The Next Moonshot in Healthcare- Full Transcript

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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[00:05] Intro Music

[00:43] Unity Stoakes: We are with two of the most inspiring “Dr preneurs”. “Dr preneurs” that I know. Dr. Howard Krein, the Chief Medical Officer of StartUp Health is going to be moderating a discussion here about the end of cancer we know it with Patrick Soon-Shiong. It’s an honor to have you here. He’s the CEO of NantWorks. They’re both special advisers on a very important initiative to the White House. And also focusing on a mission that I think is really one of the most important moon shots that, you know, to the world. So, welcome Howard, turn it over to you, and thank you for being here.

[01:28] Howard Krein: Thank you, Unity. Patrick, first off, thank you for coming and spending some time with us. I know you have a incredibly busy schedule with all the, with all the companies and with your day job as I call it. And I know that you had some special announcements and things you were going to talk about at JP Morgan. I wondered if you would just share with us just some of the, some of the exciting news that’s going on in your world.

[2:00] Dr. Patrick Soon-Shiong: First of all Howard, thank you for having me here. It’s wonderful to see you. All the young, and that’s it, they’re all young. Entrepreneurs in the group. So, 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. So quietly, we’ve been building a platform that does whole genome sequencing of the tumor-normal which is basically an entire 3 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 down stream 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.

[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 3 years? So 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.

[4:43] Howard: Impressive. I mean really impressive. [applause].

[4:13] Howard: So, you mentioned, and I think such an exciting part is, is the coalition that your bringing together. Because, as you create a moonshot for something this big, this grand, you can’t do it by yourself. You can’t do it in a silo and you do have to have communication and people working together. How is it that you, you’ve been able to facilitate getting, like, whether it’s Independence Blue Cross, pharma, government, the academic centers, something that people have been trying to do for, I think Nixon probably started the first moonshot to cure cancer. And you know, obviously, it was very difficult.

[5:34] Howard: Can you talk a little bit about how you are able to use your relationships and bring people together for this common good?

[5:42] Dr. Soon-Shiong: You know, so what we see today is something I started in 2005. I think one of the messages I want to share with you is if you have a passion and you believe in something, I think most important thing you need to think through is persistence.

[6:00] Dr. Soon-Shiong: So, 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. So this is 2005. That was completely counter intuitive to everything we’ve been trained, including things we trained by 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 yourself 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 sleep, some are wake, 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: And 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.

[7:54] Dr. Soon-Shiong: And actually go on my own internal campaigns. So, for 5 years we’ve been underground. Today was actually the reveal, so to speak. And I knew that I needed to build an infrastructure that the United States did not have. 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.

[8:21] Dr. Soon-Shiong: You and I have 3 billion base pairs. So, it’s three billion. Those base pairs actually generate genes, there’s 20,000 genes. So it’s times 20,000. Those 20,000 genes then speak to RNA’s 200,000 RNA. Those 200,000 RNA speak to 2 million proteins times 10,000 protein networks to find the protein network that’s abnormal. That is the mathematical problem that I recognized that nobody, other than trying to find large hadron collider God particle, would actually go about.

[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, so you look at that math, 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: So what do we needed to do was first, what we needed to do was build an infrastructure of 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 8 terabytes a second. And that’s inter connecting all the hospitals and all the supercomputers. That took me 4, 5 years. I then needed to build a supercomputer platforms. Brought in astrophysicist, mathematics, mathematicians to look at modeling so that we can actually do the bioinformatics of 3 billion base pairs times 200,000 RNA times a protein pathway. i.e. GPS Cancer. Those papers are published in “Nature and Science”, so it’s the sciences completely validated.

[10:18] Dr. Soon-Shiong: Built that. Then you 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 call Harris which runs the air traffic control of our nation. And actually runs the VA/DoD, 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. Around every day. So we built a program of 90 doctors to collate on a daily basis the 10,000 clinical trials. And integrate that onto the NaviNet portal.

[12:07] Dr. Soon-Shiong: So 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: So 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 CS this week. If you go to IDAlliance.com or https://nantmobile.com. The idea was to take that app and actually make that app applicable, so what we did, we released a wound tech and I just got news from wound tech, 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, C.A.L.I.O.D. 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 2 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;14] Dr. Soon-Shiong: So if you take this continuum all the way to your everyday life. To the moments of illness, like cancer, and you have the infrastructure that can actually interrogate all the way down to the molecular level, all the way back to your vital signs, and all the way back to managed outcome, I believe we can create what I call mission control. Where every human being is an astronaut.

[14:41] Dr. Soon-Shiong: So, finally, in the final piece, in order to do that I realize that there’s 20,000 different medical devices with API’s. So we took the trouble of writing API’s 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 5 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 credible 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.

[16:02] Howard: Yeah, I agree. So, now you can see why I was very thankful that he took time out of his schedule. You can see he’s been working on a few things. [Laughs]. One of the things that struck me that you mentioned was that you’re looking at cancer a little bit differently than everybody else. And as a practicing physician I think they we’re, we in medicine are taught certain practices and ways to think about things. And I think that part of being an entrepreneur, and certainly I think you are the grand entrepreneur, is thinking about how to disrupt, right? Without disruption there is no progress. Part of the amazing thing that I think that you’re also doing along with the moon shot, is saying, look, there’s other ways of thinking about these things. And then I think you’re entrepreneur, entrepreneurial side says “how are we going to do this better?”

[16:57] Howard: 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?

[17:21] Dr. Soon-Shiong: Well you know, I mean, I think since I was young I’ve had this almost insatiable curiosity. So it’s always, I suppose, just the pursuit of curiosity. Maybe it’s about my ADD. I have no idea. [laughs] I’m just joking.

[17:34] Howard: We all have a little bit of that. Right?

[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. And the people that funded me, believe it or not, was NASA. So, now I became a NASA scientist with 2 million dollars and the VA surgeon. And the other people I competed against was IBM and Xerox with NIST. And they gave me a 2 million dollar grant. So, I had 4 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 2 patients I realize even though it was making lot of money for the school and a lot of notariety, it was the most dangerous program you could do. And I asked my chairman if I could shut it down and I’m the director, so I could go invent an encapsulated islet cell transplant. And he literally looked at me and says “You’re a flake.” That was his, and so, 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 his 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 4 or 5 cells that you are born with. One, the dendritic cell, another the Neutrophil, and the third one, the T cell. And 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 cancer. 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 3. This is not some hypothetical. At ASCO GI we will be presenting data in patient with colon cancer that shows that this vaccine in phase 2 is now real. We have patient with colon cancer who had one two three four five times sometimes 7 8 rounds of different chemotherapy who would have 2 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 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.

[21:55] Dr. Soon-Shiong: This vaccine technology is a thing which I’m working on called the adenoviral vector system was so remarkable that we discovered that it actually, actually can prevent infection. So we actually now have a program against ebola. We have a program which some of you should be really concerned about called chikungunya. Chikungunya is a mosquito that’s coming here through this country. It’s in Dallas, where when you get bitten, and you contract this, it actually causes such severe arthritis it translated into bone breaking. Chikungunya actually just translating into bone breaking. So, there’s no treatment for that. And so we’re developing a chikungunya vaccine as we sit and speak.

[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. And speak, speak to that issue.

[23:5] Howard: That’s amazing. So, with the affected, the technology is here to cure cancer, or hopefully at least create that vaccine. And we’re working on developing a coalition and partners. Where, where do you see entrepreneurs in that, in that environment? Where do they fit in? We have so many young companies and companies that are, you know, when I say young Patrick, you’re still young, but I was going to say, a young Patrick it’s probably sitting out here, looking, saying I have, you know, these, these ideas, this idea for a moon shot and the motivation and the drive. How do, where do they fit in, and how did they get involved?
[23:49] Dr. Soon-Shiong: Well, 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 this mobile phone that you have in your hands is as powerful now as the great computer back then. So, you have an opportunity to really, if you’re in this healthcare digital space, to really use these, you know, variscopes, there’s accelerometers, there’s all kinds of things in care. And so, which means you have the opportunity to really what I call empower the patient. So, I think I’ve concluded the only way I’m going to get around trying to blow 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 then, 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. And all of you, with your mobile devices and your technologies. That’s why I created NantMobile health. NantMobile health and the iD Alliance is to bring in Coca Cola, Verizon, MasterCard, Visa, even the Lakers. And they’re a great team. [laughs]. I know you got a great team here. [laughs] There’s a [inaudible] here and I’m going to watch him this Thursday and it’s going to be painful. But I really think if we used the private sector and in a responsible way. I’ve worked with Coca Cola and I work with Verizon and I work with MasterCard and I work with Bank of America. We made an announcement today that Bank of America is actually adopting this GPS cancer. So, you can work with the private sector and health and use your digital health in that way.

[25:53] Dr. Soon-Shiong: We welcome your use and I say we welcome your use of our ID on our Nantmobile platform. It’s very powerful. It’s a natural language processing tool that’s called iD Calio. You could use that app and use the software. There’s machine vision recognition platform. It recognized TV , recognize books recognized physical objects, recognize wounds, so we would encourage that. We would support that. It’s not even a financial issue it’s really technological access. And we’d be happy to help and partner.

[26:37] Howard: It’s great. Let me ask you, where do you see healthcare going from here? Do you think the system is broken that 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: So 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 silo’d apps, right? So, if you take healthcare, and 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 1st 2nd 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 want to have the patient to get ill and worse and go to the emergency room, there’s a maxis amount of reimbursement. So, when you take these 3 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, which means you need to completely change the payment.

[28:36] Dr. Soon-Shiong: This idea of payment for service is completely disincentivizes anybody from doing the right thing. If however, you pay for outcomes. What are called value based care. The problem is, we say we gonna pay you for outcomes. But the providers have no capacity to measure outcomes or cost in real time. Which means you need to actually create a system that allows outcomes divided by cost given measured in real time as a person walks to the emergency room to walk home that evening so we are both that system sound silly can build a system that enables the providers to be able to know what the outcome Susan who is accountable in real time we’re going to be completely lost so this administration is instigated Affordable Care Act I think it’s a wonderful thing because it. Change we need to build on that because you’re not the proposed change cuz I feel me a reason people are changing their not changing because you’ve created this Affordable Care Act which now actually figure out a way to not pay for outcomes so I’ll job is not enabled the providers to be able to measure out guns measure of cost in real time that’s the only thing that’s going to change healthcare.

[29:57] Howard: Fantastic. You know, as you were speaking, I was looking down and I see Jerry and he always brings to mind, Jerry Levin has always, and we were talking about this a little bit before while you were up on stage, on how to stay grounded, stay present, stay healthy, as you’re tackling these huge problems. And I was just wondering. You have so much going

on. What do you do to regenerate. To rejuvenate. How do you relax? What’s your secret?

[30:28] Dr. Soon-Shiong: Well quite literally, the only time I get lost. When I don’t think about this stuff is what I’m watching basketball or playing basketball. So, it’s hard to believe, but I still play full court NBA court basketball. [laughs]. And two nights ago I played with Norm Nixon and he couldn’t shoot and I was teasing him. [laughs]

[30:48] Howard: There you go.

[30:49] Dr. Soon-Shiong: So, that’s the way I get relaxed. And I think, you know, I think that’s the only way. And I have an amazing family. My wife and my kids. And I do them no service because I spend most of my time working but they are so supportive. So, that’s what..

[31:04] Howard: Well you do us all a great service. So, I have to thank you.

[31:10] Unity: Thank you so much. [applause].

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