Founder Spotlight #7: Evan & Sol @ Clara Health
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Evan Ehrenberg & Sol Chen are founders @ Clara Health, a platform empowering patients to find the right clinical trial for them. Evan graduated from UC Berkeley at age 14 and began his PhD in computational neuroscience at MIT before taking a leave of absence to work at Palantir Technologies as a PM. Sol was previously a student at Brown before taking the Thiel Fellowship to start Clara Health.
Clara Health is working to democratize access to clinical trials for patients around the world, and to accelerate the rate of medical advancement. Today, clinical trials are the longest and most expensive step in bringing a new treatment to market, and over 80% of trials run are delayed due to difficulty finding participants. Clara is building a platform that combines leading-edge technology and empathetic patient focus to make it simple and approachable to find and connect to clinical trials that fit them best.
Personal Spark
What prompted you to pursue a career in healthcare/life sciences (HC/LS)? Was there a specific moment in time or influence you can remember? What drives you to work in this space?
Sol: For me, this whole process has been about discovering and solving high impact problems. While we could have joined any company like Google, Facebook, or Apple, as a single person it didn’t seem like we would be making that big of an impact. Making a big impact as individuals was something really important to us. We were looking for a problem that was both interesting and challenging, but also really needed in society, and this problem in clinical trial recruitment really called out to us.
Evan: When I was much younger, I was really interested in Astrophysics and a big part of this was because there was so much to learn about. I think a big part of what drove me is trying to figure out what the unknown unknowns are, as otherwise, you don’t know what you actually are missing out on. As I started to work through this, I started looking at artificial intelligence more and computational neuroscience as a means to further advance AI. The main impetus there was by creating improved AI models, you can immediately impact a number of different fields. I felt that my time as a professor or even a director of research at a larger company working on AI, the impact would be much less significant compared to as an individual creating change in the world. When Sol started Clara Health, it became obvious in terms of the impact and potential to go even further hour for hour, that the right choice was to join her on the journey.
Company Overview
How did you become motivated to tackle this particular problem?
Sol: I discovered this problem by total accident. I had no idea recruitment was an issue and causing all of these roadblocks in testing new treatments. When I was at Brown, and on campus. I saw a flyer looking for breast cancer patients for a clinical trial, and I thought 1. This flyer is designed very poorly 2. How many patients of breast cancer are on Brown campus near the library? That really made me look into the space and look at why this is happening and why things are the way they are today. And if we look at companies like Airbnb and Uber, platforms that are connecting people, this seems like a very logical solution for this kind of problem. Breast cancer patients need new treatments and those developing new treatments need breast cancer patients in order to gather data about whether treatments are effective. So the way we discovered it was fairly accidental, and after talking with many clinical trial providers and patients, it really seemed like a no brainer to tackle this problem.
In terms of founder mindset, I definitely had the mindset of ‘I don’t like when things are inefficient and I want them to be better’. And what I saw on that flyer made me really angry, and I thought oh my god I can’t believe you guys are making patients go through this process. There are so many better ways of doing this process and somebody needs to make that. I was more like “this problem sucks, maybe I should learn about it and maybe I can convince one of my friends to do it with me”. A lot of the initial founding was a lot of information gathering, just me talking to a lot of stakeholders.
Why does your solution matter for the world when you get it right?
Evan: For patients, clinical trials represent the newest science that’s being tested. And it takes so long to go through clinical trials, you won’t actually see the science get to market for a number of years until it reaches FDA approval. Most of the treatments that are approved are based on science from many decades ago. This final stage of testing with the newest science is therefore an essential component of the potential healthcare options. However, while clinical trials may in theory be accessible by patients, they are left very opaque to them. Unless your doctor happens to be the principal investigator for one of these studies or they happen to be best friends with the PI for one of these studies, you’re never going to hear about it. And even if they do end up being the PI for a study, you’re just hearing about that one clinical trial and there may be hundreds for you and dozens may be in drivable distance. So you have to be very lucky to happen to be at a center of academic excellence and your principal investigator happens to be your physician.
On the flipside, there are public databases like clinicaltrials.gov but these really are not meant to be used by patients. They are more to be used as a registry or tracker of what is being done. To us, it seemed like you needed to be quite affluent, educated, and have a ton of time spent to go through a resource like clinicaltrial.gov to access these studies. And this is one of the many reasons why there are diversity problems in clinical trials like the WEIRD problem, where many of the participants are white, educated, industrialized, rich, and democratic. That’s one of the biggest challenges from the patient journey perspective, which is that all these healthcare options are blocked off for them.
On the sponsor side, the groups who are paying for these trials to be done, their problem is that they have filed their patents for whatever treatments before the trial begins. So the longer the trial goes on, not only are they paying tons of money for the clinical trial operations, but at the same time their patent expiration date stays the same. If you aren’t reaching the market for 6 years because of a long clinical trial, that’s 6 years off your patent. When you’re looking at a potential blockbuster drug bringing in over 1 billion in annual revenue, a single day is millions in lost revenue. So you can understand how important it is to run these trials as efficiently and rapidly as possible. On top of that you find that 86% of clinical trials fall behind trial because of patient recruitment specifically. They can’t find qualified patients for their studies. Half of studies (up from 30%) that are cancelled are because of recruitment. The reason why they are cancelled is because you are spending more money to run the clinical trial and there is less and less time in the market. So the return on that investment is getting smaller and smaller until it gets to the point that you make the final economic decision to pull the trial even though you didn’t have any scientific reason to indicate that it wasn’t going to benefit the patient population. This is a massive loss for everyone involved.
It all comes down to this frustrating problem of patient recruitment, and that’s what we’re solving for. We’re increasing accessibility to clinical trials for patients and in doing so we are also accelerating the pace at which clinical trials are able to be run, which 1. Gets the therapies to the masses much faster and 2. By making the recruitment process faster, we reduce the time needed to get a clinical trial completed, we increase the return on investment, and that actually creates more funding opportunities for startups that are trying to bring new potential treatments to market.
Genesis and Progress
Timing is everything — how did you know the timing was right?
Evan: There are a couple of reasons why something like Clara would have been really hard to pull off before now. One of the important ones is that patients have increasingly been using internet and digital sources to guide their treatment journey. And now, we’ve really reached this tipping point where 85% of patients are guiding that healthcare journey using digital resources. On the pharma/med device side, we see that patient centricity is a newer buzzword that isn’t always properly implemented in best practices, but is something that is very popular to pursue. So if you look at 5–10 years ago, it would be very difficult for a company like Clara to come in and talk about why a really strong patient experience is important for ensuring that you have good conversation at all the steps of somebody applying to join a clinical trial. Now this problem is much more understood and there is less of an issue with customer education.
We also see that in healthcare, there is a massive lag in tech adoption. In healthcare systems, it’s about 17 years. Pharma is better but it’s still typically around 10 years for adopting new tech and new methods of doing things. So it’s really only now that you are seeing them adopt digital as a recruitment strategy, and still 80% of recruitment methods are still physical. Finally in terms of the pain point for pharma, it’s getting bigger every year and there are few reasons for that. Number one is that the number of trials being run every year is growing 11% YOY since the last decade. That means there are more and more clinical trials competing for the same patient population, which means that there is an even more difficult time recruiting these patients. There is a need for bigger and faster returns on investment because drug development is becoming so much more expensive.
What are some of the biggest milestones that you have accomplished?
Evan: My favorite ones are every single patient that we’ve helped. The very first patient that we enrolled in a clinical trial, we were uncertain because clinical trials are not a guarantee, there is a lot of potential but also risks involved. This is something we’re very transparent with but we knew eventually things would happen to a portion of the population. The very first patient was a stage IV lung cancer patient, and they passed away very quickly after beginning the clinical trial. It was unclear whether it was just the progression of the cancer, or the therapy itself but regardless we obviously felt so saddened by that. But, we actually received a handwritten note from the woman’s husband telling us about how thankful he was that he could at least rest assured that they looked at every single option and they knew every option that was available to them and that there were no other options in the shroud of clinical trials. And so even though the one they picked didn’t end up saving her life, he didn’t have to live the rest of his life with guilt and wondering what else could have been done. Seeing how we were helping not only patients but their families as well was a really massive milestone for us. We actually have a good vibes channel in our Slack where everyday we post messages from patients.
In terms of other accomplishments, we’ve accelerated some clinical trials by 400%. We’ve actually saved a few that were on the chopping block, and would’ve had to pull if they were not reaching certain recruitment timelines. As we’ve been around the market, we’ve had customers at top 10 pharmaceutical companies, we’ve worked with the fifth largest CRO in the world. We’ve taken on some incredibly challenging clinical trials. One of them was an ultra rare disease with fewer than 100 patients ever recorded in medical history, and they were estimating maybe a dozen people alive with the condition today, and we were able to refer four patients with the confirmed genetic condition. We’ve also seen some cool flywheel dynamics within the marketplace, expanding the platform to address even more patients and customers.
Pay It Forward
Throughout the journey, what have been some of your biggest takeaways thus far? What advice/words of wisdom would you share from your story for other founders?
Sol: The main thing we’ve learned is how hard healthcare is as an industry because of all the legal restrictions. Building a company is hard regardless. In healthcare, especially when you have to deal with HIPAA, it’s like okay, make a company, but you only have a hundredth of the tools you would normally have because you can’t use basic analytics tools, you have to build them in house. There are a crazy number of things you have to do on top of just building the product.
One of things we’ve learned is the importance of a really strong mission as a way of anchoring people. When it’s hard, you still resonate with the passion of wanting to make this work, because hard problems don’t go away, they’re just constantly there and just get harder. So that’s a lot of the motivation for why our thesis as founders is centered around making sure the mission is just sent around constantly so we can get through these times.
Evan: For us, we can also never spend too much time talking to patients, providers, companies. I think that’s true of any company whether its patients or users. Pharma or some enterprise company. You can never spend too much time understanding the problems the people using your technology or products are facing, what their journey looks like. You can never hear too many stories, everyone experiences stuff differently. I’ve never regretted taking the time to talk to just one more person about what we’re building. It’s so informative to figure out what’s the most valuable product or tool for the given individual.
What are some broader trends in healthcare that you are excited about and that you would encourage new founders to explore?
Evan: I would look at companies that are making healthcare more accessible and cheaper and easier to access for a broader patient population. Healthcare is important to every person on Earth but for most, it’s some scary thing that you don’t really want to access. People talk about the dentist and never in a good way, even though they are actually doing one the most beneficial things for you. The same goes for general healthcare. Insurance, understanding your bill, understanding where to go, can all be complicated. We talk to so many patients and it’s just so difficult. We’re doing our part to make clinical trials as accessible as possible and make it an experience as easy as Uber or Airbnb or other direct to consumer marketplaces that have done a good job at creating a really accessible user experience. The same opportunity that we have here in clinical trials exists across healthcare, and I think bridging that gap and making healthcare more accessible and almost fun to access, I think that is also a future that is completely inevitable and entirely a matter of who will take that opportunity.
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