“I think healthcare should be a right whether you’re in the Middle East or India or anywhere in the world… why not also have a major impact on the ideas you invest in.”
Three leaders in the HealthTech space joined our roundtable to discuss their careers investing in healthcare, technology and wellness industries. Dr. Vishal Gulati is a partner at Draper Espirit, a leading European venture capital firm; Noor Sweid is founder of Global Ventures, a Dubai-based, growth-stage venture capital firm focusing on investing in emerging markets; and Vasudev Bailey, PhD, is a partner at ARTIS Ventures, a long-term venture partner.
The debate between investing in healthcare to make money vs. guaranteeing it as a right is a false choice. Bailey makes clear these two ideas can and should coexist. “I think healthcare should be a right whether you’re in the Middle East or India or anywhere in the world. I think healthcare is absolutely broken. It’s not to say you can’t make money in healthcare… why not also have a major impact on the ideas you invest in.”
Investments in cutting edge health technology has placed a premium on data which has become the currency in healthcare. The increased data points serve as key inputs in the application of artificial intelligence used to assist and transform existing medical practices.
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SPEAKERS
Vishal Gulati
Partner
Draper Esprit
Vasudev Bailey, PhD
Partner
ARTIS Ventures
Noor Sweid
Partner
Global Ventures
EPISODE TRANSCRIPT
John Darsie: (00:07)
Hello, everyone. Welcome back to SALT Talks. My name is John Darsie, I'm the Managing Director of SALT, which is a global thought leadership forum at the intersection of finance, technology, and public policy. These SALT Talks are a series of digital interviews we've been doing during the work from home period in lieu of our in-person conferences. What we really try to do with these SALT Talks is provide a platform for leading investors, creators, and thinkers and to provide our audience a window into the minds of those subject matter experts, as well as provide that platform for big world changing ideas that we think are shaping the future.
John Darsie: (00:43)
Today we're really excited to bring you a panel focused on health technology and healthcare investing featuring three esteemed panelists, Dr. Vishal Gulati, Noor Sweid, and Vas Bailey, who is a PhD. I'm going to read you brief bios on each one of the panelists and then I'll give them a little bit of time to explain more about their background and how they got into health tech investing.
John Darsie: (01:06)
Dr. Vishal Gulati is a venture partner at Draper Esprit and an advisor to Oxford Sciences Innovation. He's an investor and promoter of data-driven healthcare in Europe and has an active portfolio about 20 companies. These companies represent a wide range of technology platforms and applications ranging from digital therapeutics to machine learning and AI. Dr. Gulati is a trained physician and he spent time... that includes time at the St. Mary's Hospital Department of Medicine in London, where he was a Rhodes Scholar.
John Darsie: (01:38)
Our next panelist is Noor Sweid who's a general partner at Global Ventures, which is a Dubai-based venture capital fund working with globally minded growth stage companies in the Middle East and Africa region. Increasingly, Global Ventures is focused on health tech investing is that opportunity set has expanded. Now, previously Noor was the Chief Investment Officer at Dubai Future Foundation and was a founding partner at Leap Ventures, which was a growth stage VC based out of Dubai and Beirut. Noor is a very active angel investor. Prior to her angel investing in venture capital days, she actually founded and scaled Zen Yoga, which was the first yoga studio in the UAE that she later sold to a private equity firm in 2014.
John Darsie: (02:21)
She began her career as a biopharma strategy consultant at Accenture in Boston. Noor is a Director-in-Residence for the Corporate Governance Program at INSEAD and a Founding Board Member at Endeavor UAE. She has a bachelors' degree in Finance and Economics from Boston College and an MBA from MIT's Sloan School of Business.
John Darsie: (02:40)
Our last panelist, last but not least definitely is Vas Bailey, who is a PhD. He's a partner at ARTIS Ventures where he focuses on investing in novel and breakthrough health and life sciences companies. He currently sits on 10 boards and he serves as an advisor to several other startups. He's the founder of ARTIS Ventures' Healthcare Pioneers, which brings together some of the world's brightest minds to accelerate and incubate life-changing ideas in healthcare.
John Darsie: (03:05)
In his past role as venture partner at ARTIS, he helped portfolio companies with their business development and growth strategy. Prior to ARTIS, Vas co-founded and served as the general manager of the GLG Institute. He served as a consultant at McKinsey. He received a PhD in Biomedical Engineering, focused on the use of nanotechnology and epigenetics for personalized chemotherapy in early cancer detection from Johns Hopkins University school of medicine. He's been recognized as one of the world's leading biomedical engineers by the Siebel Foundation.
John Darsie: (03:36)
Thank you all for joining us. A reminder to all of our participants, if you have any questions for the panelists during today's talk, you can enter them into the Q&A box at the bottom of your video screen.
John Darsie: (03:46)
So the first question... I'm going to go around the horn, we'll start with, Dr. Gulati. I spent some time talking through your background and your resume, but could you please give us a little bit more about your personal background and your journey into health tech investing.
Dr. Vishal Gulati: (04:03)
Thank you very much, John. Very delighted to be here. I started my career as a practicing doctor and then I did research as a clinical researcher, believe it or not in virology, which was not a very exciting field in those days, but now, it has become very, very topical. Then, I started working at the Wellcome Trust after that and got involved in the human genome program. That opened my eyes in terms of data and how having large amounts of data can open our eyes to a different world in healthcare.
Dr. Vishal Gulati: (04:42)
Interestingly, at the same time, venture capitalists around the world were looking for people with those skills to help them, look for investment opportunities. So I got headhunted to work for a venture capital firm where I spent a number of years. Around 2012 or 2013, I started to look at how the ecosystem was evolving from a very different lens. Just the availability of internet and handheld devices had completely changed people's lives. It seemed quite logical that that would come to healthcare as well.
Dr. Vishal Gulati: (05:20)
Over the last few years, all that data that we generated also opened our eyes to new technologies, like machine learning and other ways of analyzing that data and making sense and inference out of that. That has capitalized a huge renascence, a generation of companies that have taken that data and applied it to hard medical problems. That is the interface at which I love to invest.
John Darsie: (05:49)
Thank you, Dr. Gulati. Noor how about you go next?
Noor Sweid: (05:54)
Thank you, John. For me, it's more of venture capital. So helping startups grow, supporting startups and emerging markets is what we're very passionate about. My journey started in biopharma, as you mentioned, moved into wellness, at the same time scaling an IPO and a company out of emerging markets. So really it's been a little bit of everywhere.
Noor Sweid: (06:15)
When this crisis hit, when COVID suddenly became a part of the global narrative, what we saw was very clear, which is the financial crisis 10 years ago drove the need for financial inclusion and lots of technology, leapfrogging to allow people who are not part of the financial network to come into the financial network, and we saw FinTech.
Noor Sweid: (06:39)
Now we have this health crisis, which will naturally then highlight the need for healthcare, which is in a past emerging markets. We sit in Dubai, we have the Middle East and Africa is a one and a half billion person population where health care access is lacking.
Noor Sweid: (06:54)
So once we started to see healthcare inclusion prioritize and a lot of the founders across the region try to address this need, and need more and more capital for growth, we decided to lean into that and use our background and our knowledge in the space, as well as our background and knowledge in technology and venture investing to support and enable these companies to provide health care access to the population.
John Darsie: (07:16)
Thank you, Noor. Vas, you round things out for us.
Vasudev Bailey: (07:20)
Great. I've been passionate about healthcare from as far back as I can remember. I started my first company when I was 17 years old and it was in the world of fitness monitoring check. Clearly, you can't tell fitness from this, and I understand, but it was something I started. I went onto the Hopkins School of Medicine, whereas you mentioned, I got my PhD, but I'm also on the board of the Johns Hopkins School of Medicine, BME Department, which has been the top program in biomedical engineering since they created it 40 years ago. What biomedical engineering is essentially is where I invest at ARTIS Ventures, which is the intersection of technology and medicine.
Vasudev Bailey: (07:58)
When I left that world of academia and joined McKinsey and company, I had the privilege there to meet Jeff Kindler, the CEO of Pfizer wherein it changed my world and my life because this was a person who did not have great networks in the world of pharma and tech, suddenly changed overnight because I started a business with Jeff Kindler, which was called GLG Institute under GLG. We built what is the world's largest network of CEOs, at 1,500 pharma CEOs working for me at that point and including collaborating with people like David Brennan from AstraZeneca and Shlomo Yanai from Teva.
Vasudev Bailey: (08:38)
The way we think about healthcare is... not say something controversial to start with because many of you will disagree-
John Darsie: (08:44)
We like controversy.
Vasudev Bailey: (08:45)
Yeah. I think healthcare should be a right that everyone has. You should not get better healthcare just because you're born close to Johns Hopkins or close to Stanford University. I think whether you're in the Middle East or in India or anywhere in the world, healthcare is absolutely broken because I think that people who have access to great healthcare tend to do better than people who don't.
Vasudev Bailey: (09:10)
That drives me every day. It's not to say that you can't make money in healthcare, right. Is the fact that we are focused as a venture fund on returns. It is not a nonprofit, we're razor focused on delivering returns to our investors.
Vasudev Bailey: (09:24)
That being said, why not also have a major impact in the ideas you invest in as well. That's what allows me to wake up every day and motivates me to do what we do. We believe that the clear edge you can give innovators in healthcare, which is such a complex web, is through people.
Vasudev Bailey: (09:45)
So my past life of having the CEO network translates into how we give our companies an unfair edge in trying to innovate and move forward.
John Darsie: (09:53)
Well, Dr. Gulati, you're based in London, so you don't have as many of the healthcare costs related issues from a population perspective that we have in the United States and Vas here based in San Francisco. So I want to ask, starting with you Dr. Gulati, a broad question about how technology is changing the healthcare field, helping address some of those concerns around healthcare costs. Particularly for you Dr. Gulati, you're very focused on data driven healthcare solutions.
John Darsie: (10:22)
So how has the collection of data and the harvesting of that data affected and improved health care solutions.
Dr. Vishal Gulati: (10:31)
I'll give you a number of concrete examples. I think that the way healthcare is now delivered is gradually becoming much more distributed. It is no longer centralized in hospitals or centers of excellence. It's still more centralized than I would like it to be, but it is gradually percolating outside. So just in my portfolio, the companies put together have helped more than 50 million people with their healthcare needs, which is not the scale I can imagine by starting a hospital or running a center. I just cannot imagine that level of impact.
Dr. Vishal Gulati: (11:12)
Then with that data comes additional benefits. So one of my portfolio companies, which is called Ieso Digital Health, it has several hundred thousand hours of therapy CBT for patients with depression and anxiety disorders, which they have now analyzed and now they are the best CBT provider in the world.
Dr. Vishal Gulati: (11:33)
In the UK, for example, we have national level data of effectiveness of CBT, and we ranked higher than all other providers because they use the data smartly and we are able to build something out of that. So to give you an example, if the leading drug for depression today was surpassed by another drug that was as much better as Ieso is from other CBT, that would be a multi billion dollar drug.
Dr. Vishal Gulati: (12:02)
So we can build value from data which can be then measured against outcomes. Another example is a company in my portfolio, Zoe founded by a close friend of mine, which launched an app very early when COVID-19 happened for people to just track their symptoms. They now have more than four million users around the world. They have published about a month ago in Nature Medicine, what the clinical symptoms doctors all over the world should be looking for in patients who suffer from COVID-19.
Dr. Vishal Gulati: (12:41)
So just being able to collect all data has given us the superpower, where we have been able to advance healthcare at a speed which would not be possible before.
John Darsie: (12:54)
Noor you focused on investing in emerging markets, mainly the Middle East and Africa region. There's unique challenges to healthcare access in those places. How is technology helping to distribute healthcare solutions in emerging markets?
Noor Sweid: (13:11)
So I think that these questions are always better answered the way that Dr. Gulati did it. So thanks, Vishal, it's through examples. So one of the companies we recently invested in March, and this was pre-COVID, this was a theory that we had starting in January and in March we transacted into a company called Helium Health, which is based in Lagos, in Nigeria. We were fortunate to have great co-investors in that that are enabling us as well, like Ten Cent, an AIC out of Japan.
Noor Sweid: (13:38)
What Helium does is effectively, it's an EMR for hospitals as well as regulators, but then it also had the patient side. So when a patient leaves the hospital or the doctor, they have a report of who they saw, what they said and what the recommended treatment is. Now, if the patient cannot afford the treatment within the platform, they can get a loan instantly.
Noor Sweid: (13:59)
So the different pain points for patients along the journey that got addressed in emerging markets are very unique and are very real. They also apply to a lot of developed markets. So in Europe, a lot of times it's a treatment that people worry about how they're going to afford that treatment, but there's no platform to say, "I want to tell them now." What Helium's done is really worked with the banks and the regulators, as well as the hospitals and providers saying, "It's a lot cheaper to treat the patient now, when they have the flu, the next month, when they have pneumonia."
Noor Sweid: (14:25)
The uniqueness of Helium is that it's online and offline. So you cannot depend on electricity and internet in most of Africa. The need for Helium is because in Africa, less than 30% of hospital visits are documented. So you have a massive problem in a really large population. You want the data, as Vishal was saying, so now they have millions of patient data information on their platform and they're also solving real problems.
Noor Sweid: (14:53)
They've leapfrogged in the sense that it's online offline. So it's like if you take Epic and the Salesforce API that enables a patient, add an app and put it all together, but it's one solution. It's a 20 year old company. It's my Combinator founder, But he's gone back and said, "Here's a real need for real people," and he's able to leap frog.
Noor Sweid: (15:11)
We'll see more and more of these companies. Again, I go back to the financial inclusion similarity. What's the MEPS of healthcare? MEPS came and it changed the way people thought about financial inclusion and what's possible for finance digitally. So what are the companies that are going to come out of emerging markets that are going to change the way we think about healthcare and access to physicians and really push the envelope and take us from inside our box thinking to outside the box thinking.
John Darsie: (15:40)
So Vas, turning to you, you've published over 30 scientific papers and you hold four provisional patents from your research in nanotechnology for the early detection of cancer. Cancer is an area where you've really done a lot of work and specialized. How does technology and data collection and data analysis really accelerating progress in the field of cancer research and cancer treatments?
Vasudev Bailey: (16:07)
I think we will all have agreement with Vishal, Noor, and I that data is the currency of what will transform healthcare. We're at that unique moment in time where we're at digitized biology. When any of you have taken your 23andMe test or Ancestry what have you done? You essentially digitized what would have always been analog, something which would have been tossed away. We're now have access to that digitally to understand what's going on.
Vasudev Bailey: (16:31)
The same thing has happened with your blood pressure or your EKG. In the world of oncology, we have benefited from that as well, real world data and outcomes of how patients have one, done on certain drugs, but also is there a relation between their epigenetic code, the genetic code, to the progression or incidents of disease?
Vasudev Bailey: (16:53)
We've made tremendous progress in the world of oncology using data over the past decade. So much so that the highlights over the last decade in where we have made advances in oncology include one, we've started to use our own immune system to fight cancers. So the idea of personalized cancer therapy is real. We've double up what is the new notion of cancer vaccines, which we'd never thought would have been possible. We have, in the world of diagnostics, where I'd spent my time in PhD, you see companies now that are coming to life like Guardant Health just went public as a $10 billion company. I've invested in a company called Freenome. Let me also give an example.
Vasudev Bailey: (17:35)
In the world of Freenome, what we are trying to do is replace what would normally be the method to detect colon cancer, which is a colonoscopy. For those of you who have had to go get one, it is very effective, however, it's very uncomfortable and the time and the effort needed to prep for a colonoscopy, sometimes deters people from wanting to go get it done.
Vasudev Bailey: (17:58)
So simple question we wanted to answer is, just what if we could have the same sensitivity and specificity of a colonoscopy that you could just get from a drop of blood or from a blood test, would that be possible, but not just from genomics? What if we were to able to combine genomics, mediconomics, proteomics, but bring these things as multianalyte detection, but use data and AI to help in increasing the accuracy of detection for colon cancer detection. That is Freenome. So we've seen massive strides there as well.
Vasudev Bailey: (18:37)
Rest assured, in the world of oncology, it is probably the area in healthcare that has received the most number of dollars. So we will see the next 10 years or so also harvest some of the efforts that have gone into innovation in oncology.
John Darsie: (18:54)
So for our audience, what do you think a realistic timeframe is? I know curing cancer is not really the outcome that you're looking for, but how do we get to a point where cancer is no longer a death sentence for most people into the point where we can really treat most forms of cancer?
Vasudev Bailey: (19:12)
Cancer is a complex disease. It's a multi pathway disease. I think it's really hard for anyone to say that we will forever put an end to all cancers. I think that we can tackle certain types of cancers and make great progress towards treating it.
Vasudev Bailey: (19:29)
We were the first institutional investors in a company called Stemcentrx. It use stem cell therapy to treat certain types of cancers. Fortunately, this company has been the biggest exit in healthcare venture capital. We're excited to have been the first institution to have backed this company.
Vasudev Bailey: (19:47)
I think you will see novel techniques like that, whether it's stem cell therapy, CARs, and CAR T, you will see the idea of in vivo medicine move oncology to ways in which certain things.
Vasudev Bailey: (20:00)
So for instance, if you had breast cancer in 1990s and 1980s, certain types, I think it would be very difficult... it was caught in stage two, three, didn't have a good prognosis. Many different types of cancers, even lung cancer, before the world of Keytruda and Divot, the outcomes were so much worse.
Vasudev Bailey: (20:18)
So I do think there's certain cancers where you can now be diagnosed early and live your life to the fullest and have your cancer managed. That I think is very promising. I'd be curious to hear from Vishal and Noor, but to me, I think it's challenging to say that we'll ever find like one Pinochet for cancer, where we'll be able to tackle all of cancers at one go.
John Darsie: (20:44)
Dr. Gulati, I want to ask you a two part question. One is a followup to everything Vas just said about oncology and cancer research and about AI. AI has a lot of different applications across healthcare, oncology, and this hits home for me because my brother is a radiologist. But how is AI doing things to improve radiology? Do we still need human doctors? Is it just a tool that is going to benefit them and increase the accuracy of their diagnosis? How is AI being applied across oncology and things like radiology to improve healthcare responses?
Dr. Vishal Gulati: (21:18)
Thanks, John. Just to pick up on what Vas was saying, I agree with him entirely that I don't think that we will have a world without cancer. We may have a world where cancer becomes that much less scary and becomes a chronic condition that we manage rather than something we treat radically, which is what we have done in the past. A lot of these advances will come from small gains here and there, all the way from detection, to management, to discovery.
Dr. Vishal Gulati: (21:51)
So it will be a multi pronged approach and we are going to win against this enemy in small battles rather than one big war to end all wars. So I don't think that that's how we will deal with this.
Dr. Vishal Gulati: (22:04)
Coming back to your other question, which is about radiology. Radiology has been one of the first branches of medicine, which has been affected by AI. So there's a lot of abuse of AI in our industry. I'm usually a little bit cautious about trying to, in an unguarded way, say that AI is going to transform or change anything. But specific applications or specific type of AI has had some dramatic improvements in the way the data flows, in the way we make diagnoses.
Dr. Vishal Gulati: (22:44)
So I have been asked this question before, is AI going to eat radiologists? My answer has always been that, we would, but we haven't found enough radiologists to eat because globally there is a massive shortage of radiologists. So I can tell you from the associations of radiologists in the United States or from the Royal College of Radiologists in the UK, wherever I have asked this question, they have all said to me that there are just not enough radiologists. So if you can do something to take some of the load off us, we'll be very, very grateful for that.
Dr. Vishal Gulati: (23:25)
One of my portfolio companies, Kheiron Medical has done just that. They are the first European regulated product for mammogram reading. So they are able to read a mammogram, as good as a human radiologist. What they are now finding in the world of COVID, we had to stop all mammograms in the UK because patients could not visit hospitals. Now we have a backlog of hundreds of thousands of women who are waiting for their scan, which should have happened several months ago. The only way we are being able to deal with this now is by deploying MIA, which is a product for mammograms, right at the front end, which is assisting radiologist as a second reader.
Dr. Vishal Gulati: (24:10)
That one end of the spectrum, if you like in cancer. Now, if you try and imagine how we go further, having better quality images from histopathology and from radiology and applying machine learning will help us characterize patients better. If we can characterize patients better, that is better for clinical trials, we can target drugs to the right patients who are more likely to respond in. Then if we have that data, then it is easier for us to identify patients what treatment they need. So I think that that is one end.
Dr. Vishal Gulati: (24:46)
Then on the discovery side, we will use all the data that's coming out of genomics and proteomics, which is high dimensional data that human brains cannot comprehend. That can be used using specific AI technologies. We can find relationships in there which are going to help us transform the way we treat them. So it's a multi pronged approach, I would say.
John Darsie: (25:08)
So my brother's still going to have a job in 10 years. That's good to hear it.
Dr. Vishal Gulati: (25:11)
Your brother is definitely going to have a job and his job will only get better because he will have a little machine radiologists sitting next to him, helping him get better at what he does every day.
John Darsie: (25:24)
So his wife and my sister-in-law's an emergency medicine doctor, and he gets to just sit there and have a machine given the diagnosis. It doesn't seem quite fair to me [crosstalk 00:25:33]-
Dr. Vishal Gulati: (25:33)
I 100% agree with you. I think your brother is in a much better place.
John Darsie: (25:39)
Noor, do you have anything to add to the conversation about AI and how it's transforming healthcare?
Noor Sweid: (25:44)
So from my perspective, I think the most interesting way that AI is transforming healthcare is that it's personalizing it. So given all the data that Vishal's talking about accumulating, and then layering that on top of the efficacy of different drugs, you're able to ultimately within the information about the genomics of Vas was alluding to get to a point where, as a patient, if you're sick, there's a certain level of expectation that you can have that the treatment recommended to you will actually work for you.
Noor Sweid: (26:13)
Again, like now what we see in medicine is, well, if you are sick, God forbid, you know it's, "Try this," and if this doesn't work, "Try that," and if that doesn't work, "Well, try this." Especially for chronic conditions, you get into this position where, "And there's a side effect and this might work and that hasn't worked."
Noor Sweid: (26:28)
So I think what AI will do is push everything towards, if you have this genomic based and you have tried this before, and that hasn't worked, we've seen the reaction of that on you, then we have a 99% certainty that this other method will work. That applies to medicine as well as to other more holistic treatments, as well as to prevention, as well as to early identification. Because if you have these symptoms for this particular condition, then statistically speaking, based on again, your DNA and your sequence, you might actually also be susceptible to this. So why don't we check that?
Noor Sweid: (27:04)
But I only comes from loads and loads of data that is then being absorbed and the layers and layers of AI on top of that, that gives you this information. I think we're just at the beginning of that. So that level of personalized medicine and more targeted medicine, is something that we all look forward to, because it takes away the uncertainty.
Noor Sweid: (27:27)
Then on the radiology side, we have so many companies in the region and across the world where in developing markets, you have a lot of contributions from well-wishers and people that say, "Here, take these machines." So now we've put these fantastic machines in these remote villages. Then, "You can take x-rays and you can do mammograms, and do all these things." But guess what, there's no one to read these.
Noor Sweid: (27:52)
So you have all those remote teleradiology, as we call it. So then how does AI integrate with teleradiology? Because the accuracy there is not where it needs to be. It doesn't matter how much you've compressed in order to send it over. Again, it's low bandwidth. It's not the internet that we have in some markets. Then somebody else is supposed to read it and send that back. The error rates are much higher than we would like them to be.
Noor Sweid: (28:16)
So if AI can come in and supplement that input and supplement on everything that's done in that space, then that is very much welcome. To Vishal's point, there aren't enough radiologists to eat. So it's definitely something we look forward to because it augments and it supplements, it doesn't substitute as where we come up.
John Darsie: (28:36)
A question from one of our listeners and maybe Dr. Gulati, you can take this or Vas, whoever feels most comfortable, but it's about privacy relating to data. So in a world where AI is eating everything and we're placing an emphasis on trying to gather as much data as possible, but you do have regulation in the United States and in Europe and elsewhere that prevents the oversharing of data, how do privacy concerns factor into the AIs, really infiltration of our entire healthcare system.
Dr. Vishal Gulati: (29:06)
It's a very important question, John, I think that there has been a fair amount of discussion around just collecting lots and lots of data. I think with data, as I always say to all my portfolio companies, is the data is not just an asset, it is also liability. Because it comes with a huge amount of responsibility that you have someone's data and how you're going to use that. So I would say, in addition to machine learning, the second most important job that my founders do is constantly evaluate their data policies and their understanding of what data that they need and how to use it.
Dr. Vishal Gulati: (29:48)
If we are not responsible in the way we are using data and how we are applying it, we could end up destroying this whole industry. This is a very, very important challenge. This is not a problem that just engineers or just doctors or just investors can solve. This is a much wider conversation with the whole world of, what are the trade offs that we are willing to accept in return for getting what we get. I think that this is a very live debate and very, very active in all my companies.
John Darsie: (30:28)
Vas, do you have anything to add to that?
Vasudev Bailey: (30:31)
I agree that it's important. I think that we tend to work with de-identified data whenever possible. So we have no sense of understanding or identifying what we're learning from. The other part, which you see happening in the Valley today is we're working on longitudinal data that is identical to that of a real person, they call it a digital twin and we're generating data to synthetic that you can actually use. Maybe FDA one day will accept that in substitution for real data. So I think it's important and we're all conscious of it, responsible, and it is absolutely a central principle before we move forward.
Vasudev Bailey: (31:08)
But after the world of AI, just really quickly. I agree with Vishal and Noor completely that we are at the start of what is something really special, but I will say sometimes the word AI gets overused, especially here in the Valley. Is it a simple Excel macro, is it AI? Let's actually really talk about that, it's not really AI, come on.
Vasudev Bailey: (31:31)
But if it is, I'll say, you find AI in a lot of strange places and unexpected places where you would not expect. I invested in a company called Eko, E-K-O, which is changing your humble stethoscope. For the past 200 years, a stethoscope hasn't changed. Think about that. Someone is manually listening to your heart and lungs to tell you something is wrong with you.
Vasudev Bailey: (31:56)
What if you could now have the largest database of human sounds, heart sounds, lung sounds, and EKG data, and you truly use machine learning and AI and the algorithms could do better than four out of five cardiologists in detecting and classifying murmurs. You could do an injection fraction, you could do in the world of COVID not be in contact with the patient and yet diagnosis is a crackle or what is going on with your lungs.
Vasudev Bailey: (32:24)
That, I think, is a great application of AI at work, not just here in San Francisco, but anyway. You could be in Nigeria, you could be in the Middle East, you could be anywhere in the world and you are actually scaling up the use of AI. This company has seven FDA approvals, five of which have been in the world of algorithms or AI. They've been able to leave that. We've seen in the world code that another accelerant to the adoption of AI in the world of medicine.
Vasudev Bailey: (32:52)
The last comment I'll have there is, just because you can create something with AI doesn't mean it'll get used by physicians across the world. The key question they should ask is, "Who's going to pay for it? Does it fit into the workflow of physician?" Important principles as you design AI. If anyone's looking to create the next AI solution, do think about that early, because otherwise, it's just cool technology that'll never get used by anyone.
John Darsie: (33:22)
That's fascinating. Let's turn to COVID for a few minutes. I'm sure that's a subject that's at the top of people's minds. So you guys are obviously in the healthcare investing space, the health tech space. We'll start with Dr. Gulati. What's the outlook and timeframe for developing effective therapies, which is obviously one piece that could help us reopen our economy's a little bit sooner? What's the outlook and potential efficacy of vaccines for the COVID-19 virus.
Dr. Vishal Gulati: (33:49)
Thanks, John. I think it is a very topical question and it's not just a million dollar question, it is not a billion dollar question, it's a hundreds of billion dollar question right now if you look at the economic impact of COVID. The human impact is incalculable.
Dr. Vishal Gulati: (34:06)
So in my mind, there are three stages of how we get out of this. The first stage was to try existing drugs to see if any of those work. We have had some things that worked, but by and large the effects are [crosstalk 00:34:25]-
John Darsie: (34:25)
What about President Trump's favorite drug, Dr. Gulati?
Dr. Vishal Gulati: (34:27)
Unfortunately, even though I was very optimistic early on, the data just does not support that hydroxychloroquine has any benefit. So I'm afraid, Mr. Trump will have just built millions of these tablets sitting somewhere in a storeroom in White house. I doubt if they will be of any benefit to anyone.
Dr. Vishal Gulati: (34:53)
So the first generation, if you like, the effect sizes have not been huge. Remdesivir, the effect size is not huge. It is something when we have nothing, then we have dexamethasone, which has a higher effect size than Remdesivir, but still not high enough, I would say.
Dr. Vishal Gulati: (35:14)
The second generation is the new products that we might develop now specifically, and where I'm very optimistic are a number of antibody treatments. This is passive immunization where people will get specific antibodies, which are Lilly's making one, Regeneron is making one, and they're heading some experience or from Ebola, for example, that such treatments could work.
Dr. Vishal Gulati: (35:39)
What I'm trying to look for as well as the therapeutic window, is it something you've given someone's exposed or do you give it at a later stage? So we will find out what that is.
Dr. Vishal Gulati: (35:49)
So coming to the vaccines, I am more optimistic about vaccines than not have been in the last few weeks or a month. I think that the data that we are seeing particularly from the Oxford group is actually very, very good. I looked at the data that came out from the animal experiments, and I think that they have been able to show pretty good antibody response and pretty good T-cell response. So I'm very hopeful.
Dr. Vishal Gulati: (36:20)
What we don't know and no one knows is when we will have sufficient number of COVID infections in the control group to be able to say that the treatment group works. So we don't know whether that will happen in September, October, November, when that will happen.
Dr. Vishal Gulati: (36:36)
Unfortunately, in many parts where they were doing clinical trials, the transmission rates have gone down. So actually, your control group is not getting any cases. So you can't really tell whether your vaccine works.
Dr. Vishal Gulati: (36:48)
So long story short, I'm optimistic about vaccines. I can't tell you how many or if any vaccines we will have in this year, but I'm very optimistic that in 2021, we will probably have more than one vaccine that will have sufficient level of efficacy that is, at least, being given to high risk patients.
John Darsie: (37:13)
So what you're telling me is SALT Abu Dhabi, our conference that we had last December, we're probably not having any in-person SALT conference in the UAE in 2020, and that no [crosstalk 00:37:23] conference last year-
Dr. Vishal Gulati: (37:25)
I'm afraid. I don't think I have good news for you.
Noor Sweid: (37:30)
But, [inaudible 00:37:31], John, you're going to have new one in Vegas next year, which you have to count on.
John Darsie: (37:34)
Hopefully. Inshallah, as they say. Noor, at Global Ventures, have you guys been working on things related to COVID?
Noor Sweid: (37:42)
I think that the UAE is a very special place and there's been multiple responses across the different Emirates for COVID. I think that the contact tracing is a lot more interesting in some of these markets right now than the therapeutic response, which we're leaving to the Lillys of the world.
John Darsie: (38:05)
Ross, how about you? Have you been helping us with the virus at all?
Vasudev Bailey: (38:08)
Yeah, so in February and March, when we started seeing leaders of certain countries go out and promote drugs, but before clinical trials, without naming people, it was important for us to step in and actually do something about it. So we built, at ARTIS Ventures, a comprehensive innovation tracker for the world of COVID.
Vasudev Bailey: (38:30)
So we have tracked every diagnostic, therapeutic, and vaccine that has been created in the world to fight the pandemic. I can tell you, as of today, there are 331 diagnostics that are received EUA or some regulatory approval. There are 145 therapies or treatments. Many of them repurposed, like Vishal mentioned, that are in human trials. There are 31 vaccine candidates that are in human trials as we speak today.
Vasudev Bailey: (39:00)
With that, I would say, we keep a close eye. There are two ways to think about innovation here. Noor is absolutely right. The first one is a public health response. What can you do? Whether it's better masks, better contact tracing stuff to help prevent things. So that's number one. That is sometimes easier to implement and it should happen.
Vasudev Bailey: (39:21)
The second is where we're focusing, investing more leverages in the therapeutics as well as diagnostics. It's the healthcare innovation, which can put an end to the pandemic, hopefully. Well, I would agree with Vishal that I started off a little more skeptical on the vaccine stuff, and I never thought that we'd be able to even get into phase three trials. But then a year it's promising to see that there are two phase three trials that are currently ongoing and we could get data read ups as early as September.
Vasudev Bailey: (39:49)
What is worth noting to everyone is even if we had really positive data for the vaccines this year, it's really hard to manufacture. You can't really manufacture for the mass markets and scale and the supply chain is not built for us to be able to distribute this to everyone.
Vasudev Bailey: (40:04)
But it gives me hope to say that with the vaccines that we made progress in the world of therapeutics, I'm not surprised because we're repurposing drugs to ever found something that would put an end to it. But I'm happy that we have identified things that can help alleviate certain, at least if you're put on a ventilator, it can be made a little bit better and hopefully you'll find other breakthroughs there as well in terms.
John Darsie: (40:30)
In terms of the global society and our approach to how to slow the spread of the virus and how to eventually, develop immunity to it and move past it, there's been some debate about what the right approach is. Sweden, as an example, in particular, that decided to adopt an approach where they weren't going to shut everything down. They were going to try to develop some level of herd immunity.
John Darsie: (40:49)
The virus is obviously something, it's novel. We don't know much about it, but the returns from Sweden have shown that it didn't really spare their economy and they haven't really developed the type of immunity that they were hoping for.
John Darsie: (41:00)
Dr. Gulati, did we make the right decision to shut things down and have these rolling quarantines, or we're going to have to quarantine again in places like Texas and Arizona that had these huge spikes in cases, or is a herd immunity type approach the right approach?
Dr. Vishal Gulati: (41:17)
John, I'm not in favor of the herd immunity approach. I think a lot of the data supports that now. A lot of the herd immunity debate is based around number of deaths. People are saying the fatality rate is X or Y so if we let everyone get infected. It misses two very important points.
Dr. Vishal Gulati: (41:41)
One is that, this disease does not affect everyone in the same way. There are huge variations in who gets this and who doesn't. People in certain jobs, which are generally lower paid jobs, there are a lot of immigrants work, those people are exposed more to this and the impact of this is going to be much, much greater. We should think about the ethical consequences of taking such decisions.
Dr. Vishal Gulati: (42:07)
The other thing which is often missed is that, just because you don't die of COVID-19 doesn't mean everything is okay. We now see the consequences of chronic lung disease, we're seeing neurological complications of COVID-19. So it's not just that, "Oh, it's okay. Just a bunch of old people are dead." It's a lot of old people are dead and you have a huge population of young people who have chronic lung and brain disease. I do not believe that that is the right way to go, but that is my view.
John Darsie: (42:42)
Vas, do you have anything to add to that?
Vasudev Bailey: (42:45)
100% I agree.
John Darsie: (42:47)
So I have a question. During this quarantine, like a lot of other people, I said, "You know what, I want to use this time at home to get healthy." So I started looking at the wearable device market and I said, "Okay, I don't have an Apple watch or a Fitbit. Let me look out there and see what's out there." It was actually a very interesting fact finding mission.
John Darsie: (43:04)
There's a couple of devices, the WHOOP, for example, that the PGA Tour or the Golf Tour in the United States, some players are wearing it. One player while wearing it was able to get readings into his app that basically indicated early signs of COVID. He tested positive for COVID. At the NBA Basketball, they're encouraging their players to wear the oura ring, which is another device that can provide early detection signs for COVID and other diseases.
John Darsie: (43:30)
What is the future of the wearables market and how does that contribute to this data driven future within healthcare? Vas, we'll start with you on that.
Vasudev Bailey: (43:41)
I say the wearables market is very tricky. There is an immense, like excitement and adoption from the hype cycle created for people to want to adopt it. Then past that, how many people... Well, I don't have to add the market research shows that people who had Fitbit stopped using it after six months. That is the case why Fitbit doesn't exist today as Fitbit, because you know what, it's hard to sustain as a company with these wearables over a long period of time.
Vasudev Bailey: (44:10)
I'm not saying variables as a category is a bad category. I don't know if people have found out like what psychologically makes people think that there's not the next device for you to try out. How is the action coming from these devices going to truly change and transform your life? I like ordering these things just because I'm fascinated by them. So I probably opened my closet. I have I think from Stanford, like a pebble, which measures your breathing rate. I have things called [Camigo 00:44:39], which does breathing exercises and meditation. I have things like the ring to measure things.
Vasudev Bailey: (44:44)
So I've tried all of them, but I probably use them for a couple of weeks. None of them are... or even for sleep apnea, you can have an app to try and listen to your breathing and snoring. I did not snore last night, if anyone was curious. So, which is really good, maybe it my caffeine or content. But I'm not sure or overall how useful it is to transform my life.
Vasudev Bailey: (45:07)
So the key thing I'd say is, if you're innovating in the space, always for people coming up with novel solutions, just answer the simple question, "How are you going to add prolonged value to the person using it beyond that first six months of fascination?" If you answered that you do truly do have a business that is worth it.
Vasudev Bailey: (45:28)
For the COVID world, the last part that I'll add, I think is useful. I do think connected devices and connected assistance. Because telehealth without sensors is just Skype and talking to a patient. So the idea of wearables or sensors, alarms are very useful and should be integrated into medical practice.
John Darsie: (45:50)
Skype might say some hypochondriacs, a few trips to the doctor though, don't discount the value of Zoom or Skype. Noor, are you guys looking at wearables at all? Or you have an opinion?
Noor Sweid: (46:01)
Both. Yes. So option D, all of the above. So wearables, in general at large, I think, to Vas' points, "What value do you bring to my life as a wearable beyond novelty." But I think more importantly that the accuracy of the data capture varies from one wearable to another. Until people are convinced that this is actually it'll be accurate, and based on this data, there is some angular outcome for me. It's always an interesting novelty outcome.
Noor Sweid: (46:32)
No one would have can't now that's actually really interesting, is in the FinTech space and it helps a woman and it's more like a wearable. So it's the undergarments, they are on the bras measuring different things that are important for women with breast cancer, for hearts.
Noor Sweid: (46:52)
Again, going back to the woman versus men. So you have to think on FinTech side, you'll have a lot happening and there's a lot in general medicine and healthcare where people have come forward and said, "I could move on these miles, and the moment they look very different, if we only one run man." And guess what? 95% on the one run man.
Noor Sweid: (47:10)
So now you're coming back to all of these wearables and all this data capture for females round the world, not just males to say, "How is this different? What data can we capture? How are women's hearts different to men's hearts?" However, the faster we capture that data, the better medicine we can provide for women around the world and the fastest way to capture that data is wearables at this point.
Noor Sweid: (47:33)
So it's really a data capture exercise that people are plugging into. So we're looking at a few. The one I mentioned is coming out of MIT, so you're seeing a lot, but they have to be very focused on, "Here's the value I'm adding, here is how long you need to do this for," either it's a treatment or it's prevention, but it has the beyond the novelty.
John Darsie: (47:54)
So we have a couple of audience questions before I let you guys go. Dr. Gulati, the first one's for you. What's the best approach for a clinical physician to get started in venture capital, if you don't have a business background? What was that transition like for you?
Dr. Vishal Gulati: (48:08)
Thanks for this question. I've been asked this question a few times and I find that most people I know who are in VC, none of their journeys are ever representative. In other words, there isn't like a cluster of things that they have done. So in this call, there are three investors. Noor, Vas, and I, all three have had very different journeys to get to doing exactly the same job in different parts of the world.
Dr. Vishal Gulati: (48:40)
So there isn't a highly representative way how a physician or a scientist can become a venture capitalist. What I find common in the colleagues that I work with and people in my industry is that, if you will come from a medical background, you generally have a research background with it. You're not just a physician who's a frontline physician. So you've had some encounter about developing new things and you have that excitement of making something new. I think that that helps you do that.
Dr. Vishal Gulati: (49:17)
Also, when you first leave medicine and go into venture capital, it is actually quite disconcerting because venture capital is... healthcare or a bigger doctor is very specialized. So you have a very, very niche specialty. So for example, my specialty was a certain type of immune cell, which is only found in the liver and it responds to only one type of virus. So that was my specialty.
Dr. Vishal Gulati: (49:43)
But when you go into venture capital, you can no longer afford to have a specialty which is that narrow. So you have to retrain yourself in order to learn new things really, really fast. If that is the attitude you have, and that is the life you want, then I think you should definitely consider venture capital.
John Darsie: (50:02)
Next question is for Vas. You're on the board of a project called the Trevor Project, which is a company that provides mental health counseling to young LGBTQ individuals. As we know, technology can be a double edged sword and the impact it has on young people's brains. Vishal, touched on this earlier, how can technology be leveraged in a positive way to positively affect our mental health? During the COVID-19 crisis, it's especially relevant as people sit and stir in their homes.
Vasudev Bailey: (50:35)
Yeah, I think mental health is still so taboo in so many markets and people wanting to seek help is... and having even grown up in India, I can tell you that the idea that depression is something, "Is it real or something is wrong with you?" It's just almost... even an educated families. That was partly what motivated me to be part of an organization.
Vasudev Bailey: (50:58)
Even as an investor, I look and seek for things, and I'll connect Vishal about what he's working on in the mental health space, as he said he is. But in terms of technology, being an enabler to help in preventing... like you'd look at the United States, it was fascinating for me to find that the number one cause of death for people under the age of 21. So for youth, one of the major causes is a suicide and it is absolutely preventable, is absolutely one where we can help and provide the tools and methods to help and even if you save one life, it is something we have done right.
Vasudev Bailey: (51:35)
Technology has been an important part. So with Trevor, the way in which they've done that is one, they started off as an organization by providing phone support. But now they moved into using technology by using chat-based support because that is where younger people are moving. But you see where technology is being used as they even have NLP, as a natural language processing, without identifying, with anonymous, but you could still pick up triggers and understand who has a higher propensity of taking their own life. So you know where and how you can intervene.
Vasudev Bailey: (52:09)
But not just that you have a clinical path of how to respond as well. When you learn from a machine time and time, humans may have a different way of responding to a certain question someone has asked, but a machine is very clinical about it and tells you exactly how you should respond for the best outcome.
Vasudev Bailey: (52:27)
So you can train mental health professionals to also respond in certain ways that gives you the best possible outcome.
John Darsie: (52:35)
Well, thank you all so much for joining us from different parts of the world, Dr. Gulati from London, Noor from Dubai, and Vas from San Francisco. That's the pleasure of just work from home environment is that we've been able to have a lot of these conversations that might not have happened if not for the circumstances. So thanks everybody for tuning in. Noor, Dr. Gulati, Vas, thanks again for joining us.
Dr. Vishal Gulati: (52:56)
Thanks John.
Noor Sweid: (52:57)
Thank you.