YouSaid · the spoken record
Vasant Narasimhan
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- 79
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- 2019-01-14
- most recent
- 2019-01-14
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- 1
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- podcast
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“I think a couple of things will likely come. I think xenon transplantation, I mean, which has been in and out and worked on. And what's interesting is every one of these comes up and down. So, you know, gene therapy, cell therapies popped up in the 90s, kind of went away, popped up in the 2000s, kind of went away. And then the key linchpin.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“When you look broadly right now, I think you're seeing a few big areas of high innovation. I mean, I think in the whole world of CAR T, so cell-based therapies, really what this is, is harnessing the power to take cells out of the human body, reprogram those cells, and put them back into the human body. Carti is the way we do that in cancer, but there's certainly the opportunity to do that in many other diseases. There's companies working on trying to cure sickle cell disease, others working on other inherited disorders. So really reprogramming cells.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Given the company's heart is innovative medicine, and most of my background has been drug development and really developing vaccines and then developing various medicines. I think it gives me a really good insight into the heart of the company, our key technology is if you think about our pipeline today, I know every asset, every clinical trial, we know all the clinical trial endpoints. So that I think gives you a certain insight into where the company is heading and also I think enables you to hopefully guide the company into the right areas in the future. I think it'd be self-serving to say that it's better to have an MD R&D person running companies, but I think it does give you a different perspective on an R&D industry like ours. Right.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“So, I think there's two things I'd say. One is as RD person, I have a sort of the ability to really get in there and have the discussions directly with the scientists and argue why we need to actually go external and really evaluate the case with, I hopefully objective eyes. The other thing we've decided to do, at least with these very new three new technology platforms, is leave them as independent units and really let them grow up independent from the big R&D and manufacturing machine because I think exactly for that concern, it makes sense to let them build up and really incubate these new technologies, get them all sorted out. And then we can ask the question, what's the right setup down the line?”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Simply because we believe that's the heart of the company. But what I'm trying to keep asking our people is if there's somebody out there who's got it better than us, let's just go get that and then we'll build off of it.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“I think when you want to enter very new areas, sometimes it's prudent to ask yourself to somebody have this much more figured out than you do. So if you take the example of gene therapy, we acquired a company called Avexus, though really I think the front leading edge gene therapy company. Now, the scientists at Avexus, they've been working at this actually in their academic labs for 25 years. I mean, they've been working on trying to hone how to use AAV vectors to get to the neuromuscular system of children to address these issues. They've actually figured out the manufacturing, they've built the manufacturing site. We were working on gene therapies ourselves in-house, but when we looked at that, we said, this is an opportunity to really accelerate what we're doing. And so it made sense, I think, to go external. There's always that balance. We are a company that's very focused internally on research. We consistently invest at the high end on internal R&D.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“On that note, I'd love to hear from you more about how you figured out the build versus buy piece then because a big part of your work is focused on innovative medicines. And you made this argument that it takes 10 years to build up a base, even longer 20, 30 years, and yet you're also acquiring the expertise for the very new cutting edge things, which almost makes it seem like you don't seem like you don't have to even bother building up that base. Why not just acquire it? So how do you sort of navigate the build versus buy part of this?”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“It's a very timely question. We don't know the answer yet. I think right now in this nascent phase that we're in, we believe we need to just own it because the launches are so important that we can't afford there to be a lot of experimentation and not being, not really owning the supply chain. We've done $15 billion of acquisitions just last year in the space, not including all of our internal work in each of these areas. So we've chosen to build out the infrastructure ourselves. I think as the technology matures, we'll get more comfortable about which areas we could send out. I also think the entrepreneurial world will also figure out where they can play a role. I think that's still all being figured out right now. And I don't actually don't have a view yet. I don't know what's going to be the elements we must own and what are the elements that we could afford to give to other parties.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“The amazing thing about behavioral is that that's where you don't have this. I can't imagine that you have a molecule that cures depression. You're no longer up Really broad. It's depression, it's smoking sensation. Even quite possibly Alzheimer's. I don't know if you've”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, I mean, the thing is that actually, so you think about the modern medical sort of marvels, I think about like an antibiotic, like I was sick when I was in college and I had a super high fever. I got an antibiotic and like next few days, I'm fine. Maybe without that, I've been dead. And so that's kind of magic line. It's not like I have to take antibiotics for the rest of my life or whatever.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“I mean, my hope would be we could develop one for obesity, right? That somehow a digital therapeutic that could actually just move the needle a little bit more on obesity is such a massive issue for society. And it should be one where a behavioral intervention on top of other interventions could actually move the needle because so much of it is behavioral.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“I would say yes. There's, of course, a gray zone here as to what is a therapeutic? We would say medicines is our proxy for therapeutics. I mean, one example we launched in the US, a digital medicine. I mean, with paratherapeutics, this is the first digital app with an FDA label that's being used for opioid addiction and other psychiatric illnesses. And it is literally an app that has run clinical trials and has gotten an FDA approved label. So that's truly an example of a therapeutic. But I would put that within our world of medicines.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“You talk about Novartis becoming a medicines company using data science and novel platforms. You're very specific about saying medicines are medicines and therapeutic synonyms in the Nebartist mindset.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Most pharmaceutical companies have their own manufacturing. I mean, there's different trends right now. There's a pretty significant increase of use of Chinese and other producers from many elements of the manufacturing, but still historically, we've had our manufacturing facilities. The biggest trend we have right now is a shift to these advanced therapy platforms. So what we're having to do is as our volumes go down and kind of the older medicines that were produced in huge volumes in innovative medicines, we're now building up cell and gene therapy production facilities around the world. So that's a shift we're seeing.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, so if you look overall at Novartis generics from a sales standpoint and value standpoint is a small portion of the company, but you look at a volume standpoint, it's the biggest part of access. And so really what a generics, our generics business does is take when medicines go off patent, we then produce them at scale. I mean, we're the largest producer, for example, of penicillins in the world. I mean, so we have a huge role to play in providing access to medicines around the world. I mean, right now Novartis reaches about a billion patients a year through our work, and a lot of that is through our Sandos Generics unit.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“And the way that Voss describes it, I think, is absolutely true. A lot of people view reimbursement as a process to get to market access, but reimbursement is really just a proxy for value proposition. So what are the actual user stories? Who's going to actually value this? Who's willing to pay? It's almost like a pricing study. It's almost like price discovery in the consumer world. In this case, it's obviously the payer is not the direct beneficiary of the therapeutic, but they do bear the burden of the cost. And so they're the great arbiter of saying, is there true value proposition? And actually, that's why when you talk about moving away, industry moving away from Me Too drugs, it was because a MeToo drug arguably could not show a very significant marginal increase in value proposition. And therefore, you could, it was very difficult to justify an increased premium price. And so that historically has been the big challenge.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“For people that are new to the space or just a lot of entrepreneurs, they think that the FDA is the real challenge and just getting something clinical trials is expensive and hard, and that's true. But the reimbursement being first in class, being having this huge jump in care, that is the real challenge. And so what I would love to see, especially in our founders, is for them to work backwards. But work backwards, not from going through trials, but work backwards from reimbursement.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Huge opportunity costs when you take those. And that's been a real ongoing challenge for us. I think that the third element is to bring a real lens of what does it take to be successful in the market. I think historically we just had a belief that if we had a great product, it'll all work itself out. Now we actually ask the market access teams that have to negotiate with payers to show up at every meeting and say, actually, even in phase two, so really early for us, what is it really going to take to, let's say, bring a new medicine forward in asthma, a new medicine forward in multiple sclerosis? Right. And if we don't make the cut, we just have to be brutally honest with ourselves”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“We have all of the various review committees and portfolio meetings, et cetera. But really, what it takes is a lot of discipline about the criteria that you're using. So we have very clear criteria. We try to apply that rigor. I think people, there's a lot of romanticization and R&D about big ideas. So much of it is just about discipline, the nitty-gritty. The nitty gritty disciplined execution of how you look at projects. So I think that's one element. I think second, you have to build patience because part of the reason mediocre projects go forward is you start to worry you don't have enough in the pipeline and you start to lose faith that something's going to come. And you have to believe in your own scientists and your own R&D engine to say, I'm going to say no five times because I believe the sixth one could be the big one rather than get worried and just start letting things through because actually what you do is you crowd out the money. It's an opportunity.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“So it's a very important point. And there's no objective measure. I mean, various institutes have different measures, but it's nothing I think that is used externally. We”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“There's a big downside. But I think now we're reaching the point where we have no choice but to really now engage technology. In their estimates now from various sources that believe you could take out 20% of clinical trials costs if you were actually to really deploy technology at scale.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“I think it's a high margin industry. So unless it's easy enough just to keep arguing to yourself, it doesn't really matter as long as we get another big medicine out. It's okay. Let's just keep going.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“It has to be that way. I think what really our industry has not been great at is really deploying technology to make this much more efficient. So I think there's a lot of opportunity.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“I think we go through waves. I think there was a period of time where probably in the 1990s and early 2000s we had a pretty big wave of innovation and we could bring a lot of medicines forward. We went through a lull for seven, eight years. Now I think with again explosion and ability to really understand the mechanisms of disease, we're seeing a renaissance, a record number of FDA approvals. We're investing heavily in new therapy areas. I mean, 15 years ago, people would have said you're crazy if you think we're going to do gene therapy and cell therapy and all the things now that we're doing at scale. You know, the costs really come from our ability to manage complexity. When you look at it over time, the trials get more complex. The requirements from regulators get more complex because the science gets more complex. We can actually measure more things. So we add and add and add and add. And that's led to an interesting, pretty linear increase in cost per patient in our clinical trials.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Once we get it into human beings, we have about a 5% success rate, five to 10% success rate. And it varies by therapeutic area. We've actually been fortunate at our company. We average in that same metric about eight to 10%. But if you look industry-wide, it is about 5%”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“I think there can be very fast players who are really working on a couple of medicines or a couple of assets. But when I talk about building up a capability, I'm really talking about a scaled capability that could generate new medicines consistently over time. And while I do believe the pace of science is improving dramatically, we also have to keep reminding ourselves and being humble with the fact that we understand a fraction of human biology. And actually, when you look at attrition rates in our industry, really the chances of success that we have, they haven't moved in the last 15 years. Still, when we bring a medicine into human beings on average, only one out of 20 works. Really? And that has stayed constant, despite the fact we've had this explosion in USA.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Very diversified company. It really came out of a conviction in my mind that science is moving so fast, you have to focus your capital and really focus your energies. That's at the macro level. Now, when you zoom in to innovative medicines and we have to decide, okay, which therapeutic area do we stay in cardiovascular disease or do we stay in ophthalmology? I mean, those are pretty tough decisions because if you take down an R&D effort. So one example for us was infectious diseases, where we had a longstanding effort. It was not an easy decision. I mean, it was a lot of going around. Are we really sure? Because you can't change your mind now, you know, in three, four years and say, I wish I had it back. It'll take you another 10 years to build it back up again.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“So we do it currently in two levels. One is from an overall portfolio standpoint. We've made the decision to really focus as a medicines company powered by advanced therapy platforms and data science. So in order to really make that happen, we transacted in 2018 around $50 billion of deals to really change the shape of the company. We took principal decisions to leave consumer healthcare because we just didn't believe we would be a long-term leader in consumer healthcare, a decision to spin our Alcon business, which is to get out of medical devices and contact lenses. And alongside that, as we moved out of those other areas, we made significant investments acquisitions in this next wave of therapy, cell therapy, gene therapy in an area called radio drug conjugates, which is a nuclear medicine kind of area. So that was at one level at the portfolio level changing a 20 plus year trajectory to actually become a very”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source
“Build up RD expertise in our industry over long periods of time. If you think about cardiovascular disease, we've been in it 40, 50 years. When you think about transplant and immunology, again, 40, 50 years, oncology, 25 years. So you build up and accumulated expertise. And really the art of it is to make sure you have a depth of new medicines to keep filling your pipeline in each one of those therapeutic areas. Now, there are instances where we find new breakthroughs and areas we're not in. Those you have to really think about, are you going to really stay in that area for the long term? The other element of the story is when you really have exhausted your pipeline, we're not so good as an industry at this, but you have to also be prepared to exit, I think, areas where you're going to be subscale. And that's something we're working on. We've made a number of exits, actually, this year where we just said this is areas we just can't sustain longer term.”
2019-01-14 · a16z Podcast · a16z Podcast: The Science and Business of Innovative Medicines · IDENTIFIED FROM THE TRANSCRIPT · source