Biotech Leaders Get It
22
Jun
2022

Bringing Precision Medicine to Neuro: Ivana Magovcevic-Liebisch on The Long Run

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22 Jun 2022

Today’s guest on The Long Run is Ivana Magovcevic-Liebisch

She is the CEO of Cambridge, Mass.-based Vigil Neuroscience.

Ivana Magovcevic-Liebisch, president and CEO, Vigil Neuroscience

The story starts with Amgen. The big biotech made a strategic decision to get out of neuroscience in 2019. That meant a couple of drug programs targeting TREM2 came up for sale.

One is a monoclonal antibody, and the other is a small molecule. They are aimed at a neuro-inflammation target on microglia cells, and it has been implicated in genome-wide association studies for rare neurological diseases, and for larger indications like Parkinson’s and Alzheimer’s.

Atlas Venture, which has a longstanding relationship with Amgen as a limited partner in its funds, sought to in-license the programs – which it thought had potential in a small, focused, asset-centric startup.

That’s where Ivana and Vigil Neuroscience enter the picture. She’s an experienced executive, with stops at Dyax, Teva, and Ipsen along the way. She’s been through some ups and downs in the early days of Vigil – venture financings, an IPO, a bearish stock market, and a partial clinical hold while the company and FDA discuss dose ranges with its lead monoclonal antibody for a rare disease called ALSP.

I saw Ivana speak at a recent conference about the importance of building a strong team and culture to navigate through a downturn. I think she has some valuable perspective for managing in these times.

Now before we get started, a word from the sponsor of The Long Run.

Calgary is home to more than 120 life sciences companies, from emerging startups to established firms. With this critical mass of research, technical talent and expertise, the city is an active hub for life sciences innovation.

Technologies homegrown in Calgary are changing the face of healthcare. Syantra is revolutionizing breast cancer detection using artificial intelligence-derived algorithms. NanoTess is harnessing the power of nanotechnology to tackle chronic wounds and skin conditions. And this is only the beginning. Calgary’s life sciences sector is projected to spend $428 million on digital transformation by 2024.

If you’re a bright mind or bright company solving global health challenges, Calgary is the place for you. 

Take a closer look at why at calgarylifesciences.com

Now, please join me and Ivana on The Long Run.

21
Jun
2022

Why Kymab Agreed to be Acquired by Sanofi

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21 Jun 2022

Vikas Goyal, former SVP, business development, Pandion Therapeutics (now part of Merck)

UK-based Kymab made headlines back in January 2021. Sanofi agreed to acquire the antibody drug developer for $1.1 billion upfront, plus $350 million in potential milestones.

The main attraction for Sanofi was KY1005, a monoclonal antibody targeting OX40L, a regulator of the immune system. Five months before the deal, Kymab announced it hit both primary endpoints of a Phase 2a trial of patients with moderate to severe atopic dermatitis that wasn’t responding to topical corticosteroids.

Sanofi, in its official statement, mentioned its interest in an ICOS-agonist antibody in clinical development for cancer, along with Kymab’s broader capabilities in antibody drug discovery.

I spoke recently with Brandon Lewis, the former head of corporate strategy at Kymab, on the dynamics that were at work in this transaction.

Brandon Lewis, former head of corporate strategy, Kymab

Why was this deal the right thing to do?

We realized that in order to give KY1005 the best chance of success we needed a committed partner with deep intellectual and financial resources focused in immunology. Sanofi presented the opportunity to collaborate. Sanofi has a great share of voice with patients and physicians plus an incredible amount of knowledge about the potential in dermatological diseases and beyond for the OX40-Ligand (OX40L) pathway. And they saw how our molecule could have application across multiple dermatology indications and certain autoimmune disorders.

At that moment in time, it was becoming increasingly clear that there were only so many R&D teams that had the wherewithal, capacity, and interest to drive the bus through this tiny little window to see what could happen for patients. And after many years with both of our lead molecules advancing on promising trajectories, we felt our lead OX40L molecule KY1005 deserved that, as did our immuno-oncology program KY1044 (an ICOS agonist antibody).

As we began to see some early open label clinical activity for KY1044 and recognizing the evolving competitive landscape in immuno-oncology in general, along with the opportunity to pursue both mono and combo therapy paths, we believed it would be hard for an emerging drug development company to do both programs properly and at pace by ourselves.

Several potential partnerships were available, offered, discussed.A few entered negotiations. Nigel Clark (Kymab’s SVP of Business Development, now CBO at Nucleome) is an incredible dealmaker with a unique business acumen. The parties varied from dermatology-specific companies, a few regional partners, as well as a few large pharma / large biotech companies that saw elements of KY1005’s potential but not the same breadth of potential that we saw. Of course, there was a range of opinions on how KY1005 should be priced, and whether to stick with dermatology or go broader.

We ultimately wanted a partner with the necessary enthusiasm, interest and knowledge of the space. And so that led us back to the folks at Sanofi. They had reviewed everything in the space. And had become category leaders in immuno-dermatology, which is classically a difficult space to gain adoption with new therapeutic interventions. Plus, dermatology practices have unique economic incentives regarding interventions. Even great drugs have to compete with things like microsurgery, Mohs, and cryotherapy. To get that share in dermatology, we knew we had to work with a committed company that had an established presence with both patients and physicians to launch another new therapy with a novel mechanism of action.

What drove the timeline for your acquisition? Why did this happen in January 2021?

In 2017, Kymab had four therapeutic areas and a large research and translational footprint of 150 people, plus a burgeoning clinical development organization. And the company had just raised its last equity financing in 2016.

ASCO 2017 had been incredibly exciting, and the world went mad for immune oncology. We had our first two presentations on our ICOS program at SITC in November 2017 where there was a lot of excitement with combination checkpoint inhibition at that moment. So strategically the plan was to raise a modest amount of capital, take KY1005 and KY1044 into Ph1 studies and get some early clinical data, with KY1044 as the lead focus. We had also recruited Dr. Sonia Quaratino  as our Chief Medical Officer to lead the clinical development of both programs. She joined us from Novartis and is brilliant at translational clinical development. She is an immunologist with very strong oncology development experience.

Fast forward to ASCO 2018. The highly anticipated results for IDO landed awkwardly and theICOS data presented by others in the field was going to require a lot of additional interpretation. On Day 1 of ASCO the palpable enthusiasm in the audience quickly turned to concerns and questions . We had not yet presented any human clinical results from KY1044, but now we had to respond to the market’s collective confusion about the target and emerging questions around clinical development trials for combination therapy. This again, presented a considerable communications challenge to overcome and required a new approach to establishing KY1044’s target product profile.

So now we are in the summer of 2018 post an enthusiastic American Academy of Dermatology (AAD) in February and let’s say a more somber ASCO. We had already achieved some incredible preclinical in vivo data in acute and chronic Graft-versus-Host Disease (GvHD) models with our OX40L antibody, KY1005, in some challenging primate models run by Leslie Kean (then at Seattle Children’s now at Boston Children’s) which we published in Science Translational Medicine. In this model, we had a striking survival benefit. And when we examined the treated animals at the end of the study, it looked like we were resetting these activated T cells back to a homeostatic state. So, we realized we had an incredibly potent molecule that was doing the biology that we wanted it to do.

It is crucial to choose the most appropriate setting that will showcase a molecule’s full potential or shortcomings in the clinic. Atopic dermatitis provided this for KY1005. There was a clear biological rationale supported by a strong and growing body of research that published in 2012 identifying the presence of OX40L in atopic dermatitis lesions.

Despite the biology associated with OX40/OX40L axis there was still limited human clinical proof-of-concept for these mechanisms at that time back in 2017. Roche-Genentech had earlier published very nice data in transplant, but they moved forward in asthma where the studies did not produce the intended results. We had been evaluating the potential intervention in atopic disorders and skin diseases where the literature supported the biological rationale to target the OX40/OX40L axis. In the first quarter of 2018 the first in human study of KY1005’s safety and tolerability was nearly completed and we were incredibly optimistic.  After this readout, our optimism matured to excitement as KY1005’s properties and drug-like attributes became further substantiated. Sonia and I headed to AAD in February 2018 in San Diego with this preliminary knowledge of KY1005 and a busy schedule of meetings with key opinion leaders and principal investigators, to further refine our thoughts around the Phase 2a study design in patients with atopic dermatitis given what we understood about KY1005’s proposed mechanism of action.  There was a lot of excitement in the medical dermatology space.[Regeneron and Sanofi’s] Dupixent [an IL-4 and IL-13 inhibitor for atopic dermatitis] had begun to catch its stride and there were many companies presenting “small” signal seeking studies around blunting the immune response in atopic disease.

If you recall, until now, the OX40/OX40L checkpoint axis was primarily being investigated as another immuno-oncology approach and had limited success. These approaches were trying to agonize the [T-effector cells] Teffs and dampen the [T-regulatory cells] Tregs. KY1005 is designed to do the opposite by working to restore a more normal balance of these cell subsets. This is what we investigated in the acute GvHD animal models.  This presented a real hurdle when educating the Street that our intervention was in autoimmune diseases not immuno-oncology and KY1044 was doing the opposite targeting ICOS pathway in immuno-oncology.

A company then named Glenmark (now Ichnos) was presenting on an open label uncontrolled data with its anti-OX40 antibody in atopic dermatitis. It was a small dataset, but it provided additional encouragement for the pathway and its clinical rationale. However, there are always risk and rewards with making apples and oranges comparisons. When interacting with external stakeholders there is never enough time to get through the whole story in most 1×1’s, and even more to actually do a proper deep dive on why you selected the optimal molecule .

Sonia and her team were working hard on the filing for the KY1005 study in atopic dermatitis patients.We were convinced KY1005 and its emerging therapeutic profile would have a meaningful benefit, there was a clear unmet need to offer better therapies than topical steroids, and we saw potential to be one of the first to market.

The classical development challenges remained, working through the atopic dermatitis clinical trial designs, dealing with inter site variability and patient recruitment. We worked hard and worked fast to get the trial done. And of course, the competitive landscape in atopic dermatitis evolved. We saw data from Anaptys, Equillium, Dermira, and others. And all of a sudden, we were 6th or 7th in line with KY1005.

We also had two new targets progressing to development candidate stage and were facing the decision to shift resources from discovery to development. Our discovery team was continuing to find cool new things to work on. And our development organization was trying to push INDs and CTAs forward.

In 2019 we had recruited a great new CEO Simon Sturge and he brought a new level of large pharma and biotech experience, along with corporate discipline and a commercial strategic focus to the Company. Biotech companies are constantly looking for funding and so we were always evaluating a variety of options, including, but not limited to, a possible IPO.

Later in the summer during a series of non-deal roadshows meeting investors in the US we were hit with a “black swan event” of the Woodford funds. It had been one of our largest investors after our 2016 Series C. And in the background we were also dealing with an ongoing patent challenge to some of our platform patents.

Drug development is incredibly hard, but there are so many other seen and unforeseen obstacles that will emerge and have to be overcome.  I mean every time we got through one door . . . But the company persevered. Our investors and board remained very supportive of us continuing to build the company and refine the story. And we were executing nicely on both our lead clinical programs..

Now move forward to 2020 and our OX40L program is looking really promising. There was no question we had a competitive advantage on dosing schedule, durability of response, and on our impact on the immune axis. Meanwhile other biological mechanisms had not achieved the clinical success many were hoping for, and although the JAKs efficacy results were encouraging, long-term safety questions would need to be understood. And in 2020 we also got some favorable patent decisions in the US and UK.

So now there was no question this could be a successful drug. The question became, would a small company like Kymab turn KY1005 into a category killer? And could we keep up the pace to move forward much more aggressively? We were at a crossroads and the timing was right to work with Sanofi.

How important was the US Patent Trial and Appeal Board’s decision in all of this?

It was really our own data trailblazing the role of OX40L inhibition in atopic dermatitis that drove all of this. The patent issues were not at the core of it. I think this was a distraction that you don’t want to have as an operator and executive. It would have been a constant battle to get people to focus on what the Company is doing. If I was sitting on the other side of the table, this kind of issue is also an easy way for a partner to change their risk matrices in their models, because at the end of the day this is about getting to a number.

And just for context, David Chiswell (Executive Chairman, scientific advisor, and former CEO of Kymab) and I worked closely together during the early days of Cambridge Antibody’s corporate affairs and development during the early clinical translation of D2E7, which ultimately became Humira. At the time, the investment world was consistently telling us that “we don’t need another TNF-alpha inhibitor because we already had Enbrel and Remicade, they are effective and appear to be disease modifying”. And so we had some personal experience with how external dynamics can affect a young company. You have to follow the data and be confident in the collective work of your teams or you will get lost in the “noise”. Obviously, this is much easier said than done.

How did the deal process go?

We were fortunate to have many options available to us in parallel. We had a broad process that started north of 40 companies. About half of those guys went to the next room. And several of those went to letters of intent that we reviewed with our advisors and investors. Across those proposals we had a version of each path forward. We had a capital markets solution that would let us do a lot on our own, a partnership proposal that was more-or-less a traditional 50/50 collaboration, and a partnership proposal that would have seen us building a global clinical organization and us taking KY1005 all the way to Ph3 ready.

But you know how it goes. In the middle of this, we got a call late one night, and suddenly teams are working through the holidays to get a deal done with Sanofi. Sanofi had been watching the Company intimately for a long time, and their scientists and clinical teams had been huge advocates for our OX40L program. And when Paul Hudson, CEO of Sanofi, took over and started doing the deals like the acquisition of Synthorx, that opened a window for us in a very different way across our ICOS and other oncology programs. And now Sanofi offered a way for us to properly resource all our programs.

Why did you take the $1.1 billion? How did you get comfortable that was the right price? Why not $700 million or $3 billion?

Ha, through many painful hours of splitting hairs and ongoing market analysis conducted by our business development and finance teams internally before the process was even kicked off. There was no question our OX40L was targeting a very large market opportunity, and out of everybody Sanofi uniquely understood the size of the market given their commercial presence.

And look, some other partners may have been getting to larger cumulative payments in their respective models, but the structures were such that the real payments may never have happened.

And on the capital markets side, we had enough investor feedback to estimate how much money we could likely raise and at what terms.

How did you manage all this activity?

We had an incredibly strong and dedicated internal team along with a deep bench of experienced advisors as is required with these endeavors.  Personally, I thought we should either take it all the way on our own and raise enough money to do that or take an option that removes the risk and would not be dilutive to our existing shareholders.

As for me, I’m sitting inside the company as an external corporate development person, so I liaise with all my key stakeholders internally. And of course, looking across this incredibly productive platform, which is generating multiple leads for development candidate consideration, how can you ensure everyone gets the resources needed for each respective program and also align them with our strategic corporate development objectives and also balance with the resources actually available to you. We were still a young biotech, we didn’t have the evolved and established portfolio management and resource allocation expertise of more mature development companies.

There was a lot to manage. It was a lot like a chess game where we had keep thinking three steps ahead. Because every time we didn’t think ahead something would surprise us. It was not easy and I’m so proud of our team. Nigel only had 3.5 people in his business development team. It was only me and Anne Hyland (Kymab’s CFO) in the external facing finance function. And for a big chunk of this critical time, the CEO role was transitioning from David to Simon.

Why do a whole company sale? Why not a co-development collaboration on the atopic dermatitis program or a cancer partnership?

All these paths were considered at different times. We didn’t set out to sell the company.

This all really happened over the course of four years. When I joined Kymab, it was obvious to us that we had a great potential in our platform to generate antibodies to otherwise refractory targets and to achieve high biological function with those antibodies. Kymab had developed great tools to probe the immune system, identify antibodies, and create very focused and evolved biological libraries to design functional attributes of our antibodies in a way that had not historically been done for biologics.

We were working in infectious disease and had a collaboration with the Gates Foundation, we had a hematological focus with our BMP6 and matriptase programs (now licensed to RallyBio) and then of course we also had immunology and immuno-oncology. The breadth of our platform was so robust, that there was a real challenge as we began to grow into a clinical stage company. It’s not easy to develop relationships with PIs and have deep knowledge across all those areas.

And when we looked at the intellectual and financial capital needs to bring our two clinical programs and our growing preclinical pipeline through Ph2 proof-of-concept, it was going to require raising multiple hundreds of millions of dollars. So, in addition to a broad range of partnership pathways, we also aggressively and simultaneously explored several capital market solutions whether that was IPO in the US or locally in the UK, a mezzanine round, and even SPACs and reverse mergers. We believed it might be difficult to raise that amount of capital given our business strategy cut across so many therapeutic areas, but we were far enough along in these discussions to know the capital was available.

We were really at a crossroads. And like many companies, it started to become clear that our lead program was driving a lot of the perceived equity value. We could have put several strategic puzzle pieces together and come out with a mosaic.

With Sanofi we found a single partner with interest in immunology, oncology, hematology, infectious disease, and in antibody platforms. And through the acquisition by Sanofi, we found a business solution to help build and resource Kymab’s drugs and platform through one transaction as opposed to a less certain series of 4+ different transactions.

14
Jun
2022

Seattle Children’s Invests $45M in Minority Scientists Tackling Pediatric Disease

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14 Jun 2022

Many bright young people never get a chance to fulfill their potential as scientists because they never get on the usual scientific career on-ramps.

Many young people who get sick struggle because no one had the motivation or the wherewithal to develop new treatments or diagnostics.

Seattle Children’s Research Institute sees the problems, and has crafted a major initiative to tackle both at once. It’s through the Invent@SC Postdoctoral Scholars Program being announced today. It’s a program to recruit and support 50 postdoctoral researchers from underrepresented minority groups, helping them build on their scientific training to become scientific entrepreneurs and drug developers.

The 5-year, $45 million program includes a $12.5 million commitment from the Washington Research Foundation. Postdocs will get starting salaries of $65,000 a year – more than the NIH standard for living in Seattle – plus access to experienced industry mentors and technology resources. They’ll get training in inventorship, team science, and entrepreneurship that is seldom part of post-graduate education but which is essential to industry.

The program was designed with input from young minority scientists familiar with the challenges of those who come from disadvantaged backgrounds. To make it appealing to people who may not immediately gravitate to a predominantly white city like Seattle, it includes a community component with experienced lab, clinical, and industry mentors, many of whom are Black. The group’s connections also extend to the wider Seattle scientific community that includes labs at the University of Washington, Benaroya Research Institute and Fred Hutchinson Cancer Center.

Jim Olson, principal investigator, Seattle Children’s Research Institute; program director, Invent@SC

Jim Olson, a pediatric oncologist and founder of Seattle-based Presage Biosciences and Blaze Bioscience, is leading the Invent@SC program. He moved his lab from Fred Hutch to Seattle Children’s and gave up his clinical practice of 30 years to carve out more time for the initiative.

“This is a one-of-a-kind program,” Olson said. “It’s focused on pediatric therapeutics, with an emphasis on recruiting scientists from diverse backgrounds. We want to help educate the next-generation of biotech entrepreneurs.”

Most people that go to biotech companies were never trained to discover therapeutics, do milestone-driven research, or make the kind of go/no-go decisions required in industry, Olson said. He envisions Invent@SC developing a culture like that of a biotech company, with an emphasis on collaboration, and clear goals to develop new treatments for pediatric diseases.

Steve Graham, the co-chair of life sciences at Fenwick & West in Seattle, is retiring this month after a 40-year career. He’s one of the more prominent African Americans in biotech. He’s been winding down commitments.

But he said he couldn’t say no to an invitation to advise this new generation of young minority scientists.

“When I heard Jim describe this program, I said to myself that I have to do this,” Graham said. “This is something he really cares about fiercely. He’s passionate about it. It’s not a passing fancy. He’s truly aware of the issues, and his awareness extends to knowledge of what he’s not aware of. You sometimes run across people who are very, very smart, and that can sometimes translate into thinking they know everything. That tends not to be helpful in finding solutions.”

Steve Graham, co-chair, Fenwick & West Life Science Practice

Uciane Scarlett, a principal at MPM Capital in Boston, a cancer immunologist by training and a Black woman originally from Jamaica, is another of the mentors.

Scarlett said she agreed to help because Invent@SC meets a need for underrepresented scientists, it’s rigorous and milestone-driven like industry, and it’s focused on cell, gene and protein therapies that have a high chance of making an impact. (Disclosure: I’ve also agreed to serve as a mentor.)

“I am a true believer that the root cause of the limited diversity in life sciences is due to certain opportunity gaps for underrepresented groups,” Scarlett said. “Professor Olson is taking a holistic approach with the BIPOC program as he’s going above and beyond funding scholars to do research in childhood cancers — he’s also bridging a major component of the opportunity gap, and that’s access to relevant networks and mentors.”

Uciane Scarlett, principal, MPM Capital

The Seattle program isn’t the only one dedicated to launching scientific careers for members of underrepresented minority groups. The Howard Hughes Medical Institute (HHMI) last month announced the Freeman Hrabowski Scholars program. It’s starting with $1.5 billion of commitments over the next 20 years to propel the careers of 150 young scientists committed to improving diversity, equity and inclusion in science.

Moment of Inspiration

The original idea for the program goes back about six years, Olson said. That’s when one of the African American grad students in his lab, Eric Nealy, attended a seminar for HHMI Gilliam Fellows in the Washington DC area.

Nealy came back to the lab beaming.

“What’s going on? Did you find a new girlfriend or something?’” Olson recalled saying.

No, Nealy replied:

“I just spent a week surrounded by people who look like me who are smart and doing great biomedical research. It was the first time I felt like I belonged, like I wasn’t the only one.”

Alison Williams and Eric Nealy. Photo courtesy of Seattle Children’s.

That got Olson thinking. Could he create a more inclusive community, starting small in his own lab? He had conversations over the years with many scientists from minority groups – including Nealy, who’s now a postdoc, and Alison Williams, a research scientist in the Olson lab. Their input, along with others, helped shape the program.

Creating an inclusive and supportive community in this case means more than recruiting a couple of Black scientists. It means casting a wider net to attract scientists from indigenous groups, or others from underrepresented backgrounds. It could include people who grew up in foster care, were homeless, identify as LGBTQIA, or are the part of the first generation in their family to go to college.

The goal will be to recruit an average of 10 postdocs per year for five years. The program is seeking applications this month, and will accept them on a rolling basis, Olson said.

Applicants will be evaluated not just on the traditional accomplishments valued in academia. Some of those accomplishments get accumulated after doors are opened for people who have multi-generational connections to science, Olson said. The Invent@SC program, aware of traditional structural disadvantages for young people who don’t have those advantages, will seek candidates based more on potential, motivation, curiosity, creativity and commitment to gaining new knowledge, Olson said.

Once candidates are selected, the next crucial step will be in fostering the sense of support and belonging. The program is holding a launch event tomorrow in Seattle as a first step. It’s establishing a social fabric that’s hard to measure, but undeniably important in advancing scientific careers where failure is so common.

“Too often, you find people of color, or women, who find themselves in positions where they could thrive but they don’t thrive because there’s no one there to understand their position,” Graham said. “As a result, they don’t get the right kind of moral support.”

Seattle Children’s, like other institutions in the Seattle scientific community, has an entrepreneurial track record. Its faculty have contributed to Juno Therapeutics, Be Biopharma, and Umoja Biopharma, among other recent startups. It has valuable resources for scientific entrepreneurs, including an 11,000-square-foot GMP facility for making novel cell therapies, and a 4,700-square-foot VectorWorks GMP facility for manufacturing product candidates for early phase clinical trials.

Olson emphasized the combination of the resources of Seattle Children’s, and the people who are curious and hungry to make good use of them. The tools of cell therapy, gene therapy and advanced biologic capabilities at Seattle Children’s are unique among its peer institutions, he said. Those tools can be brought to bear on research into pediatric autoimmunity, mental health and infectious diseases.

Olson, 59, said underrepresented minorities have made major contributions in his lab over the years. That includes the “tumor paint” work that led to the founding of Seattle-based Blaze Bioscience.

The Invent@SC program is an attempt to build on that type of success, and to do it in a more intentional and intensely focused way.

“When I see people coming into my lab with unrealized potential and all of a sudden they discover tumor paint and start a company, or help come up with technology for Presage, they sometimes look back and can’t believe what they accomplished,” Olson said. “I saw something special in these people. Sometimes it was a chip on the shoulder. Resilience. Or natural curiosity. All I did was create an environment where they could flourish. I get so much joy out of that.”

7
Jun
2022

Rethinking Biotech Manufacturing: Rahul Singhvi on The Long Run

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07 Jun 2022

Today’s guest on The Long Run is Rahul Singhvi.

Rahul is the co-founder and CEO of Resilience.

The company made a splash in the fall of 2020, when it debuted with an $800 million Series A financing. Bob Nelsen of ARCH Venture Partners led the deal. The company has now raised a couple more rounds that add up to more than $2 billion.

Rahul Singhvi, co-founder and CEO, Resilience

Nelsen, a previous guest on The Long Run, saw what many others saw – a global supply chain for manufacturing that was suddenly vulnerable to disruptions from a pandemic, and, more recently, from war. He and other investors came together to found Resilience as a domestic manufacturing response to this vulnerability. They sought to build more capacity in the US and Canada for advanced biologics, and gene and cell therapies, with a network of high-tech facilities.

Rahul came to this moment with a wealth of pertinent experience. He had spent 25 years of his career working on vaccine manufacturing.

He’s been busy the past two years at this startup, acquiring existing biotech manufacturing facilities and re-tooling them. He and his team have been forming partnerships with large and small companies that need to manufacture advanced products, and could use help with sharpening their processes and technology for manufacturing at scale.

The vision of what Resilience is doing has become more clear, at least to an outside observer like me. I’ve written a fair bit about the opportunity for more domestic biotech manufacturing, for national security reasons, for national high-tech competitiveness, for regional economic development, for creating high-quality manufacturing jobs, and for creating stable businesses.

Rahul also points to a technology industry analogy, in which more specialized, sophisticated partners work together in an ecosystem, rather than each individual company trying to own every piece of the value chain. It’s an example of horizontal scaling that has worked in tech, and could now work for biotech.

Now before we get started, a word from the sponsor of The Long Run.

Calgary is home to more than 120 life sciences companies, from emerging startups to established firms. With this critical mass of research, technical talent and expertise, the city is an active hub for life sciences innovation.

Technologies homegrown in Calgary are changing the face of healthcare. Syantra is revolutionizing breast cancer detection using artificial intelligence-derived algorithms. NanoTess is harnessing the power of nanotechnology to tackle chronic wounds and skin conditions. And this is only the beginning. Calgary’s life sciences sector is projected to spend $428 million on digital transformation by 2024.

If you’re a bright mind or bright company solving global health challenges, Calgary is the place for you. 

Take a closer look at why at calgarylifesciences.com

 

Now, please join me and Rahul Singhvi on The Long Run.

2
Jun
2022

Out in the Community in 2022

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02 Jun 2022

Luke Timmerman, founder & editor, Timmerman Report

TR subscribers: I’m traveling more, and looking forward to seeing more of you in person.

I’ll be at the BIO Convention in San Diego, June 13-15. They have plenty of outdoor patio space overlooking the ocean at the San Diego Convention Center. Let’s chat.

While at BIO meeting people and gathering ideas, I’m also moderating a panel on improving diversity, equity and inclusion.

Time: 1:45-2:45 pm

Date: June 15

Place: Upper Level, Session Room 5A, San Diego Convention Center

Panelists:           

  • Michelle McMurry-Heath, president and CEO, BIO
  • Paul Hastings, CEO, Nkarta Therapeutics, chairman of BIO
  • Rob Perez, operating partner, General Atlantic, founder of Life Science Cares
  • Nancy Hong, managing director, RiverVest Venture Partners
  • Luke Timmerman, founder, Timmerman Report (moderator)

Emerging Frontiers in Oncology: I’ll be in Cambridge, Mass. June 30 to moderate at the Emerging Frontiers in Oncology meeting. It’s a half-day forum at the MassBio event center at Technology Square, followed by a networking reception at Catalyst.

Speakers include:

  • Keith Flaherty of MGH, co-founder of Loxo Oncology
  • Judy Lieberman of Boston Children’s Hospital
  • Doug Williams of Codiak Biosciences
  • Marian Nakada of J&J Innovation
  • Rosanna Kapeller of Rome Therapeutics

The event is organized by Uciane Scarlett of MPM Capital, as a fundraiser for the Timmerman Traverse for Life Science Cares. For tickets, ask Uciane (pronounced YOU-shuh-nee) uscarlett@mpmcapital.com.

Timmerman Traverse for Life Science Cares: My team of 20 biotech executives and investors is gearing up for a 20-mile hike of the Presidential Traverse in the White Mountains of New Hampshire Sept. 11-14. The team goal is on pace to hit the goal of $800,000 to fight poverty in Boston, San Francisco, San Diego and Philadelphia. SVB, SmartLabs and Goodwin are among the top sponsors.

Highlights of the Timmerman Traverse, 2021

This is a phenomenal way to give back to the wider communities where biotech operates, and there will be opportunities to mix and mingle with the stellar members of this team. To see who’s hiking and support someone you know, click here. For sponsorship opportunities, see Emily Stanford at LSC emily@lifesciencecares.org.

Kilimanjaro 2023. One way I seek to build community in biotech is by creating diverse and tight-knit teams for my philanthropic expeditions.

I’m now recruiting a team of 27 people to join me on the next Kilimanjaro Climb to Fight Cancer. It’s scheduled for Feb. 9-20, 2023. The goal is to raise $1.5 million for cancer research. Please let me know if you, or someone you know, might be a good candidate for this group expedition to the highest peak in Africa. I’m seeking biotech entrepreneurs and investors who have a thirst for adventure, are physically fit, and willing to raise a minimum of $50,000 for cancer research.

To request an invitation: luke@timmermanreport.com.

24
May
2022

Seeking Wellness Through More Data, Less Technology, and Better Habits

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24 May 2022

David Shaywitz

It only took a pandemic, but well-being has at last emphatically arrived in the corporate world.

Before the pandemic, wellness was often viewed as just another item on the HR benefit menu. Some companies offered limited reimbursement for fitness classes, or subsidized access to select health and wellness apps.

But in the turbulent wake of COVID-19, well-being is increasingly viewed as worthy of C-suite attention, and recognized as critical to company success.

As we collectively navigate our way towards improved well-being, we might consider two recent books that address the topic through two very different lenses.

Big Data Meets Well-Being

Several years ago, Seth Stephens-Davidowitz, a data scientist and New York Times columnist, wrote about what data science had to say about human behavior. His book, Everybody Lies, was a revealing and engaging read, as I discussed here.

Seth Stephens-Davidowitz, data scientist, author, and New York Times columnist.

Stephens-Davidowitz has now returned with Don’t Trust Your Gut, a delightful, quirky romp through the data science literature on self-improvement. 

Why self-improvement? Predictably, because Stephens-Davidowitz followed the data. He analyzed the reaction to his last book and noticed that readers told him they were most interested in the use of analytics to help others, particularly those less fortunate. 

Yet when he looked at the actual data (the passages underlined most in the Kindle version), he discovered readers were, in fact, most interested in themselves, and he aims to oblige. (This distinction between stated and revealed preference is a key theme of his last book, and a frequent topic of this column – eg here — since the ability to discern the difference is often critical to entrepreneurial success.)

Stephens-Davidowitz starts by demonstrating how data science can be used to study human relationships by mining dating sites, which turn out to contain a treasure trove of information. Some of the insights prove modestly surprising: for example, among those individuals seeking heterosexual relationships, tall men were especially prized, but tall women were not. 

At the same time, Stephens-Davidowitz writes, data scientists – despite extensive effort — have been utterly unable to predict whether two people will actually be happy in a relationship. The top lesson drawn by a researcher who exhaustively examined a dataset of 11,196 couples? “How unpredictable relationships seem to be.”

Ever the sabremetrician, Stephens-Davidowitz points out what he sees as the grand arbitrage opportunity here: since “good romantic partners are difficult to predict with data” but “desired romantic partners are easy to predict with data,” the winning move, he suggests, he to pursue the “Youkilis of love” (Kevin Youkilis was a famously undervalued baseball player because he didn’t look the part). He advises daters to “focus more of their attention on targets who the rest of the data market ignores, even though they are just as likely to be great romantic partners.”

Having shown us the approach, Stephens-Davidowitz applies this data-driven methodology to a range of subjects, from the impact of parenting (which may matter less than we think) to the role of genetics in sports success (genes are evidently far more determinative in basketball and track-and-field than in skiing and weightlifting) to activities that make us happier than we think (going to museums, exercising, gardening) to the importance for artists to aggressively maximize their opportunity to be discovered, rather than venturing forth timidly and in effect “pre-rejecting” themselves.   

Perhaps my favorite section focused on entrepreneurship, and the lessons learned from researchers analyzing massive datasets. For instance, a team analyzing every business created in the United States between 2007 and 2014 found that of the 2.7 million entrepreneurs represented, the average age of founders is about 42. They also learned that older people “succeed at creating highly profitable businesses more often than their younger peers” — a trend that continues “at least until the age of sixty.” In other words, the young tech geniuses the media often focus on are not representative – even in technology, where the average age of a founder of a highly profitable company was 42.3 years old.

Similarly, while we’re often told that industry outsiders have the independence to develop the most profitable startups, Stephens-Davidowitz cites research demonstrating that in reality,

“There is an enormous ‘Insider’s Advantage’ in entrepreneurship. Entrepreneurs are roughly twice as likely to build an extremely successful company if they previously worked in the field in which they started the company. The advantage gets larger the more directly the previous experience is related to the business.”

(Readers will note parallels between some of the findings Stephen-Davidowitz reports and those uncovered by VC and author Ali Tamaseb in Super Founders, as I’ve discussed.)

While not the definitive account of any of the topics it touches on, Don’t Trust Your Gut demonstrates the unreasonable power of empirical evaluation of extremely large datasets, including in the context of wellness, and reminds us of the many ways we can be deceived by selective sampling.  

Put Down Your Phone

Johann Hari is a journalist and writer who, like many of us, was struck by the outsized role technology – social media in particular – plays in our lives. In Stolen Focus, he explores the origins and dangers of this contemporary menace.

Hari starts with an anecdote – familiar to most parents – of watching his teenage godson Adam become increasing absorbed into the social media on his smartphone, to the point where he seemed to enter an almost dissociated state of scrolling and staring blankly at the screen. Eager to engage Adam in a real world experience – and because Adam had once been captivated by all things Elvis – Hari took his godson to Graceland, having secured from Adam, in advance, the promise of abstaining from technology once they got there.

Johann Hari, author, “Stolen Focus.”

Yet, the moment they arrive at Graceland, Hari and Adam are each handed….an iPad and headphones, for a self-guided tour of the mansion. 

But the most striking part, as Hari describes it, was when they arrived outside the famous “jungle room” (supposedly Elvis’s favorite place in the compound), Hari notices the middle-aged couple in front of him captivated by the ability to switch between images of the left and right side of the jungle room simply by flicking their fingers from side to side on the iPad. 

Flabbergasted, Hari points out to the couple that they can achieve the same effect by looking up from their iPads and looking at the actual room in front of them. We’ve become so entranced by our technology, he realizes, that we instinctively are drawn to the image of the jungle room even when the room itself exists before us.

Hari explains how we’ve become so addicted to our screens: the business model for tech companies like Google and Facebook means that their revenue is maximized by increasing our time and engagement on their platforms. Consequently, he says, the smartest engineers in the world leverage the most powerful AI and savviest user experience expertise to escalate our addiction. 

Hari also discusses why the constant beckoning of our smartphone apps is so destructive: it steals our ability to deeply and consistently focus. (Here, he echoes themes from Cal Newport’s Deep Work, which inspired me to quit Twitter in 2019.) It’s not that responding to a notification itself is so time consuming, but rather that it takes a shockingly long time – more than 20 minutes, he reports – to regain focus afterwards.  We tend to be closer to our best selves when we can deeply focus, and when we can’t, everything is worse. We may pride ourselves on our ability to multitask, he says, but in splitting our attention, we’re sabotaging ourselves, our work, and our happiness.

Hari writes that workplaces interested in worker well-being might do well to rely less on advocating wellness practices like meditation (which Hari says he personally enjoys and values), and more on creating intrinsically better environments for workers.  Essentially, he argues that instead of putting a band aid on the problem, companies should seek to provide greater opportunity to focus at work (i.e. fewer gratuitous distractions) and to relax at home (i.e. protected time and “right to disconnect” – now a legal protection in France).

While the book seemed to lose its way and go off the rails about halfway through (I couldn’t make it through to the end), the idea that we’re physically addicted – by design – to our apps is a crucial point worth amplifying.

Observations

When I thought about how I was interacting with my phone, and the number of times I reflexively checked it, I resolved to try to establish some new habits. 

For one, I re-quit Twitter (I had started up again in the context of Omicron) – with immediate satisfaction and minimal regret (sorry, Elon). I also now stow my phone when I drive, so I’m not even tempted to interact with it. This took a little adjusting, but I really appreciate this new habit as well.

I like the idea of seeing wellness through the lens of discrete, modifiable habits, as Hari alludes to and a number of authors have suggested; this seems like a pragmatic way of productively changing behavior.   The same science that has informed the development of smartphone apps that steal our focus and detract from our happiness can also be used to instantiate healthy habits.

In fact, it’s exactly the same science: many engineers designing today’s technology trained in B.J. Fogg’s legendary “persuasive technology lab” at Stanford (now known as the “behavioral design lab”). Fogg is also the author of the Tiny Habits, aimed at helping us use small changes to drive meaningful behavior change. (Good Habits Bad Habits, by USC professor Wendy Wood, is also highly recommended.)

Of course, not all apps are harmful, and some can even be a force for good. For example, I’ve been pleasantly surprised by impact of a corporate wellness initiative that simply involves signing up for an app that collects your daily steps from whatever device you select. You sign up in teams of four, and strive to average 7500 steps/day. Participants are encouraged to share photos of their walks with other participants through the app. 

Silly as it sounds, I’ve really appreciated this experience – it’s been lovely seeing where my colleagues are walking, and I find I’m getting out much more than I used to; I’m especially likely now to use short blocks of downtime as an opportunity to get in some additional steps.

Finally, I wanted to highlight a particularly positive recent experience I had attending an external two-day retreat with an exceptional group of biomedical leaders, innovators, entrepreneurs, and investors. The opportunity to engage with other colleagues in a relaxed setting — on hikes and over meals, in person and without masks — was extraordinary. 

The experience reminded me how much we’ve missed this human connection over the last two years.  It also emphasized how elevating and essential physical exercise and human connection are – not just for our health, but also for our happiness.

23
May
2022

Building a New Type of Drug Discovery Engine: Chris Gibson on The Long Run

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23 May 2022

Today’s guest on The Long Run is Chris Gibson.

Chris the co-founder and CEO of Salt Lake City-based Recursion.

Chris Gibson, co-founder and CEO, Recursion

The company was founded in 2013 when Chris was working in the lab of Dean Li at the University of Utah.

The idea at Recursion is to do what it calls “industrialized drug discovery.” It combines some of the common tools of drug discovery – CRISPR, synthetic biology, automated lab tools, high-powered computing, and Artificial Intelligence / Machine Learning to hopefully churn out more drug candidates faster, and with a higher probability of success. The company has a long history of phenotypic screening, and leans on that expertise, combined with the new tools, to create maps of biology that are supposed to help scientists predict how any two tested genes or molecules might interact with each other.

Recursion raised $436 million in an IPO in April 2021, which looks pretty well-timed based on the state of the biotech stock market today. It has a couple of partnerships – with Bayer and with Roche / Genentech. The Bayer deal is focused on treatments for fibrotic diseases, while the Roche / Genentech deal includes oncology and neuroscience indications.

Chris is a next-generation founder and industry leader who isn’t afraid to buck convention, and has a lot of interesting things to say about technology, about company building, and about creating a thriving ecosystem outside of the main industry hubs.

Now before we get started, a word from the sponsors of The Long Run.

 

Calgary is home to more than 120 life sciences companies, from emerging startups to established firms. With this critical mass of research, technical talent and expertise, the city is an active hub for life sciences innovation.

Technologies homegrown in Calgary are changing the face of healthcare. Syantra is revolutionizing breast cancer detection using artificial intelligence-derived algorithms. NanoTess is harnessing the power of nanotechnology to tackle chronic wounds and skin conditions. And this is only the beginning. Calgary’s life sciences sector is projected to spend $428 million on digital transformation by 2024.

If you’re a bright mind or bright company solving global health challenges, Calgary is the place for you. 

Take a closer look at why at calgarylifesciences.com

 

Alpenglow Biosciences sheds new light on pharmaceuticals with AI-powered, 3D spatial biology. Pathology is an essential component of drug development, yet it is stuck in archaic times by looking through 2D slides. Alpenglow has developed an end-to-end drug development solution with proprietary 3D imaging, cloud processing, and AI analysis to digitize entire 3D tissues, providing 250 times more data and deeper insights. Learn how Alpenglow can illuminate your path to breakthrough results at alpenglowbiosciences.com.

Now, please join me and Chris Gibson on The Long Run.

23
May
2022

Sachi Bioworks: Out of the University, Into Outer Space

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23 May 2022

Lisa Suennen

When they started their first venture together, Dr. Anushree Chatterjee and Dr. Prashant Nagpal were both leading research labs at the University of Colorado, Boulder. Prashant’s lab focused on nanotechnology and molecular biology: Anushree’s focused on building antibiotics for drug-resistant bacteria. 

That startup, Praan Biosciences, was founded in 2014 to develop improved genetic sequencing technology. Anushree and Prashant had one foot in the company and another on campus. By day they were academics in two separate labs, by night they were laboring to create a prototype gene sequencing instrument.

By 2015, it became evident to the founders that Praan was not going to be a success; they determined that there was no way to bring their vision to life with one foot in the academic lab and the other in a startup. 

“To fulfill the vision, we realized, we had to live the experience,” said Anushree.

Anushree Chatterjee, co-founder, chair & CEO, Sachi Bioworks

The shift in their thinking had begun.

Life in their respective research labs resumed. Time passed, but Prashant and Anushree, a married couple, realized how much they wanted to make an impact beyond academia.  They continued to learn and publish and get interviewed on their papers, but every time that happened, they would get letters from patients begging to try the drug upon which their research was focused. It became clear to these two individuals, long committed to scientific research, that there was no point, at least to them, in making a new medicine if it couldn’t translate into impact for patients.

New Startup, New Approach

They decided to make a change when Anushree took their one-year-old child to the doctor for an infection. The pediatrician wrote a prescription for an antibiotic.

“Let’s hope this works. If it doesn’t, we’ll try another,” the doctor said. 

Anushree wasn’t one to settle for this trial-and-error prescribing approach. She had spent her career working on drug development. Her thinking crystallized. “There are too many unknowns, even about approved drugs. There is a technology gap and we have to fill it,” she explained.

The pandemic drove the couple’s thought into action. As they sat at the dinner table, they realized what they had to do, “we need to change ourselves to change medicine.”

Prashant Nagpal, co-founder, COO, CTO; Sachi Bioworks

The two took a sabbatical from University of Colorado and shifted their attention to a new idea that could potentially drive faster identification of COVID-19 treatments, as a starting point.  

Prashant never went back to the academic lab. He decided to become a full-time entrepreneur. While Anushree has maintained her research position, she is an active thought partner with Prashant in how to move their new company, Sachi Bioworks (“Sachi”), into the emerging field of Space Medicine. The two say they have been far more productive in this arrangement.

Sachi, a word which means “miracle” in Japanese, is focused on creating a paradigm shift for the field of drug discovery. Their product has gone from concept to full manufacturing line in two years’ time. It’s a reflection of the change of clock speed required in industry as compared to academia.

In those two years, Sachi’s founders developed a system for making what they call Nanoligomers.  For those of us who are not chemical engineers, Nanoligomers are polymer molecules made up of a group of monomers (naturally!), which are themselves molecules that can be bonded to other identical molecules. 

By creating these Nanoligomers, Sachi aims to transform drug discovery with accelerated synthesis, validation, and production of specific nucleic acid therapies. They are using a robotic system to make candidate molecules per day that should be able to upregulate or downregulate any gene of interest, with high specificity.

The company already has four drug candidates in preclinical development for Parkinson’s, inflammatory bowel disease, an undisclosed neuroimmune disease, and one candidate designed to counteract radiation exposure. 

An Unusual Backer

The company has found an unusual backer in the drug discovery world — NASA. 

The company is advancing its work on radiation countermeasures under a NASA-funded SBIR grant. Astronauts in deep space are exposed in one day to the same amount of radiation that people on earth experience in one year. As early NASA-funded Translational Research Institute for Space Health (TRISH) experiments on SpaceX astronauts have shown, the impact of space travel has dramatically different impacts on each astronaut based on their genetic make-up, among other things.

Earth-bound medicine, Anushree noted, helps 50% or fewer of the people who are prescribed a particular drug. In deep space, there are a handful of astronauts on board. Each has their own genetic profile. They cannot stop at a local CVS. Ideally, they would have access to medicines that work for each person onboard.  

Space medicine, Anushree realized, was a perfect testing ground. The Sachi system could allow for the creation of thousands of drug candidates in real time. Existing pharmaceuticals rapidly degenerate in space, but Sachi thinks it can overcome that problem by enabling the astronauts to formulate their own personalized treatments onboard the spacecraft. 

Since the speed to a viable target is, at least in Sachi’s view, reducible to days instead of years, it is theoretically possible to send their miniaturized system into space to allow astronauts to rapidly design and deliver truly targeted, safe drugs on-the-fly (literally). 

In its first NASA space medicine project, the Sachi system was able to identify 17 target genes in 6 weeks and show an ability to turn proteins on and off as desired. They were able to do this in mice without needing a lipid to bind and deliver the treatment and without creating toxic concentrations of drug in the liver or other key organs. 

The goal is to be able to target any gene in any patient — on earth or in space — and create drugs for an audience of one (or more than one) at an order of magnitude lower cost and with less complexity.

The industry, and regulatory agencies, will need to make some significant changes to realize the value of what Sachi is doing. That includes regulatory pathway for new kinds of drug development; the business models if drug development costs plummet; and the methods of drug manufacturing, particularly if you can manufacture up to 1,600 drugs at the same time without a dedicated line and with no retooling. 

Changing Mindsets

The biggest risk Anushree sees? That many of the today’s players won’t be able to shift gears fast enough to keep up.

“The traditional drug development process focuses on risk reduction. Our approach switches the focus to impact maximization. With the ability to engage in rapid cycles of discovery, testing, learning and building, scientists no longer have to be afraid of the cost of failing,” says Anushree. “Creating a valuable drug for $10 billion is nice, but I’d rather deliver 100% biological impact at low cost and fast.”

Prashant noted that the move from academic to translational medicine required a dramatic change in thinking. 

“In the lab, people work in a very linear way based on how the money is targeted; in a company, you’re in the middle of the ocean and need to chart a path out without a map,” he said. In industry, he can’t just work on the science while neglecting other functions such as business operations, human resources, finance.

Perhaps most important, at least to Sachi’s co-founders, you can no longer measure your success by publications – you can only meaningfully measure success by getting to market and having an impact on patients. 

Anushree adds that having two small children has helped both founders switch mindset. The non-linear nature of parenting has helped them both use the pressure of managing career and family to become more flexible, less resistant to change, more open to new ways of getting things done. This has borne fruit for family and for their passion project, which is now garnering attention throughout industry.

Sachi has funded its work primarily through SBIR grants and other non-dilutive forms of funding. Even without big-name VC fund checks and the industry connections that come with them, Sachi says it will have its first drug ready for human testing in 2023, just three years after inception.

If it can achieve that goal, and continue to build a platform for fast, custom-manufactured precision genetic medicines, it would indeed represent a significant shift in drug discovery.

19
May
2022

A Path Forward for More Biotech Workers

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19 May 2022

Luke Timmerman, founder & editor, Timmerman Report

Biotech needs more workers. More people who don’t have PhDs and MDs.

The industry is 40 years old, and maturing. More companies are developing commercial products. Someone needs to make these products with precision, and at scale.

Given the sophisticated nature of the products (cell therapy, gene therapy, advanced biologics, RNA medicines), the fragile global supply chains, and the importance of steady supplies for patients, there’s a case to be made for manufacturing close to home. (See “Biotech’s Future off the Beaten Path, Feb. 2022.”)

Many companies see where this is going. One estimate by MassBio shows that 20 million square feet of lab and manufacturing space is coming online in Massachusetts by 2024. These facilities alone will create 40,000 net new jobs. That’s a lot of jobs for manufacturing technicians, lab managers, clinical trial associates, quality control, facilities managers and many other jobs that don’t require a PhD. There are currently about 85,000 biotech jobs in Massachusetts.

Who will do this all this extra work? Where will these people get the necessary skills and experience?

The good news: There are people who are willing and able to do this work, if companies are willing to put some skin in the game and invest in training.

Last week, I learned about a fascinating apprenticeship program run by MassBioEd, a branch of the local trade association. The early results are impressive. More on that in a minute.

The program was designed by Karla Talanian at MassBioEd, and based on models from Apprenti, a tech industry workforce development group.

Karla Talanian, senior director of life sciences apprenticeship program, MassBioEd

Here’s how the biotech program works.

People apply for a 4-month training program in biomanufacturing, or a 3-month training program to become a clinical trial associate. Students learn some fundamentals of industry.

For biomanufacturing, Northeastern University is the academic partner. Faculty teach 2 months online, and follow that up with 2 months of hands-on work at a Northeastern lab in Burlington, Mass. The clinical research track is taught online by faculty from the Association of Clinical Research Professionals — people who know how clinical trials work.

Tuition is free. When the apprentices complete their training, they are paired up with an employer for 1 year of work. Employers get to choose from a handful of graduates in an interview process. The biomanufacturing technicians start at $21 an hour, while clinical trial associates start at $27 an hour. There’s an opportunity for a raise at the halfway point.

The apprentices have a boss, but they are also matched with a workplace mentor – a seasoned employee who can answer questions. Once a month, the apprentices can meet with their peers and other program participants. At the end, there’s no obligation. The employer can hire the employee for a full-time permanent position, or let the employee walk away for a job elsewhere. But once a person has been trained at a company, if the person is doing well, there’s a natural incentive to want to retain the person.

The initial cohort of 30 people – 19 in biomanufacturing and 11 CTAs – have completed their training and are now embedded in the workforce.

Who are they? In their previous lives, they were restaurant workers, retail cashiers, Uber and Lyft drivers. One was a math teacher. MassBioEd does targeted outreach to immigrant support groups, adult education centers, veterans groups to find candidates.

The first group of apprentices had an average age of 33.

It’s a diverse group, in many ways.

  • 60 percent people of color
  • 63 percent female
  • 26 percent immigrants
  • 47 percent were unemployed

The one thing they all had in common? “None of them would have had a prayer of getting a job in the industry without this program,” MassBioEd’s Talanian said.

The program has been life-changing. Some of the program graduates had attended college for a while, but didn’t finish for whatever reason – couldn’t afford it, got pregnant, had to take care of an ailing family member. They’ve tried to get by, but struggle in low-wage/low-benefit/no future jobs. The idea of going to work in biotechnology is thrilling. It’s an industry with good salaries, good benefits, upward mobility, interesting colleagues, and making products that help people. It changes their outlook on life.

“Many of them didn’t think they’d ever have an opportunity to pursue their dreams,” Talanian said. “They are so grateful and excited to have this opportunity. They dive in.”

One professor from Northeastern University, with 20 years of experience, was blown away. The professor told Talanian that out of the 19 students in the initial biomanufacturing group, about 14-15 were among the most motivated, dedicated students he’s ever taught.

The employers are impressed. All five of the employers that signed up for the pilot project have renewed their commitment for Year 2, agreeing to take on more apprentices, Talanian said. The group includes Pfizer, Bristol Myers Squibb, Alnylam Pharmaceuticals, MassBiologics, and Arranta Bio.

“If all five came back, it must be working well,” Talanian said.

Al Boyle, chief technical ops and quality officer, Alnylam Pharmaceuticals

Alnylam participated in the original cohort because it was good for the community, but it was also good for the company as it scales up manufacturing in Norton, Mass.

“The level of energy and commitment to making this opportunity at a new career successful stood out the most for us,” said Al Boyle, chief technical ops and quality officer for Alnylam. “We knew the talent pool would be diverse, but I think the level of diversity was even larger than we thought we’d see.”

Word has gotten around the biotech community. After a couple of years working hard to persuade companies to commit to the program, Talanian now finds herself with the opposite problem. She has to shoo away some interested companies because she’s maxed out capacity for Year 2. The program is expanding from 30 spots for 5 companies to 100 spots for 11 companies. (Participants listed below).

Manufacturing and clinical trial associates are obvious places to start, but there are biotech functions that could benefit from filling up the entry level pipeline.

Talanian is hearing from companies that want apprentices who can get into lab operations support. These are jobs for people who order supplies, deal with environmental health and safety regs, cleaning, lab certifications, repairs. “We want to let the scientists do science, and take all that other stuff and professionalize it. Make it a respectable position to go into,” Talanian said.

Laurie Halloran, president and CEO, Halloran Consulting Group

Laurie Halloran, the CEO of Halloran Consulting Group, is a member of the MassBioEd board who has acted like a “godmother” to the program. Halloran told me she sees potential for similar apprenticeship programs for regulatory affairs – another area where it’s hard to hire.

“We can’t keep stealing each other’s people. We need to grow more people,” Halloran said.

There are still companies that are cautious, taking a wait-and-see approach, she said. “They don’t want to be the guinea pigs.”

This is a program that’s graduating from the experimental phase. It looks more like a train that’s leaving the station.

If the industry is serious about meeting its workforce needs, and about diversity/equity/inclusion, then it will consider programs like this one. The employees are motivated, curious, and likely to be loyal to the company that gave them their first shot.

There’s a lot of talent in this country, waiting to be tapped. Biotech could be a beacon for a new generation of young people starting their careers.

If the industry is willing to take a few chances, it could reach new heights.

Science Policy

  • The Answer to Stopping the Coronavirus May Be Up Your Nose. NYT. May 16. (Akiko Iwasaki, Yale University)
  • What COVID Hospitalization Numbers Are Missing. The Atlantic. May 18. (Ed Yong)
  • How Public Health Failed America. The Atlantic. May 15. (Jay Varma)
  • The COVID Capitulation. Substack. May 15. (Eric Topol)

Science

  • Unexplained post-acute infection syndromes. Nature Medicine. May 18. (Jan Choutka et al University of Chemistry and Technology, Prague, Czech Republic)
  • CRISPR’d CAR-T Cells in the Clinic. In the Pipeline. May 18. (Derek Lowe)

Strategy

  • Reflections on Alnylam. Nature Biotechnology. May 9. (John Maraganore)
  • Out On The (Cutting) Edge: How The Tools Of Extreme Survival Can Help Build A Biotech Company. LifeSciVC. May 18. (Aoife Brennan)
  • A new biotech investment firm, headed by Alexis Borisy and Zach Weinberg, to ‘free the founders’. STAT. May 11. (Alison De Angelis)
  • Healthcare hedge funds are in critical condition. Institutional Investor. May 11. (Stephen Taub)

Our Dysfunctional Healthcare System

  • Seven health insurance CEOs raked in a record $283 million in compensation last year, while profits grew and patients delayed getting treatment during the pandemic. STAT. May 12. (Bob Herman)

Financings

Cambridge, Mass.-based Remix Therapeutics, a company making small molecules aimed at RNA processing targets, raised $70 million in a Series B financing. (TR coverage)

The US government’s Biomedical Advanced Research & Development Authority (BARDA) and UK-based Wellcome committed another $370 million to CARB-X – a program at Boston University to fight antibiotic-resistant bacteria. The program was started with $355 million in 2016.

HealthQuest Capital raised $675 million for a growth equity fund. Garheng Kong founded the firm in 2013, and it now has $1.6 billion under management. The firm said it plans to use the new fund to back “commercial-stage companies that improve patient outcomes, or reduce cost and inefficiency in the healthcare system.”

Apollo and Sofinnova Partners announced a strategic partnership, in which Apollo is acquiring a minority stake in the European-based life science venture firm. Apollo is also committing up to 1 billion Euros to facilitate the venture firm’s growth.

Philadelphia-based SwanBio Therapeutics raised a $56 million Series B financing to develop gene therapy for neurological conditions. Syncona Limited and Mass General Brigham Ventures led. The lead program is an AAV gene therapy in clinical development for adrenomyeloneuropathy.

Research Triangle Park, NC-based Locus Biosciences said it raised $35 million to advance bacteriophage therapies for bacterial diseases.

Redwood City, Calif. and Research Triangle Park-based Kriya Therapeutics, a gene therapy company, raised $270 million in a Series C financing. Patient Square Capital led. Kriya plans to use the money to expand its pipeline, and scale up its engineering, manufacturing, and computational platforms.

Curie Bio, a new VC firm headed by Alexis Borisy and Zach Weinberg, has raised $250 million from a syndicate that includes GV, Casdin Capital and A16Z, according to STAT. The firm plans to “free the founders” as Borisy put it, allowing founders to hold onto a greater equity stake in startups than usual.

San Diego-based Aspen Neuroscience raised $147.5 million in a Series B financing. GV, LYFE Capital and Revelation Partners co-led. The company is developing an induced pluriopotent stem cell-derived autologous dopamine neuron replacement therapy for Parkinson’s Disease.

Morrisville, NC-based Inceptor Bio raised $37 million in a Series A financing to develop CAR-T, CAR-M, and CAR-NK therapies for cancer. Kineticos Ventures led.

Deals

Pfizer agreed to pay $11.6 billion to acquire Biohaven Pharmaceuticals, which had developed and begun to successfully commercialize an anti-migraine drug.

Cambridge, Mass.-based Be Biopharma, the developer of engineered B-cell therapies, announced a partnership with Resilience. Be Bio plans to lean on Resilience to manufacture viral vectors and cell therapies with personnel dedicated to its projects. Terms weren’t disclosed, but the companies described the arrangement as “a creative cost and risk-sharing model,” in which “Resilience will be responsible for manufacturing costs and receive potential future milestones and royalties.”

Cambridge, Mass.-based Myeloid Therapeutics formed a partnership with Acuitas to provide lipid nanoparticles for delivering the company’s in vivo mRNA programming therapies for cancer.

London-based RQ Bio came out of stealth mode, announcing it has outlicensed monoclonal antibodies to SARS-CoV-2 to AstraZeneca.

Menlo Park, Calif.-based GRAIL expanded its partnership with Intermountain Healthcare, the largest private employer in Utah. The company is now offering its test, designed to detect 50 different types of cancer at an early stage, to Intermountain employees and family members.

South San Francisco-based Atara Biotherapeutics said that Bayer intends to end its partnership in Sept. 2022. Atara will get back the full rights to allogeneic and autologous CAR-T cell therapy candidates directed against mesothelin-expressing tumors.

Japan-based Otsuka Pharmaceutical is ending its partnership with Akebia Therapeutics, the developer of vadadustat for anemia from chronic kidney disease. The drug application received a Complete Response Letter from the FDA earlier this year.

Personnel File

Seagen’s co-founder, chairman and CEO, Clay Siegall, is out of a job after 25 years. He resigned after being arrested and charged with 4th degree domestic assault, stemming from an incident at his home on Apr. 23. Days earlier, the company said Siegall was on a leave of absence, and that it had formed a special board committee to investigate the charges with an independent law firm. Roger Dansey, the chief medical officer, is serving as interim CEO while the board begins the search for a permanent CEO. It’s a troubling and sad chapter for a company that has long been a leader in antibody-drug conjugates for cancer. Seagen is the anchor company of the Seattle biotech community, with four marketed cancer drugs, nearly 3,000 employees worldwide, and a market valuation of $26 billion. People have been speculating about Seagen as a takeover candidate for at least 15 years, and rumors are spreading again. I think Seagen still could have a bright independent future under a new leader. Antibody-drug conjugates are maturing as a technology, and they are likely to be applied to many more tumor types in the near future. I also wrote here in February about the company’s shrewd bet on manufacturing in Everett, Wash. ‘Biotech’s Future Off the Beaten Path.’

Flagship Pioneering merged a couple of its portfolio companies, Inzen Therapeutics and Cygnal Therapeutics, into a new entity called Sonata Therapeutics. It will aim to use small molecules and genetic medicines against cancer, fibrosis and autoimmune disorders. Volker Herrmann, the former CEO of Inzen, will run the new company. Pearl Huang, the former CEO of Cygnal, is moving on to new opportunities.

Waltham, Mass.-based Xilio Therapeutics, the developer of tumor-selective immunotherapies, hired Stacey Davis as chief business officer. She comes from Novartis.

Eli Lilly said Mary Lynne Hedley is joining its board of directors. She is currently a senior scientific fellow at the Broad Institute, and previously was president and chief operating officer of Tesaro. That company was acquired by GSK.

Cambridge, Mass.-based Agios Pharmaceuticals said it’s cutting up to 50 jobs in research, and that chief scientific officer Bruce Car is stepping down in July. Sarah Gheuens, the chief medical officer, will keep that role and also take responsibility as head of R&D. The company said it expects to save $40-$50 million a year.

Cambridge, Mass.-based Scholar Rock said it’s cutting 25 percent of its workforce.

Switzerland and Cambridge, Mass.-based CRISPR Therapeutics hired Phuong Khanh Morrow as chief medical officer. She was previously with Amgen.

The Mark Foundation for Cancer Research, based in New York, promoted Ryan Schoenfeld to permanent CEO. He had been serving on an interim basis since August.

Waltham, Mass.-based Morphic Therapeutic, the developer of small molecule drugs against integrin targets, promoted Bruce Weber to president. He’s been chief scientific officer since Jan. 2016. Morphic also hired Joanne Gibbons as senior vice president of regulatory affairs. She previously worked with Codiak Biosciences.

Dublin, Ireland and Bridgewater, NJ-based Amarin announced a boardroom shakeup. Per Wold-Olsen is the new chairman of the board, and Erin Enright and Alfonso “Chito” Zulueta are new directors. David Stack and Joe Zakrzewski are stepping down from the board. Lars Ekman will no longer be chairman, but he will stay on the board.

Boston-based Odyssey Therapeutics, the developer of precision immunomodulators and cancer therapies, named Jeff Leiden as chairman of the board.

San Diego-based Ambrx Biopharma hired Janice Lu as chief medical officer.

Cambridge, Mass.-based Glympse hired Jonathan Wilde as chief scientific officer. The company is developing diagnostics that measure protein activity. He previously worked at Veracyte.

Hayward, Calif.-based Eikon Therapeutics, the developer of super-microscopy technology for drug discovery, added Robin Washington to its board as an independent director. She was the CFO of Gilead Sciences from 2008-2019. (TR coverage of Eikon, May 2021)

Our Shared Humanity

Immigrants are about 80 percent more likely to start a business than a US-born citizen, according to a recent study in American Economic Review: Insights. “The findings suggest that immigrants act more as “job creators” than “job takers” and play outsized roles in US high-growth entrepreneurship,” the authors wrote. (MIT news).

Regulatory Action

The FDA approved Eli Lilly’s application to market tirzepatide (Mounjaro) for adults with type 2 diabetes. The first-in-class GLP-1 and GIP agonist is given as a subcutaneous injection once a week. The drug not only beats others in the diabetes category on hemoglobin A1c scores, but has shown a consistent ability to help patients lose more weight. It recently showed that weight loss effect in a study of obese patients who don’t have type 2 diabetes. Analysts are predicting it will be a multi-billion dollar seller as it reaches its full potential in coming years. (See Apr. 2022 Frontpoints on “A Big Opportunity in Obesity.”)

The FDA gave Emergency Use Authorization to Labcorp for the first direct-to-consumer RT-PCR test that can detect both SARS-CoV-2 and influenza viruses. The patient can collect the nasal swab at home and send it in to Labcorp for testing.

The FDA gave Emergency Use Authorization to Pfizer/BioNTech’s COVID vaccine, in a low-dose form, as a booster for kids ages 5-11. The third shot can be given to kids at least five months after they get the first two shots. Fewer than one out of three kids in the US have gotten the vaccine at all, so demand for the booster is likely to be pretty low. The CDC’s Advisory Committee on Immunization Practices reviewed the data and recommended the booster shots for kids 5-11 a couple days later. (STAT) (See also “A Missed Opportunity for Grownups,” Dec. 2021). Meanwhile, parents of kids under age 5 are still waiting for any COVID vaccine to get authorized.

Cambridge, Mass.-based Foghorn Therapeutics said a Phase I study of its experimental treatment for acute myeloid leukemia and myelodysplastic syndrome was placed by the FDA on partial clinical hold. The hold was placed after a patient death, while investigators look into the cause.

The FDA lifted a clinical hold on Gilead Sciences’ lenacapavir for HIV treatment and HIV pre-exposure prophylaxis. All trials for the injectable medicine can now resume.

Data That Mattered

Watertown, Mass.-based Enanta Pharmaceuticals said it failed to hit the primary endpoint of a Phase IIb clinical trial of a small molecule drug for community-acquired RSV. The study enrolled otherwise healthy adults with community-acquired RSV. It did achieve statistical significance in knocking down viral RNA counts, but that didn’t translate to the desired effect on symptoms in this population. The company said it still plans to evaluate the drug, EDP-938, for high-risk patients.

Sometimes a chart is the best way to display data. See Verve Therapeutics’ results with a base editing therapy for cardiovascular disease targeting both PCSK9 and ANGPTL3. Cambridge, Mass.-based Verve also said it plans to start its first clinical trial with VERVE-101, a PCSK9-only edited therapy, in New Zealand in mid-2022.

 

12
May
2022

Changing the Balance of Power

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12 May 2022

Amanda Banks, MD

Early in my career as a physician, I took care of a woman who died from complications of an abortion procedure.

The patient had traveled to the blue state where I practiced, from a red state where she lived that restricted abortion access, to obtain care she couldn’t find or afford at home. She had previously gotten a procedure performed by a reckless physician who ultimately went to jail for several counts of murder.

She had survived being a refugee from a country that viciously and routinely violated human rights, only to die in an ICU a few months after her arrival in the US. Our team kept her on life support until her family could arrive, when care was withdrawn at their request.

As the US Supreme Court stands on the precipice of overturning Roe vs. Wade, and multiple states consider legislation criminalizing women who decide they must terminate their pregnancies, I cannot stop thinking about this woman and her family. We are about to enter a world where tragedies like this will become far more common.

What is this world, and how did we get here?

The degree to which our country has become polarized on the issue of a women’s right to determine her own reproductive health choices is extreme, but this isn’t about political views. It is about power.

We live in a country, and in a world, where power is concentrated in the hands of  very few. While there are many powerful people who use their influence for positive change, it only takes a few to make catastrophic decisions that affect people with no power, no voice. The powerful are usually men. The powerless are disproportionately women, people of color, poor people without resources.

The women who will most feel the pain and consequence of being stripped of their rights to decide whether, when and how to have children are mainly poor women, black and brown women. If Roe vs. Wade is overturned by the Supreme Court and many states follow through with plans to ban or greatly restrict access to legal abortion, women from these red states will consider traveling long distances to obtain reproductive health services in states that still have safe, legal access to abortion.

The hurdles may be insurmountable in many cases.

Rich women in blue states will likely continue to enjoy these rights, at least for now, perhaps until the powerful reach for even more control.

Look around the world and we see this dynamic playing out on a terrifying scale: In Ukraine, where Vladimir Putin’s thirst for power has made civilian targets of women and children, who are killed, orphaned, trafficked and sold. In Afghanistan, where last weekend the Taliban government ordered women to remain covered in public or their male relatives would be jailed. The list is long.

And yet, we have power too. We have platforms to galvanize our industry as a whole to stand up for those who cannot stand up for themselves.

It is our duty.

It is in fact also our mission (or should be) to improve the health of everyone equally.

We can and should offer generous benefits to our employees living in states that are likely to restrict abortion to obtain the care they need if they have to travel.

We can choose to open subsidiaries and start companies only in locations that will continue to provide reproductive healthcare, and shift away from those that do not.

We can donate money and time to organizations providing aid inside Ukraine and to Ukrainian refugees, and to those working to lift people out of poverty in our own communities.

We can diversify our own leadership by including more women and people with different racial, ethnic and socioeconomic backgrounds on our boards and in our C suites.

We can make our medications and technologies accessible to everyone regardless of their ability to pay.

We must vote.  

These actions may seem disjointed but they are not: they are tied together by giving power and resources back to people from whom it has been denied. They matter. They will add up. They will create a power counterbalance at a time where we cannot afford to stay silent.

I think of my son and daughter, and wonder, like all mothers do, what kind of country and world they will ultimately find themselves in, and how they might use their own power to help shape a better one.

Nothing I could have done would have changed the outcome for my patient or her family all those years ago. But I remember her, and tell her story, so that we can all remember how real this is, and how perilously close we are to a world where all choice is stripped away. Stand up.

11
May
2022

The Limits of Biomedical Innovation, and Why We Should Embrace Them

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11 May 2022

Alex Harding, MD., senior vice president, Remix Therapeutics; internal medicine physician, MGH.

Last October, I wrote for this publication about the emergence of Antibody-Drug Conjugates (ADCs) for cancer, based on my father’s experience being treated with Padcev for bladder cancer. A few months later, I posted on Twitter that, while Padcev had stopped working for my father, he had since started on another ADC called Trodelvy.

His tumors had shrunk. He was taking advantage of the time he had been given to do things he enjoyed. My editorial here and subsequent tweet were celebrations of biomedical innovation and all that has been achieved in the last 20 or so years to improve and extend patients’ lives.

The celebration ended in early April. I found myself sitting in an armchair pulled up alongside my father in his hospital bed at Johns Hopkins Hospital in Baltimore. While his cancer remained in check, bacteria had gotten into his bloodstream, causing him to develop the severe weakness, confusion, and low blood pressure characteristic of septic shock. Worse, some of those bacteria had deposited onto the aortic valve of his heart, a condition called endocarditis.

Even though the team at Johns Hopkins had given him antibiotics that eradicated the bacteria from his bloodstream, my dad’s condition did not improve. His blood pressure remained low. He began to accumulate fluid in his legs and lungs, an indication that his heart was not pumping effectively. The bacteria had damaged the aortic valve so much that, while his heart pumped blood out of the heart every time it contracted, the blood rushed right back into the heart through the leaky aortic valve each time the heart relaxed.

He was hospitalized for three weeks. While he improved over the first week with antibiotics and treatment for his low blood pressure, he got worse over the next two weeks. He began to grow weaker, and as fluid filled his lungs, he needed more and more oxygen support. My dad’s heart had failed.

He was dying.

Over the preceding year and a half, Dad had been on four different anti-cancer medication regimens. The treatments came with significant side effects, but most of them also worked effectively to shrink his tumors. He tenaciously coped with side effects from his treatments and continued to lead a fulfilling life. But now, with his heart failing him, that had changed. There would be no more ADCs, no genetically-targeted anti-cancer drugs, no medicine that would miraculously restore life. After being a beneficiary of the remarkable successes of today’s biomedical innovation efforts, he now faced its limits. My dad, Rob Harding, died on April 7. He was 75.

There are a couple of things you should know about me as you read this.

First, I love drugs (the legal kind). As a physician, the main tool at my disposal to treat patients is my electronic prescription pad. As a biotechnology professional, my singular goal is to help discover and develop new drugs. While some have critiqued modern cancer drugs for offering marginal benefit to patients at the expense of debilitating side effects, those critiques don’t apply to my father. His bladder cancer responded to the treatments he received in stunning ways. While he did have major side effects from the medicines, the benefits unequivocally outweighed the downsides for him.  I am not a luddite who resists technological advances. On the contrary, I yearn for more progress that can help patients live longer, better lives.

The second thing you should know about me is that I have spent a lot of time with dying people—not only my parents (my mother died of ALS one year ago), but also the countless patients I have treated as a physician who were approaching death. That experience has given me perspective on how to care for a dying person.

Patients are cared for at the bedside, not in the lab, and that aphorism certainly applies to dying patients. Sometimes, when a patient is facing death, the doctor’s job is to find a medicine to extend their life. Sometimes, a patient facing death needs a treatment that eases their suffering. And sometimes, when death is coming, what’s needed is not a medicine at all, but an attentive ear or a gentle hand—simply being there.

As someone who loves drugs, the hardest thing for me was knowing when to stop throwing new things at the problem. There was always one more drug we could try: a new anti-cancer drug that might erase his liver metastases more completely than the current therapy; perhaps a different antibiotic could better address the infection on his heart; maybe the right medical cocktail could restore his heart’s strength.

How could I step back from my reflex to reach for a new medicine?

As I sat facing my father in his hospital room, I thought through the events over the prior three weeks. I looked at my dad as he lay still in bed. Eventually, I could see that he did not need another medicine. His hand was cool to my touch and puffy with accumulating fluid. I squeezed his hand and he squeezed mine.

All doctors live for the opportunity to save a life. It’s what we dreamed about when we started medical school, and the thrill of making the right diagnosis and giving the right treatment to a patient teetering on the precipice is what spurs most of us to keep going. Indeed, the entire artifice of the biomedical innovation machine—academic labs, biotechnology start-ups, pharmaceutical companies—revolves around the ideal of saving a life. Sure, the FDA describes “Feels, Functions, or Survives” as the key criteria to determine whether a drug should be approved. “Feels” and “function”–in other words, improved quality of life—certainly matter a great deal, but we all know that drug discovery glory goes to increasing survival.

And yet, a universal, inescapable truth will eventually confound all our efforts to preserve life. It is a fact that is both utterly obvious and rarely discussed: Everyone we love will one day die.

If you are lucky enough to live a long life, you will probably accompany people you love on their journey toward death, too. It’s worth thinking about how you will handle such a situation.

In the biomedical professions, we tend to delude ourselves into thinking that most medical decisions have been studied with sufficient precision that they can be considered a matter of science. Often, such faith in science is exaggerated. The decision on when not to continue aggressive measures, in particular, remains firmly planted under the domain of art, detached from hard data.

In a world where data is king, letting go of scientific endeavor at the end of life can feel like a loss of control. It is difficult to concede that our scientific arsenal is no match for nature. And yet, doing so can be exactly what is needed to provide someone you love with comfort and dignity as they die. It does feel like losing control. But it is also a way to bring what’s important back into focus. All the sophisticated technologies—the drugs, devices, and equipment that form the apparatus of biomedical innovation and its efforts to prolong life, dissolve away. What’s left is the person you love.

Hard as it was, I had sat with enough sick patients to know. As I sat there with my father, I saw that it was time to embrace the limits of scientific progress. It was time to sit together, me and him. No more IVs or EKGs, no more pills or blood draws. Just two people.

In that hospital room, Dad and I talked about the summer vacations our family had taken when I was a kid. He had particularly fond memories of our trip to the Grand Canyon when I was 8, and when I was older, to Brazil. He mentioned a few people he wanted to make sure my brother and I invited to his memorial service. We reminisced about going to baseball games together at Camden Yards. He had taken me to the game in 1995 when Cal Ripken, Jr. tied Lou Gehrig’s record for consecutive games played.

After we talked for almost an hour, Dad needed a break. He dozed off. I squeezed his hand a little tighter.

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