Bioscience and Healthcare of the Future: Overrun by Choices, Changes and Opportunities
“The future will be overrun by an army of new choices and changes in attitudes towards one’s own health. That creates a whole new area for bioscience and health, and for investing,” Mike Edelhart, managing partner, Social Starts & Joyance Partners said, opening the Demy-Colton Virtual Salon, “The New Alchemy of Investing in Health.”
The transformation has started, as biopharma companies focus on personalized medicine, and healthcare systems and payers give a nod towards personalized healthcare in an effort to extend healthspans as well as lifespans.
It’s still a hard slog, though. For biopharma companies, “Prevention isn’t very attractive yet,” Alexandra Bause, Ph.D., co-founder and investment director, Apollo Health Ventures, said. “It takes a long time to show you can prevent disease. Right now, we need to find biomarkers, know we can modulate them, and then run clinical trials. Pharma is in favor, as long as we have biomarkers.”
Not even biomarkers can make payers less hesitant to embrace disease prevention. They’re focused on this year’s budget. Expenditures with a return on investment a decade away – when the individual may be with another insurer – aren’t enticing.
“As long as payers have a short-term view, they have no incentive to pay for disease prevention,” Harald Stock, Ph.D., co-founder, CognifiSense, said. Instead, companies are creating consumer awareness, and in some countries (Japan among them) government involvement may be needed to deal with societal levers (such as predominately older populations) before the social fabric erodes.
What these panelists and a growing number of biotech companies believe is that the healthcare of the future will be multimodal, involving therapeutics, digital modalities, and early interventions.
For example, Stock’s firm usually invests at the intersection of classical and non-classical approaches, in the areas of pain, oncology, and women’s health. As an example of how disparate modalities are combining, he mentioned “getting antibody vectors into tumors.”
Bause’s company focuses on aging with companies that target the presymptomatic, underlying causes of disease. “The science is at such an early stage that it’s not clear how to intervene in the process of aging,” she admits. Apollo’s investments, therefore, are in population aging, the basic biology of the aging process, and technologies to better understand the biology and to process and analyze the vast amount of resulting data.
As their preferences show, the healthcare transformation is driven by the convergence of multiple factors. “Next-generation sequencing has been a game changer. Because of it we look at diseases differently,” Stock said. “We now think not of ‘lung cancer’ or ‘non-small cell lung cancer,’ but about the surface proteins the tumor expresses and what they mean for specific patients. That concept also applies to other conditions.”
For example, he continued, pain is coming to be viewed as a subcondition of disease. To treat it, “There are receptor pairs that let us develop even small molecules that are more efficacious and that lack the side effects of opioids. They’re life-changing for patients.”
This new way of looking at disease also requires a better way to diagnose conditions, which requires a more detailed understanding of disease and ways to handle more complex data systems. That, in turn, affects clinical trials, subgroup analyses, and other factors in drug development.
In aging, Bause says, we’re seeing “biological processes we weren’t aware of, around not just the genome, but its regulation, innate biology, non-regulatory RNA, and the microbiome, for instance.” The question for many of her portfolio companies is how to maintain healthy homeostasis.
“The microbiome is a blue-water area of science,” Edelhart pointed out. “Each time we look up, there are more striking indications – but no fundamentals – of its importance in health. It feels like the early days of genetics. It has the potential to change our perspective of everything. We expect to focus even more of our efforts there.”
Edelhart also is watching the science behind happiness and disease. Scientific research shows the biological effects of happiness. “This isn’t just rhetoric,” he stressed.
Beyond that, “We’re seeing a new generation of people saying, ‘I have the right to be the best me I can be, inside and out…to have a role in those healthcare decisions…to be happy as I define it.’”
Digital medicine is a factor in that perspective. As consumer health apps and telemedicine continue to be adopted, the already high level of health awareness in the population grows. That is one of the silver linings of the COVID-19 pandemic.
Another is the increased level of international cooperation and collaboration, evidenced by scientific papers and business ventures. That collaboration is likely to continue, panelists agreed, along with the high speed of development. “Global problems – like the pandemic – require global solutions,” David Giampaolo, founder and chief executive of Pi Capital, said. “We’ll not only see international cooperation continue, but accelerate.”
Much of the collaboration will be virtual, but there’s an important place for communities of innovation, Stock said. He cited Cambridge, MA’s Kendall Square community of biotech companies. “Between 1996 and 2015, approximately 60% – as I recall – of all new healthcare innovations came from a 25-mile radius around Kendall Square.
“That environment provided a huge amount of capital with the potential for high returns. It also had the combination of scientists and academics, world-class academic institutions and research centers, and the presence of big pharma, medical, and technology companies.” All this attracted people to the area and fed their innovative zeal and creativity, Stock explained. And, the culture accepted that some endeavors would fail. Consequently, rather than being penalized, entrepreneurs learned from their failures, often creating something even better.
Like Kendall Square, the future of healthcare depends on the right conditions of innovation and expertise. That means there’s a role for traditional pharmaceutical companies, even as the ecosystem system transforms.