25
Jul
2018

Finding the ‘Middle Market’ of Biotech VC: Chris Garabedian on The Long Run Podcast

Today’s guest on The Long Run podcast is Chris Garabedian.

Garabedian is best known for his controversial stint as CEO of Cambridge, Mass.-based Sarepta Therapeutics, the developer of treatments for Duchenne Muscular Dystrophy. Whatever you may think of his tenure there — and the FDA’s decision to approve eteplirsen on a slim reed of clinical trial evidence – there is no denying that Sarepta got into that position because Garabedian saved the company. When he started there in 2011, it was called AVI Biopharma. It was running out of cash and left for dead. I know because that’s when I first interviewed him and wrote about the company.

Chris Garabedian, founder and CEO, Xontogeny

Rather than repeat the history of Sarepta, which has been pretty well-documented, I asked Garabedian in this interview to talk more about his early career coming up on the business side of biotech. He learned the ropes in market research, then joined Abbott, and got serious about biotech in more senior positions at Gilead Sciences and Celgene.

He has developed some interesting beliefs on how the R&D side of the house can work with the business side. Those beliefs culminate in a new entity he started called Xontogeny. It’s sort of like a small venture-capital firm aimed at scientific entrepreneurs who need more oomph than they get from a small “friends and family” financing round, but don’t need a full-blown $50 million Series A round from the likes of the big VC firms.

He calls it “the middle market.”  You can hear him describe it. (See previous TR coverage from May 2017).

Now, join me and Chris Garabedian for The Long Run.

17
Jul
2018

Nine Observations on Leadership and Teamwork from Mt. Everest

Most of you have heard by now that I reached the summit of Mt. Everest, the highest mountain in the world, on May 22.

Not only was this a dream come true, it was the culmination of my charity fundraising campaign, the Everest Climb to Fight Cancer. It fetched $339,000 for cancer research at the Fred Hutch, a leading center for immunotherapy. I’m extremely grateful to all who contributed, and overjoyed that it inspired so many others to pursue their own dreams, their own “Everest.”

This two-month odyssey also gave me ample time to think deeply about leadership and successful team dynamics. I will share some of these observations here.

OK, here are a few lessons from the mountain:

There’s power in a clear goal with a hard deadline

When you are part of a team with a clear, audacious goal like climbing Mt. Everest, it focuses the mind. It influences every little decision you make each day. Little things that might subtract from the goal fall by the wayside.

The personal trainer who helped me in the lead-up to Everest, Dave Johnson, told me afterwards that he sees the difference. There are people who come in saying they want to lose 10 pounds. Then there are people who want to lose 10 pounds before their wedding day in 4 months.

There’s a big difference in the clarity and urgency of those goals. In the first case, you can on occasion tell yourself it’s OK to have ice cream at dinner. It’s only once in a while, you might say. I can make up for it later. In the second case, you pass. Why? Because it’s not going to help you fit into that wedding dress in four months. These little everyday decisions, to stay disciplined and focused on an overarching goal with a non-negotiable deadline, make a huge difference over time.

For me, one example was getting to bed at 9 pm every night. Even if a friend was visiting from out of town and wanted to get a beer and stay up to midnight, sorry. No can do. That would set me up for a poor 5 am workout, and I couldn’t afford to cut corners if I wanted to achieve this overarching goal. Usually there’s a way to accommodate another goal if you think about it. Maybe that friend could meet for coffee at 10 am the next day, and then nobody skips a beat in training.  

Those of you who worked at a company that have passed a Phase III trial and been given four months by management to file a New Drug Application to the FDA know what I’m talking about. That team-building exercise or that HR training that would ordinarily be scheduled? Forget about it. You are laser-focused on the big goal. 

Run a Tight Ship

Guides on Everest have a crystal clear mandate — get as many members of your team up to the summit and back home safely. Some of this depends on the strength of the team members to begin with, and their level of commitment. But every day on a 60-day trip is mapped out to allow for gradual acclimatization to altitude, and to maximize team health and strength. Some wiggle room is built in to adjust for the right weather window of opportunity.

Ben Jones, Everest expedition leader, Alpine Ascents International

Details matter. For example, a few guide services this year switched to new oxygen regulators and masks. These regulators were defective. When these oxygen masks failed for a quite a few climbers and guides, above 8,000 meters (26,000 feet), that’s a deadly serious situation. It forces everyone to immediately descend. Summit bids were lost for dozens of climbers because someone screwed up a pretty basic thing. Ouch.      

Fortunately, our team was using 4-year-old oxygen mask regulators that had been proven time and again on the high mountain. Check that detail off on the checklist. But there were a thousand other details to pay attention to on this quest.

My expedition’s leader, Ben Jones, was quite businesslike in keeping strict schedules. If he said we would leave Base Camp at 3 am, he meant 3 am, not 3:05 am or 3:15 am. No lollygagging, no begging to sleep in. This was for a good reason: he wanted to make sure our team would pass through the Khumbu Icefall – the most dangerous part of the mountain — during the cold hours of the early morning, when melting and avalanche risk were at a minimum. If you were struggling in the morning, there was a simple solution. Get to bed earlier the previous night.

Having a clear, overarching goal acts like a forcing function that influences a thousand little decisions, in a positive way. For those who followed the Alpine Ascents Cybercast of my trip, you know Jones is a gifted photographer. But he didn’t stop much in the Khumbu Icefall. As the leader, his main goal was to set a deliberate, but quick pace that everyone could keep up with, and that allowed for safe travel while clipped to the tope. Efficiency in this sense goes hand-in-hand with safety — the more time spent on the course, the higher the chances are that an avalanche or rockfall or something else bad might happen.

There would be plenty of other times and places for taking photos and savoring the moment.

Create an ‘All for One, One for All” Culture. Nip Selfishness in the Bud

Selfish behavior, when allowed, tolerated or even rewarded, is corrosive to team morale. It can quickly devolve into every-man-for-himself selfishness.

On the mountain, consider carrying weight. Every ounce counts. Each Sherpa, and each climber, was expected to carry certain pieces of gear, and a certain number of oxygen bottles on the high part of the mountain. Want to foist an extra 8-pound bottle onto your Sherpa to lighten your pack? Want to pay extra for the privilege? Not happening.

My respect and allegiance for the expedition leader grew immensely when I saw how he responded to an individual that consistently put selfish interests ahead of the team. Jones was not falling for it, not about to be played for the fool. He was clear, consistent, polite and firm in these situations. If you can’t carry your gear, maybe you need to stop climbing. No, you can’t have an extra oxygen bottle cranked up to the max. No, the monks said we can’t take photos inside the monastery we visited on the trek. That means you, too.

Making exceptions here and there would take a toll on other members of the team who have to pick up the slack.

On the flip side, we gained strength as a team, and became more cohesive, by helping each other out. When someone helped me with a small thing, like checking whether a backpack strap is properly fastened, I’m more motivated to help out that person the next time they need a hand. This can become a positive feedback loop, where everyone is looking out for everyone else. Jones consciously cultivated this “all-for-one, one-for-all” ethic, at times without saying it in so many ways.

For instance, we had a system of checking to make sure each other’s crampons were properly fastened each morning before climbing. While some of this was for safety – you can’t climb with a loose or missing crampon – the bigger effect was in creating a generous team spirit of helping each other out in small ways. Once that team ethic is established, you can be confident the team would mobilize in case we ran into a serious all-hands-on-deck situation.

Communicate Clearly and Consistently

At the hotel in Kathmandu, Jones told us about his experience on Everest. He was there for two tragic seasons cut short – the Khumbu Icefall avalanche of 2014 and the earthquake of 2015. He  had summitted four times himself in other years.

Over time, he became a believer in patience on Everest. He was going to let the eager-beaver teams go first. Experience had taught Jones that other teams would flock to the fixed lines at the first glimpse of good weather, creating logjams. As long as the weather patterns appeared to remain favorable for the extended forecast, he preferred that we hang back at Base Camp, maintaining team strength with decent food and water and supplies. We would make our move later.

This was going to test everyone’s patience, especially on a two-month expedition. It’s far longer than anything any of us had done before. Jones told us it would be a tough test mentally. It was. Everest can’t be climbed in a straight line up.

Most of us knew the itinerary, but he took time to explain anyway. From Base Camp (17,500 feet), you go up to Camps 1 and 2 for a few days to acclimate, then descend back to Base Camp to breathe thicker air and maintain strength. A week or so later, you go up on another push, this time for another five days all the way up to Camp 3 (23,500 feet). Then, again, you descend back to rest at Base Camp, because it’s so hard for the body to spend much time above 18,000 feet. Our group did a brief detour to a lower elevation, then waited at Base Camp even more. We were antsy, obsessing over weather forecasts before embarking on our weeklong summit bid.  

We wondered: What if the weather window closes, the monsoon arrives early, and none of us get to summit? Jones knew that was a possibility. But he repeatedly, and patiently, communicated his reasoning for waiting. He was steadfast in this strategy from beginning to end. If there were a few unhappy campers, then he would just have to explain his reasoning one more time.  

He may have gotten a little testy and annoyed at times. But he knew what he was doing, and proven right in the end.

Stay Poised Under Pressure. On our summit rotation push to the South Col (Camp 4, 26,000 feet/8000 meters), we had a problem. At a break spot, one climber set down his helmet on the ice, without securely clipping it to his backpack.

Whoosh! Down the mountain it went. No way could anyone go down to retrieve it, we’d never find it. No way could this climber go up the mountain without a helmet – it wouldn’t be safe. None of us carried spares. We were on a steep stretch of the Lhotse Face about 6,000 feet above Base Camp, which was two days away.

“Oh shit,” I blurted out as I saw that helmet bounce away.

That was followed by an uncomfortable silence.

None of us had experienced a setback like this. After a few minutes, one of the guides improvised a work-around. The guide in back would loan his helmet to the climber so he could continue upward to the South Col. One guide would hang back at the break area, checking with descending Sherpa for an extra. Luckily, it worked out. The guide wore that helmet himself to the South Col a couple hours later.

There was no finger-pointing, no recriminations, no yelling. Maybe there was some muttering about carelessness. But mistakes will happen on any long journey. The key is always in how you adapt and move forward.

Don’t be Fooled by First Impressions. We all make snap judgments about people. It’s human nature, part of how we navigate the world. When our team gathered at the hotel in Kathmandu, we all sized each other up – old, young, male, female, fit, or maybe less fit and less likely to summit.

But when you are on a two-month climbing crucible with a small group, eating three meals a day together, the superficial stuff fades away. You get to know people at a deeper level. That person who might seem like a jerk may have sides to his personality you don’t see at first. One of my Everest guides, after 20 years of leading expeditions, said he’s learned to disregard his own first impressions of people. Appearances aren’t just deceiving. They are almost always wrong.

Take this example. One member of our team had a habit of making rude, abrasive, smart-aleck remarks. Casual insults would spill forth on the trail, at dinner, around camp. “One of these days, you’re going to have to learn how to dress yourself,” this guy blurted to a teammate who was struggling in the wee hours, getting ready for the day’s climb. The other teammate threatened to “kick his ass” and the offender apologized.

These sorts of remarks bugged people. They create a sort of cumulative toxicity. At Base Camp, in my pen-and-paper journal, I wrote. “Let the insults, put-downs and snide remarks roll off my back.”

I’m glad I held my tongue. Over time, this tough, Type A achiever revealed himself to be a good teammate. Some abrasiveness, it turned out, stemmed from some tensions at home that had nothing to do with any of us. It also became clear this person had a kind and empathetic and generous streak. When I had a mild low-back spasm at Camp 2 (21,500 feet), he offered me some ibuprofen and muscle relaxants he had packed. That helped me get through a hard day. He was also generous in his tips for the Sherpa. A strong climber, he carried extra gear to lighten the load for others.

I wouldn’t have guessed at the start, but we became good climbing partners. By the end, dare I say, we were friends.

Cultivate Your Tolerance for Adversity

This is a phrase used by the Natural Outdoor Leadership School (NOLS) – an excellent nonprofit leadership development organization. This concept is all about remaining calm and resilient in the unpredictable outdoor environments. It’s not about “suffering at all costs.” It is about maintaining self-control, and focusing on the things you can control. Namely, your own thoughts.

You can’t control the weather, for instance. There’s no point in complaining about it. You can, if it’s raining, put on rain gear. If it’s too windy to move, you can stay in your tent a while.

My tolerance for adversity was tested during a couple nights at Camp 2 (21,500 feet). This is an area where you don’t yet use supplemental oxygen. I had fitful sleep. I’d wake up, feel like I was suffocating, and gasp for breath. Panicky thoughts creeped in. “How will I climb tomorrow without sleeping?” I’d ask myself at 2 am. This sort of negative self-talk is common, guides say. But I also knew these negative thoughts weren’t going to do me or anyone on the team any good.

So, I would force myself to focus on more positive thoughts. I’d say to myself, “I’m always better when I wake up in the morning, get some food and water, and start climbing again.” That helped put me in the right frame of mind the next day.

Everyone had their moments when they had to think hard about the fine line between sucking it up with “tolerance for adversity” and when they were pushing it too far.

One of my fellow climbers suffered a freak injury — a torn groin muscle during the trek to Base Camp. He loaded up on the ibuprofen. He gamely tried to push through it for a while, to no avail. He had to go home. He was surely disappointed. We were sad. But talk about resilient! He cheered for us when we summitted. He told his hometown newspaper afterwards that he’s giving it another shot. He said: “I think failure is inevitable if you’re reaching for big goals. If you hit all your goals, you’re not reaching far enough. So, I look at failure as part of the process.”

That’s the kind of “tolerance for adversity” that it takes to achieve the big goals.

Technology Has its Uses. Until it Starts to Detract from the Mission.

This was one source of disappointment. Our team, myself included, had a lot of gadgets. Smartphones, cameras, FitBit watches, GoPro video and more. We had a spotty Wi-Fi connection at Base Camp, and spotty cell phone service there at 17,500 feet. For sure, it was nice to call family. It was nice to log on to Twitter, and share the occasional photo update.

But. But. But. This constant connectivity had its downside. The spottiness of Internet connectivity caused endless consternation and complaints among team members who were trying to stay connected to home and work, while tuning out a stunning physical location at the world’s highest mountain.

One of the tea shop owners in Namche, where we stayed a couple nights, hit the nail on the head. “You’re all connected to the outside world, but not connected to each other.” That hurt. What a stupid thing, to be tethered to our phones in this amazing place. Do we even recognize how addicted we are? At one point, Jones asked everyone to stop using their phones at the dinner table – almost like a parent chiding a teenager.

I’m glad he said something. I definitely think the constant staring at smartphones made it harder for us to jell as a team in the early days. Some of my favorite moments on the climb were on the high mountain when we had no connectivity at all.

Distractions are one thing, misinformation was another. For example, there was plenty of half-baked weather forecast information to chew over online, which provided fodder to second-guess our guide. We all knew the guides were taking into account historical weather models, updated satellite data and forecasts from multiple competing meteorologists, combined with first-person feedback they got via radio from people stationed at different spots on the mountain. Yet there we were debating a superficial website with junk data. In human activities that require long and hard concentration, the smartphone, can be more of enemy than a friend. If you allow it.

Express Your Gratitude. Often.

I paid close attention to Sherpa culture on the mountain. Nepal is one of the poorest countries in the world. And yet these people work hard, and value their families. They seem happier on balance than most people I know in the wealthiest country in the world.

One of my fellow climbers, a successful businessman and worldly individual from Mexico City, had a habit of saying “Thank you, my friend,” at the end of sentences. Whenever the assistant cook at Base Camp would bring us tea or bread or anything else, this climber would always say “Thank you, my friend,” with genuine warmth.

He was treating others as he would like to be treated.

The spirit of gratitude and generosity can be infectious. At our Puja ceremony before we began our climb from Base Camp, gratitude was everywhere. The Sherpa were there, making their offerings to the Chomolungma, the Mother Goddess of Earth, as Everest is considered in Tibetan Buddhist culture.

With Everest guide Jangbu Sherpa at Base Camp.

I didn’t convert to Tibetan Buddhism, but we all had respect for the local traditions. At our Puja, we listened to a Buddhist monk chant. We flung grains of rice in the air near the rock altar. The scent of burning juniper and sage filled the air. We drank a little rice wine (not too much). We laid down our sharp items, crampons and ice axes, at the altar, asking the Mother Goddess to allow us safe passage up the mountain. We smeared tsampa (barley flour) over our faces, as the Sherpa blessed us all, and themselves, for not just a safe climb, but for long life.

There were hugs galore. I made sure to hug one of the Everest guides, Jangbu Sherpa. He’s also the guide who led me up Aconcagua last year. It’s the highest mountain in the world outside the Himalayas. Jangbu convinced me, one year ago, that I could climb Everest.

Thank you, my friend.

10
Jul
2018

Scientist, Executive, Teacher: Vicki Sato on The Long Run Podcast

Vicki Sato is the latest guest on The Long Run podcast.

Regular listeners may recall I invited Vicki on the show back in March. We had a great conversation, or so I thought. Turns out the audio recording quality was terrible. It was a technical glitch. My fault. I’m sorry you weren’t able to hear her.

Fortunately, Vicki was gracious enough to take some time out of her busy schedule to try again. This time, her voice comes through crystal clear.

For those unfamiliar, Sato is one of the biotech industry’s true leaders. 

Sato grew up in Chicago, and is a product of the public schools. She has some interesting reflections on her youth and how she ended up getting into science. At one point, she had the guts to switch fields from plant biology to human biology. She did well enough to end up on the Harvard faculty (after answering a “Help Wanted” ad in Science, believe it or not). 

Beginning in the mid-1980s, and for about 20 years, the next phase of her career was as an executive. First she worked at Biogen, then Vertex Pharmaceuticals. She made her name in biotech in those years. Her fingerprints are all over a number of drugs that are linchpins for those companies today.

Vicki Sato

The last decade or so she’s been a teacher and mentor — on the Harvard Business School faculty and as a board member. As a director of Bristol-Myers Squibb, Denali Therapeutics and Vir Biotechnology, she oversees strategic direction of companies working on treatments for cancer, neurodegenerative disease, and infectious disease.

Having been around for this many years, she’s perceptive and wise. She has high standards for herself and others she works with. She’s also a warm person who cares a lot about the next generation of biotech leaders. She stays active because she has a passion for the science, which I think you’ll hear clearly in this interview.  

Before diving in, a word of thanks to the sponsors of the show. Harvard Medical School executive education, and Presage Bioscience.

Now join me and Vicki Sato for The Long Run.