians to nurses, to mathematicians, to app writers, to set designers. And I think, that kind of activity can only come from a group like this.

How Entrepreneurs Can Get Involved

[16:57] Dr. Krein: As I think back to young Patrick, before you had started either of your other companies, before Abraxane came, what was it? Did you always know that you had this other side? This inventive and disruptive side? Or was it something that came out of a practice or an experience?
[17:37] Dr. Soon-Shiong: So you know, I came out of South Africa. Came out, you know, I was very young. That’s why I think I have this advantage. I was an MD at the age of 23 and then came to this country and looked around. Everybody was much older. So, I was a PGY2, which means I was a surgical resident. And so I did a masters at night while I’m a surgical resident and finished early and became Assistant Professor and immediately got bored. Quite literally. So, I started writing a grant on stem cells. So this is 1985–86. On stem cells and nanoparticles. The people that funded me, believe it or not, was NASA. So, now I became a NASA scientist with two million dollars and a VA surgeon. And the other people I competed against was IBM and Xerox with NIST. And they gave me a two million dollar grant. So, I had four million dollars working on understanding stem cells and being part of the Johnson Space Program on the shuttle program, throwing up stem cells in weightless environments. I spent a lot of time at JPL, so I got excited by all the electrical engineers and some of the work that’s going on there. And then I joined the biology program, the microbiology program and immunology program at UCLA. And wrote my first paper in 1990 on the natural killer cells.
[19:16] Dr. Soon-Shiong: So, none of that is surgery. And I was doing pancreas. I mean doing regular big surgery, like Whipples, which you’re familiar with, and decided that the next big challenge at UCLA was to do whole open pancreas transplant. So I did UCLA’s first whole organ pancreas transplant and after two patients I realized even though it was making lot of money for the school and a lot of notoriety, it was the most dangerous program you could do. I asked my chairman if I could shut it down — I’m the director — so I could go invent an encapsulated islet cell transplant. He literally looked at me and says, “You’re a flake.” I said, “I may be, but I’m going to shut this down.” And we shut that down and did the islet cell transplant which became the nanoparticle. The nanoparticle begat this whole concept. Now, this is where I’m getting to. That we have really, truly looked at cancer in the wrong way. That what we have now is a true opportunity to activate four or five cells that you are born with. One, the dendritic cell, another the neutrophil, and the third one, the T cell. They have to go in harmony. You really have to figure out how to harmonize and orchestrate these cells. Without going into detail, if you do that we can truly get a vaccine. And I really mean a vaccine. Where are you have, let’s say diagnosed with cancer. We treat it. We create this vaccine, which creates memory cells that allows you to prevent it from coming back. I must tell you that within next year will be in phase three. This is not some hypothetical. At ASCO GI we will be presenting data in patients with colon cancer that shows that this vaccine in phase two is now real. We have patients with colon cancer who had one, two, three, four, five times sometimes seven, eight rounds of different chemotherapy who would have two months to live. Now alive years. So, this idea that we, by the year 2020 we create a cancer vaccine is not some hypothetical aspiration. I in my deepest scientific soul believe that it is here now. Question, will it take 10 years or will it take five years? And, you know, this affects everybody’s life. If you can do this in five years that’ll be incredible.
[22:40] Dr. Soon-Shiong: So, the opportunity to take a fundamental platform of technology and then adopt it to your immune system and generate a vaccine. Which means then we need to completely change the concept of doctors using chemotherapy today. So, how do I take that on? And that’s what I’m trying to take on now.
[23:49] Dr. Soon-Shiong: When I look at what you’re doing out here, and I think you need to really take the power of the computer, which is in your hands. This mobile phone that you have in your hands is as powerful now as the great computer back then. So, I think I’ve concluded the only way I’m going to get around trying to row upstream against the academia. And I’m an academic, but the dogma of academia is going to be the largest impediment to progress of cancer in this country. Let me say that again: the dogma of academia.
[24:39] Dr. Soon-Shiong: Which means we need to empower the patient with knowledge. But with responsible knowledge. And you can do that, through your mobile devices. So I want to create a patient-empowered movement. Rather than a patient-centered movement. So, you can work with the private sector and health and use your digital health in that way.

Dr. Soon-Shiong’s Thoughts on The Current Healthcare System

[26:37] Dr. Krein: Let me ask you, where do you see healthcare going from here? Do you think the system is broken and needs a complete reworking? Do you think that there’s some some underpinnings of architecture that we can actually continue to use, or do you think it’s time for us to look at new ways of delivering?
[27:01] Dr. Soon-Shiong: Let me let me describe how I see the healthcare system. The problem is everybody — and I’m sure a lot of you even in this room — are building things in sort of siloed apps, right? So, if you take healthcare, there’s only three domains. Now think about that. There’s this knowledge domain. And I invented Abraxane in 1991. And I knew by then, I brought it to MCI on the first, second generation Taxol symposium, and it got approved in 2005, and only approved in pancreatic cancer in 2013. You do the math. 17 to 18 years for a breakthrough technology to get to the delivery domain. Now let’s look at the delivery domain. Inside the delivery domain it’s completely discoordinated. You cannot find your information if you went to your private practice physician, and then to the hospital, and then back, and then, if you left the city, to another city. Then you go to the payor domain. And if, you as a physician want to keep the patient healthy, there’s no ICD 9 code. If you have the patient to get ill and worse and go to the emergency room, there’s a maximum amount of reimbursement. So, when you take these three things together, the knowledge domain, the care delivery domain, and the payment domain, and put it in one system, you begin to see it’s completely broken. If however, you take the knowledge domain and the care delivery domain and the payor domain and make it a single system and create what we call value-based care that means you need to completely change the payment.

Resources, Websites and Tools Mentioned:

[00:43] StartUp Health
[00:43] NantWorks
[01:28] JP Morgan
[02:00] Independence Blue Cross
[02:00] RNA
[02:00] GPS Cancer
[02:00] CLIA/CAP
[03:39] Coalition of the Cancer Moonshot 2020
[06:00] Abraxane
[08:58] The National LambdaRail
[08:58] Large Hadron Collider
[08:58] The God Particle
[09:33] Journal of Nature and Science (JNSCI)
[10:18] Allscripts
[10:18] Harris Corporation
[10:18] VA/DoD
[10:18] NaviNet
[12:07] Institute of Medicine
[12:07] National Academy of Science
[12:45] NantMobile Health
[12:45] iD Alliance
[12:45] Woundtech
[12:45] CES
[12:45] machine vision
[13:36] Calio by iD
[13:36] Procter and Gamble
[15:11] Google
[17:37] NASA
[17:37] IBM
[17:37] Xerox
[17:37] NIST
[17:37] Johnson Space Program
[17:37] JPL
[17:37] UCLA
[19:16] Whipple Procedure
[19:16] ASCO Gastrointestinal Cancers Symposium
[24:39] Coca Cola
[24:39] Verizon
[24:39] MasterCard
[24:39] Visa
[24:39] Bank of America
[27:01] Taxol
[27:01] ICD 9 Code
[28:36] Affordable Care Act

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