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D.A. Wallach

lines on the record: 76
first: 2020-03-31
most recent: 2020-03-31
sittings or episodes: 1
sources: podcast

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“Sure. Well, it's a good segue into how the technology moves from basic biology research that's happening in universities to ultimately big public companies, be it new biotechs that have gone onto the public markets or the large pharma companies that ultimately buy those that are appealing. And this can be a very long process historically. There are products that are now coming onto the market, delivering absolute breakthroughs for patients whose histories go back 20 or 30 years to some esoteric lab somewhere. And I guess the argument I would make is that the initial scientific breakthroughs are quite unpredictable. The National Institute of Health in the United States, which finances a lot of basic research in universities around the country,”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Can put a lid on it. And then you move down to this third generation, our future daughter. And that is truly preventative medicine. That is the real future of medicine, which is to say stop people from even getting diseases in the first place. That's the most elegant possible intervention we could achieve.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“And so I sort of use this as a poignant sort of case study of the past, present, and future of medicine. My mother-in-law was actually the one who led us to know about this mutation in my wife's family when she got two very advanced cancers in her mid-40s. And thankfully, some breakthroughs in the pharmaceutical side of things have, we hope, saved her life, but at a minimum have extended her life for many, many years. And so in that generation, my mother-in-law, we have benefited from breakthrough medicines. Then in my wife's generation, that led us to know about this mutation. And as a result, we were able to get out in front of it, and she gets annual screening, like annual colonoscopies, among other things, to make sure that if she gets cancer, we detect it so early that we”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Have the DNA in them that includes this mutation. Half of them didn't. And so sort of as a miracle of IVF, we were able to fertilize a number of eggs outside of her body in a lab and genetically sequence all of the resulting embryos. And then we chose to”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Of that outcome. So, first off, we should start by thinking about where we can point this stuff, where it's going to really help people in ways that are totally non-controversial. Then you move into more complicated possibilities, and that would include the selection of embryos or the editing of embryos as a very personal example. I'm a couple weeks away from being a father for the first time. And the daughter that we're going to be having is actually a product of some amazing medicine because we were able to use IVF to select an embryo that was free of the mutation that my wife bears. Wow. So in theory, half of my wife's eggs”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, it's a very complex ethical space, and people have been talking about it long before this technology was even within reach. But of course, to your point, now it's kind of important that we give this serious thought. And I see both sides of it. I think the first point I would make is this technology should, as we develop it, first be put to the use of helping people who are obviously suffering. So there are set of applications for gene editing, for instance, that should just be ethically, totally without controversy. I would include my wife's disease in that. I mean, neither my wife nor I think that it would be exciting for her to get cancer at 40, but yet without us doing anything to prevent that, she has an 80% plus chance.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“It sends a machine into your genome and it latches onto the genome at a specific location where you've told it to go and then it enzymatically transforms a single letter of DNA into another one. So it's sort of a lighter touch way to go and transform a single point mutation. Now as I mentioned, there are lots of patients like my wife where that's all you need to fix is a single letter. Looking forward over the next hundred years, what we are hopefully going to be chasing is the ability to edit much more complex genetic diseases where multiple different genes are involved. And in order to fix a disease phenotype, you're going to need to go and make multiple edits.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“The DNA cuts both strands, and then your cells actually have a bunch of machines for repairing that break that you artificially introduced. And when they are repairing the break, they can introduce and edit like some new DNA that you'd like to impart there. What this alternative technology beam does is rather than cut the DNA,”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Sure, since I'm here on Invest with the best, maybe I'll sell my own book a little bit. I just thankfully was a part of an IPO about two weeks ago in a company I backed a couple years ago called Beam Therapeutics. And Beam has developed a next generation version of CRISPR. So some of the folks who invented CRISPR are founders of this company. And the difference between CRISPR and what Beam is doing, which they call base editing, is that what CRISPR does is it sends a machine into your cells and it cuts your DNA. So your DNA, as you probably will find familiar, has this double helix structure. And the virtue of that double helix is that the same information is on both sides of the ladder. So what you do with CRISPR is you send a machine in that cuts.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Go and introduce RNA into some number of her cells that codes for the functional version of this machine and then her cells would sort of manufacture using the blueprint of that artificially introduced nucleic acid. So that would be an example of a gene therapy. And that's a whole class of treatments that people are now exploring.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Edit the DNA in every single one of those cells. And so the most promising option for someone like her might in the future be that if she was conceived using IVF, perhaps we could edit the DNA when she was only a few cells because that would be a tractable number of targets for us to go and hit. Downstream of that, once someone is a fully grown person with trillions of cells like she has, then the question is, is there any way to sort of remediate it in a less fundamental way? So for example, what actually results from her mutation is that she has a smaller number of the machines that she needs. In other words, in a normal person, you'd have a hundred of these spell check machines in her, you only have 50. And so what if we could use a virus to”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“And cancer is interesting. She's a fascinating case, my wife, because not only does she have this genetic defect in this MLH1 gene, but what that will lead to is a genetic disease cancer. So we've actually made a lot of progress in the past couple decades using DNA sequencing to deliver benefits to both patients with genetic diseases and cancer patients. So in the case of patients with genetic diseases, there are multiple new approaches to remediating those genetic abnormalities. And if again, you take my wife's example, what we would like to do is have a way of either fixing her DNA so that we could edit that mutation out of it. But if you think about it, she's got trillions of cells in her body, it would be very hard to”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Lining of your GI tract are turning over at a pretty rapid rate. So six months from now, the cells that will line your intestines are different cells that were there six months ago. And so as this cellular replication is constantly occurring, there's a process that basically goes and does spell check. And in my wife, in every cell in her body, this spell check machine is slightly defective. Well, what does this mean? Over a lifetime, it stochastically increases the probability that mutations will occur in her DNA and at some point it's very likely that one of those mutations will endow the cell in which it occurs with a significant evolutionary competitive advantage.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Absolutely. So I'll talk about two different examples of it in practice. The first would be the broad category of rare genetic diseases. So there are many people in the world who are born with genetic mutations, sometimes as minimal as a single letter of DNA being different in their genome. And she doesn't mind me mentioning this, so I'll use my wife as an example. She has a single mutation in a gene that is called MLH1. And this gene produces a protein, again, a protein is like sort of a molecular machine. And what that machine does in every single cell of her body is fixes when the DNA is copied as cells divide. So the cells in your body are dividing all the time, particularly tissues like the”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“At DNA, but then to look at the proteins that exist in our cells or in other natural systems, we've got tools like mass spectrometry, flow cytometry, and other basic research technologies that in the aggregate give us this much broader and higher resolution picture of just what's going on in life.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Now, DNA, unfortunately, for our understanding, DNA is only the bottom layer. And the so-called central dogma of biology, one of the most important theories in biology is what's called the central dogma, which is that DNA gets transcribed into RNA, which is another type of biomolecule. And then RNA gets translated into proteins. And proteins are the workhorses of biology. These are the little molecular machines in our bodies and other organisms that are doing all of the stuff. And so alongside DNA sequencing, we've also been developing better and better tools to look at these additional layers of life. RNA, it happens. You can look at using the same tools that you used to look at.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Absolutely. So DNA sequencing has come down in cost at a pace that arguably is greater than Moore's law, which is to say that we have reduced the cost of sequencing a human genome from $3 billion when the first one was done to today as low as a couple hundred dollars. And so what that has allowed us to do is much more affordably obtain the genetic information that exists in the natural world. So not only have we been sequencing human DNA to learn about our own biology, but we've also been sequencing microbial DNA and DNA that's in our environments. And this truly is the programming language of life. So this is really the first time that we've been able to go under the hood at scale and see what the heck's going on.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Really, only 200 years old. Humans have been around for about 300,000 years. And so to think that everything we know and have learned about life and living systems, we've learned in only the past 200 years. And I'm talking everything from the discovery of cells to the insight that germs can spread disease to the identification of DNA as this universal programming language for life. That's all the past 200 years. And with that understanding came this medicine 1.0 that I was referring to. What's now happening is we've had some serious breakthroughs in the past few decades around biology research tools. And those tools are now enabling us to learn about how life works at a totally unprecedented pace. And it's that rapid learning that is giving rise to breakthrough products and technologies that can actually be taken to market.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Is try to control symptoms of disease. And we're moving into Medicine 2.0, which is all about trying to cure disease or even better prevent it. And alongside this, the other kind of meta transformation is from a mass industrial production model where we have one size fits all products to what people call personalized medicine, which would be a model where we tailor medical interventions and medical products to every single patient because every one of us is unique biologically. And maybe just to zoom out even further, my take on this whole thing is that we're entering really the second great historical era of medicine and biology. So I like to point out to investors that medicine is only 200 years old and biology is.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Me go back to that initial observation because I think the distinction that it invites then is between the experience of healthcare for more or less And the maybe mistake that I made when I first started thinking about the space was that it was most likely that innovation was going to happen or needed to happen in the, call it healthy healthcare system, when in fact the majority of this healthcare economy, as it should be, or at least as it has to be at a minimum, is devoted to the sick care part. And so what are the most impactful frontiers for innovation for patients who require medical attention? My view is that the simplest of those is that we want to cure diseases. And so, broadly speaking, what's happening right now is we're moving from an era of what I would consider medicine 1.0, where largely what we do”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“So, one of the things I love about investing in healthcare broadly is that it really is an entire economy. You can think of it as the healthcare economy That economy, there are just so many little niches, and you're always learning about more of them that you didn't know existed. So my approach has been to cast a very wide net at the first pass, but then over time to identify the particular subcategories that I'm really drawn to.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“To answer that question, you have to explode out the taxonomy even further. So then, as I said, within the first category, biopharma or the product side, you have a huge number of subsidiary markets. So you've got drugs, as I mentioned, which in many ways is the biggest. You have diagnostics. You have medical devices. You have research tools. And then now you even have an emerging category of software businesses that are increasingly involved in drug discovery and diagnostics. So each of these markets is capable of absorbing a lifetime of investing energy. And the deeper you go into any one of them, the finer grained your taxonomy of that market becomes because you can slice and dice businesses within each of those subsectors quite a bit further.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, so the highest order taxonomy, I think, would be to distinguish between, call it biopharma and healthcare. So they're all integrated, but the way I think about it is biopharma refers to the products of medicine. Encompass drugs, diagnostics, medical devices, and potentially research tools. And then healthcare is sort of the delivery system by which we get those products to patients. And then, of course, it also includes in the delivery side services that are provided by physicians like surgery. So the healthcare economy can roughly be broken down in this way. The products of medicine on the one hand, and then you could think of it as the stores on the other.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“Came down to sort of the indignities of going to the doctor's office and having to wait for an hour and be treated like cattle. And then they move into an exam room and you wait for another hour. So it just struck me that as a consumer technology investor, this was one sort of consumer experience that had yet to be significantly modernized. And that was kind of my door in. And the first investment I made in healthcare was a company called Doctor on Demand, which is a telemedicine service. So their product's very simple. You install an app on your phone, you open the app, and you're thrown into a video chat with a physician. And through a video conference, it's actually possible to question you about your symptoms and to diagnose a pretty wide range of conditions. And even subsequent to that, to prescribe medication without you needing to be”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“We all understand healthcare, or most of us do, who are 40 or under, primarily understand the healthcare industry from the perspective of a relatively healthy person. So when I initially got interested in the sector, I was kind of thinking about how terrible my experience as a sort of average healthy patient was.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source
“I had been investing, as you allude to, in wide range of early stage consumer technology companies, and that included most notably Spotify, which was sort of my pivot out of my life as a musician into my life investing. And I think what has always guided me is kind of a dual motive. On the one hand, looking for where you can make a lot of money, but also where you can have a great impact. And I kind of resist the term impact investing because I almost think all investing should be impact investing. In other words, it's not a good thing in general to be directing your power as an investor or any other kind of person at things that are bad for the world. So I've been superficially interested in healthcare because obviously it's pretty central to all of our. Lives and our families' lives.”
2020-03-31 · Invest Like the Best · D.A. Wallach – Investing in Healthcare - [Invest Like the Best, EP.166] · IDENTIFIED FROM THE TRANSCRIPT · source