0:00

I'm Matt Pillar , host of the Business of Biotech podcast

0:02

, and if you're listening to my voice right now

0:04

but not seeing my face , maybe you

0:07

haven't heard that we've launched a new Business

0:09

of Biotech video cast page under

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the Listen and Watch tab at bioprocessonlinecom

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. There you'll find hundreds

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of videos of my interviews with biotech

0:18

builders , categorized by topic

0:20

, like finance and capital markets , regulatory

0:23

discovery and manufacturing . Don't

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try it if you listen while driving , but

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be sure to check it out when you get where you're going . Go

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to bioprocessonlinecom , hit

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the listen and watch tab and choose

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business of biotech in the dropdown .

0:41

Some of the best conversations to be had are

0:43

with biotech execs who , in

0:46

a life previous to developing therapeutics

0:48

, were practicing physicians , having

0:51

exercised patient care from the

0:53

bedside . Their worldview is often

0:55

a little more empathetic and they often draw

0:57

brighter lines between the drug

0:59

development work done in industry and the patient

1:02

needs their companies seek to address work

1:05

done in industry and the patient needs their companies seek to address . I'm Matt Pillar . This

1:07

is the Business of Biotech , and my guest on today's show is unique in that he never

1:10

fully turned the corner when he entered

1:12

the biotech leadership ranks . He's

1:14

founded and led a couple of biotechs

1:17

now including the exciting new company he's found

1:19

in Tome Biosciences . He

1:21

even held a leadership post at AstraZeneca

1:23

for a while , but he's also still

1:26

a practicing physician at Brigham and

1:28

Women's Hospital . On today's

1:30

episode of the Business of Biotech , Dr

1:32

Rahul Kakkar , president and

1:34

CEO at Tome Biosciences , joins

1:36

us to talk about his worldview as a physician

1:39

slash biotech exec , how

1:41

that perspective informs his affinities

1:43

and his approaches to different modalities

1:46

, the gene therapy tipping point

1:48

and a whole lot more . Dr Kakkar

1:51

, I'm thrilled to have you on the show and welcome

1:53

.

1:54

Pleasure is mine . It's Rahul , please .

1:56

All right , there you go . We'll go with that from

1:58

here on out , and

2:00

here's where I want to start . I want to start with story

2:03

time , rahul . That's where I want to start , because

2:05

there's a story , I'm sure , in

2:07

the transition from your undergrad

2:09

to life sciences , because

2:12

you earned your BA at

2:14

Tufts in art and architectural

2:16

history and then at some point

2:18

and this is the story I want to hear you decided you're going to

2:20

stick around for an MD . You

2:22

know , I don't see that every day , so tell us

2:24

tell

2:33

us what was going on there ?

2:33

Yeah , I was , I was . I was laughing as I saw the the , the question you were

2:35

going to ask . I was like you really had to dig deep in the internet to find that one . Given

2:38

how long I've been around I

2:41

have been , I guess there's

2:43

two answers to that One . I've

2:46

been a bit of a black sheep . Everywhere I've gone in my professional career , um

2:48

, and my pivots , uh

2:51

, in my career , whether it was coming out of undergrad

2:53

, um , or even moving from

2:56

academia and industry , has been a series

2:58

of um . I guess

3:00

, to be kind , you could call it epiphanies

3:02

more like panic attacks were probably

3:05

a more accurate way of saying it . But I

3:08

fell in love with

3:10

art and architectural

3:12

history over the course of my undergrad . I actually

3:14

fell in love with it in high school , to be honest

3:16

. I remember I was the only one sitting

3:19

in the basement of the converted church

3:21

taking the architectural history AP class

3:24

exam in my in high school

3:26

. That was an

3:28

. That was an option for you in high school . It was

3:30

, it was . I was the only

3:33

one sitting in that basement taking the exam

3:35

. Cool , I I

3:37

loved looking at

3:41

the human experience

3:43

from the perspective of the

3:45

things we've built and the things

3:47

we've made . I think they tell a

3:50

much more vibrant and interesting story

3:52

of who we are , rather

3:54

than the way history is usually taught

3:56

, and so that's probably

4:00

because I couldn't stay awake in history class . That's kind of how I

4:02

chose to really understand , you

4:04

know , questions that all of us

4:06

think about at some point in our lives , which is you

4:10

know , where have we been and where

4:12

are we going ? Fundamentally , though , moving away from

4:14

the study of art

4:16

and art , architectural history or even

4:18

consideration for a career as

4:20

an architect , which was a serious consideration for a while

4:23

, um rested

4:25

on , um , like many things , the guidance

4:27

of my parents , um where

4:29

, you know , moving into the sciences and medicine

4:31

, um was seen as a

4:34

more stable career , um

4:37

, a more reliable career , and my parents

4:39

were immigrants to this country , um

4:41

and worked their tails

4:43

off um to go

4:46

from effectively nothing Um

4:48

. You know , my father's family , uh

4:51

was one of those families that had to move from what

4:53

is now Pakistan into India when the British cut

4:56

the cut the country Um , and so

4:58

, literally , when he came here , he had nothing to his

5:00

name , um , and worked very , very hard to put

5:02

me through school , and so his

5:04

advice was . You

5:06

know you can love and study

5:09

whatever you'd like , but at the end of the day you've

5:11

got to support your family . So

5:13

that was sort of the push into the sciences

5:15

. But I never was satisfied

5:18

with just I don't want to say just , but with becoming a

5:20

practicing physician and practicing my entire career , and so that kind of led to the second panic

5:22

attack becoming a practicing physician and practicing my entire

5:24

career and so that kind of led to the second panic

5:26

attack , which was at the end of my

5:28

cardiology fellowship at MGH , when

5:32

again I really wanted to be part of the story

5:34

of how we move in

5:38

this case human health , but our society forward , rather

5:41

than being someone who simply practiced .

5:44

Yeah , yeah , that's , wow , that's a's . That's

5:46

pretty cool story . I still I . There's still conflict

5:48

though happening for me , like between the

5:50

sort of the , the liberal arts bend

5:53

, you know the right and left side of the brain . Right , like

5:55

, how , how do you , how do you reconcile that , like I

5:58

don't know , making the leap , I mean I could see

6:00

, from art and architectural history to perhaps

6:02

architecture , but then you know there's

6:04

a leap to perhaps architectural engineering

6:07

, and then it's a whole different ballgame to leap into

6:09

medicine . Right

6:11

, like , do you ? Was

6:13

there any conflict or struggle internally

6:15

with you in terms of , like you know the right

6:17

and left side of the brain , kind of arguing with one another about where

6:20

your true skills and passions lie ?

6:22

Oh , intensely , intensely . So

6:24

I actually got into medical school early in my second

6:26

year of college and so that really

6:29

opened up the last couple of years of college

6:31

to really study whatever I wanted , which is where I

6:33

focused on art and architectural history and

6:37

I actually took a year off because

6:39

I seriously considered moving away from

6:41

the sciences , because I was already in , yeah

6:44

, accepted to Tufts Medical School . I

6:46

was now , you know , graduating with a major in

6:48

art and architectural history or art history with a focus

6:51

in architecture , and

6:53

that struggle that you allude to

6:55

astutely was front

6:57

and center when I decided I'm not really sure I

6:59

want to go to med school at the end of the day . So

7:02

my father's company , which was in Lynn Massachusetts

7:04

, a steel manufacturing company , needed a draftsman

7:07

, and so I went and worked in the family business

7:09

for a year . Really , yeah

7:11

, the Logan Airport Terminal , a

7:13

light fixtures , what I worked

7:15

on , kind of

7:17

drafting those out for

7:20

, lifting the plans from the architect's plans and

7:22

then detailing them out so our shop could actually

7:24

make the curved steel to

7:27

go into the soffits . And

7:29

after that year of

7:32

essentially working in boots

7:34

on the ground in a

7:37

steel manufacturing company , going

7:39

out to the site , to Logan Airport , seeing these things

7:41

fabricated in the plant and then installed

7:44

it . I

7:46

don't know what it is , but it's almost like it got out of my system

7:48

. At the end of that year came along and I said you know what ? I've

7:50

got this , I've got this acceptance

7:52

at , at , at medical school , and

7:55

I think I'll regret

7:58

it if I don't give it a shot . And

8:12

um , I I went , uh , you know , matriculated and was happier than I've ever been . And I I don't think

8:14

I would have really put heart and soul into

8:16

medical school had not had , I

8:18

not had that experience . And today gap

8:20

years are common for people going

8:22

into medicine . It wasn't at the time , back

8:25

in the 1800s , when

8:27

I went to med school .

8:29

Oh no , don't say that . I think you and I are roughly the same

8:31

age , so let's not go there .

8:34

But I think they're incredibly important because

8:36

I think it's very hard to

8:39

relate to patients who

8:41

are in many cases , decades older than you

8:43

are when you're a med student or an early resident , unless

8:46

you've gone out there and actually experienced

8:48

some part of the world um

8:51

, some of my um , some

8:53

of my classmates who I respected

8:55

the most had traveled the world for a year

8:57

, um in their gap years um

9:00

, and , like I said at the time , that was not the norm

9:02

. So I think , particularly

9:04

if there is in medicine

9:06

, it's in many ways a humanity

9:08

in and of itself and

9:11

I think to really do patients justice

9:13

, you have to have some real world experience

9:15

yourself . And I think getting that early

9:17

on is incredibly

9:19

important and I actually applaud the move to more

9:21

people taking gap years before they head into

9:24

the rigors of medical school and residency .

9:27

Yeah , yeah , you mentioned

9:29

the patient exposure early on

9:31

and you know , more

9:33

often than not , when I talk with a physician

9:35

turned founder or physician turned biotech

9:38

builder , the physician part is planted firmly in the

9:40

past . The physician part is is planted

9:42

firmly in the in the past . You

9:45

continue to practice and

9:50

you just mentioned that you couldn't see yourself practicing , you know , being a practicing

9:52

physician for the duration of your career . Yeah , you continue

9:54

to do that , even as you build biotech businesses

9:57

. Why , why do you ? Why do you choose

9:59

to continue to practice right now ?

10:00

You know I have such incredible respect

10:03

for physicians who practice

10:05

full time . It's become

10:07

an incredibly difficult industry . The

10:10

course of my career of practicing

10:12

from 2011 , when I graduated

10:15

from my fellowship , to now even it's

10:17

only become more fractured . The

10:21

number of individuals going into medicine

10:23

and practicing has decreased over time , and

10:27

the pressures that physicians face day

10:29

in and day out , battling

10:31

not just human disease but

10:34

battling a system that doesn't serve them or their

10:36

patients , takes an incredible

10:38

amount of patience and dedication

10:40

, and so my hat's off to them . Um

10:43

, I'm not good enough to to weather

10:45

those kinds of daily slings and arrows that

10:47

that my PCP does , for

10:49

instance , um , when

10:51

I um when I left

10:54

mass general , I finished my fellowship and

10:56

went to AstraZeneca . Um , the

10:58

dirty little secret is I actually left MGH without

11:00

a plan . Um

11:03

been um doing

11:05

some consulting slash intern work for brian

11:07

roberts at venrock . Um really

11:09

open to my eyes to the um

11:11

ecosystem of venture investment

11:13

and biotech . This was about

11:15

the last six months or so of

11:17

my cardiology fellowship , so would have been

11:19

end of 2010 , early 20 into 2011

11:22

, first half of 2011 , and

11:24

fell in love with the translation of

11:27

science to useful

11:29

tools , diagnostics and medicines , and

11:31

Brian offered me to come join him in California

11:34

, which was , for me , a

11:36

dream come true . But my

11:38

wife at the time said we're

11:40

both in medicine , we're planning

11:42

to to have children , all our parents are

11:45

out here and you want to go where ? California

11:47

? I don't think so , which

11:50

was wise because it would have been very hard to

11:52

raise a family being so far away from

11:54

the infrastructure , as

11:56

it was of grandparents and I grew

11:58

up without grandparents since they were all in India , so I definitely

12:00

wanted my kids to have their grandparents around

12:03

, but I left , you know , saying

12:06

no to MGH and

12:09

and and hats

12:12

off to Brian Roberts for continuing to be a mentor and a friend

12:14

after I told him no all those years ago , which

12:17

was a hard , one of the hardest professional decisions I've

12:19

ever had to make in my life . My life , um

12:21

and um

12:24

, and I , at that point

12:26

, I continued to practice because I had

12:28

, I think , 2011

12:30

, um

12:39

, yeah , 2011, . You know , we were starting a family and and I didn't

12:41

have a stable job , and even when Don Frail at AstraZeneca rescued

12:43

me from kind of wandering , wandering a

12:45

wall fam , looking for a job and

12:48

Cambridge , I still didn't know what was going

12:50

to happen in biotech and needed to provide

12:52

for my family . So at first it was really necessity

12:55

and I and I will say

12:57

I did get a bit . I was working at the Winchester hospital

12:59

, which is a small community hospital town I grew

13:01

up in , actually Winchester mass , um , pulling

13:03

intensive care unit shifts overnight , um

13:06

, and then heading into astrazeneca during the day to do drug

13:08

development , and it's the kind of thing you can do

13:10

when you're in your early 30s because you don't need

13:12

a lot of sleep . It is definitely not something

13:14

I can do now , um , but

13:17

at first it was a necessity . But over those first

13:19

several years I just found that

13:21

there was a thrill , thrill

13:23

of being up all night a

13:25

patient in septic shock , throwing in a

13:27

line , doing the right things

13:30

to pull them through the night and give them

13:32

a chance at the light of day to

13:34

overcome their infection or their

13:36

cardiogenic shock or whatever they were going

13:38

through . And

13:41

you know , I said to myself at the time when I

13:43

hit 40 , my biotech career

13:45

is doing OK , I'll stop practicing . And

13:48

I hit 40 and I realized I couldn't

13:50

give it up . And now I'm coming

13:52

up near 50 . I'm not

13:54

sure I'll ever stop . There is , even though

13:57

I haven't been in

13:59

strict cardiovascular drug development

14:01

since my first company , since Corvidia , although

14:03

there are some cardiovascular programs that we're thinking about

14:05

here at Tome . In fact , I just came out of a meeting where we're discussing

14:08

one of our first potential cardiovascular

14:10

targets , which makes me incredibly excited

14:15

. There is a cross-fertilization of

14:18

going into the hospital

14:20

one week a quarter , which is about what I do helping

14:24

patients and their families understand the risk

14:26

benefit of whatever procedure

14:29

, surgery , um

14:32

, even just medicine

14:34

that is medically indicated , and

14:37

then coming back to tone and

14:40

really thinking about the

14:42

programs we're pursuing , not

14:44

from will they work in

14:47

a mouse , in a monkey , in a what

14:49

have you ? But ultimately , if

14:51

I were to try to prescribe this drug

14:53

to a patient of mine , what's

14:55

the conversation I would have ? What's

14:57

the risk benefit ? Could I hand

15:00

on heart and ethically make

15:02

that argument to my patient ? Whether

15:05

they are my patient , my family member , what

15:07

have you ? So it's , it's grounding , it's

15:09

incredibly grounding and

15:12

it's exhausting , but

15:14

I can't imagine stopping .

15:16

Yeah , yeah , I mean that

15:18

. That . You know that . I guess that's the assumed

15:20

sort of physician . You know

15:22

biotech leader connection , right . The

15:26

assumed sort of physician . You know , biotech leader connection , right . Where is there perhaps still conflict

15:28

? Or have you seen conflict between the two roles

15:30

that you play ? Now I keep focusing on

15:33

conflict . I don't mean to do that , I don't mean because

15:35

I'm negative conversation , but I

15:37

mean you know , even in your personal life , like that's gotta

15:39

be , it's gotta be tolling on your family or taxing

15:41

on your family , I'm sure , to some , some degree , during those

15:43

weeks where you're , you know , still

15:46

practicing or For sure

15:48

.

15:49

I think the conflict comes when

15:51

I routinely particularly

15:54

given that Tom is in cell and gene therapy right , which

15:56

are some of the most expensive areas

15:58

of medicine , and

16:01

I go into the hospital

16:03

and I

16:06

want to put a patient on a fib , on

16:09

apixaban , which

16:11

is a branded blood thinner , and

16:13

there's two to three other

16:15

drugs in the same drug class that I could choose

16:17

from . That's my preferred because

16:20

it doesn't have as much danger

16:23

when somebody has kidney disease as well and a lot of cardiovascular

16:25

patients have kidney disease and

16:27

myself and the team , whether it's a

16:29

nurse , practitioner or residents , have to cycle through

16:31

drug after drug in

16:33

the drug class , potentially to a

16:35

drug that's less ideal because

16:38

their , their insurance company won't cover

16:40

it . Um , and we , daily

16:43

we are dealing with patients being discharged

16:45

and having to switch medicines

16:47

because they can't get coverage for

16:50

because , because whatever the drug that

16:52

is ideal for them at least in my judgment , is ideal

16:54

for them , isn't covered . Um , these

16:57

cost considerations come in routinely

16:59

in decisions around which drug to choose

17:02

. Um , and going from

17:04

that , and these are , these are drugs that are a few thousand

17:06

dollars a year , never mind cell and gene therapy

17:09

, which are , you know , are priced in the millions , um

17:11

. And so there is a conflict which is over

17:14

time and you know , tom is still very early , we're still pre-clinical

17:16

but over time , how

17:19

do we craft a , a

17:22

commercial strategy around

17:24

cell and gene therapy that is still grounded

17:27

in the fundamentals of

17:29

value to the patient , more

17:32

so than how do we maximize

17:35

our return ?

17:36

Do you struggle to put , like keep

17:38

that in perspective in these early days

17:40

at home , or like is it your

17:42

sort of natural inclination to want

17:44

to fast forward to tackling that problem

17:47

, given that you've got that patient exposure

17:49

and the payer experience on

17:51

a regular basis ?

17:53

Not , not as much . I mean , I think you know we are

17:55

many , many years away from approvals

17:58

, not as many years away from the clinic per

18:00

se and

18:02

and honestly , you know if , if these drugs

18:04

work , we'll be doing good for patients , even on

18:06

a limited basis in early clinical trials

18:09

. I don't necessarily

18:11

want to fast forward it , because I think you know these

18:13

are very , very novel technologies

18:16

which are irreversibly

18:18

manipulating the genome . I

18:20

think the caution

18:23

that we and others in this CRISPR

18:25

DNA space are taking is prudent

18:27

.

18:29

You mentioned a little bit earlier

18:31

. You mentioned that you know , when you got bit

18:33

sort of by the venture capital bug and

18:35

started learning a bit about translational

18:37

science and I mean that's you

18:39

know that's exciting stuff , right , no-transcript

18:57

. Had

19:08

you had prior to that exposure , had you had any translational experience , perhaps in academia

19:11

?

19:11

Like , had you worked in any labs ? Did you kind of have a sense of what that was all about when you

19:13

were , when you were exposed to it in industry ? Um , zero and uh but , but , but the differences

19:15

. I thought I did , but looking back I had no idea

19:17

what I was doing . Um , in fact , when I was working

19:19

in the , one of the reasons I

19:21

chose the lab that I worked in as

19:23

part of my cardiology fellowship , which is a lab

19:26

of Richard Lee at the Brigham , it

19:28

was because Richard was very entrepreneurial , had started

19:30

several companies , had always had this translational

19:33

bent , but

19:35

you know , he and I have

19:37

tremendous respect for him . We had a great time in

19:39

his lab but we butted heads in

19:41

a collegial way . But

19:45

we butted heads because all I wanted to do was take the molecule I was working on

19:47

that that the science at the time was suggesting was cardioprotective

19:49

, and move it into pig

19:51

studies . So we could move it into human studies . And

19:54

, and Richard's advice

19:56

, which was absolutely correct , was , if you're going to have an academic

19:58

career , you need to keep chasing that

20:00

molecule in a dish , because that's where you're going to write your next

20:02

grant on . Keep chasing that molecule in a dish , because that's what you're going to write your

20:04

next grant on , um . So I knew I had an instinct to see this

20:06

, you know , to see molecules move

20:09

into into human medicine , um

20:11

and see what good they can do Um

20:13

. But I was incredibly naive at how complex

20:15

and how difficult um that

20:18

process actually is .

20:19

Yeah , how did you , uh , reconcile

20:22

that ? Like what , what was the process to

20:24

getting to the point where you're like , okay , you know , I

20:26

need to , I need to take a beat . This is

20:28

how this industry works . Like , what

20:30

was , what was sort of your modus operandi

20:32

during those that transition , I guess

20:34

, in your career ?

20:35

Yeah , so

20:39

it was very much . I need to

20:41

learn from the

20:43

best person that will have me , and that's

20:45

why I think Brian was was , for

20:47

me , an inspirational figure as an investor

20:49

, um and um

20:51

, someone who I continue to value as a friend and

20:53

mentor , and someone who , um

20:55

, having never actually been able to directly work for him

20:57

, has always been sort of regret in my career . Um

21:00

is is that I was very for him

21:02

has always been sort of regret in my career is that I was

21:04

very , very fortunate . Lightning

21:09

struck twice in this case , where Don Frail was building a group

21:11

at AstraZeneca that was focused on drug repurposing and took

21:13

a flyer on me . He was coming

21:15

over from Pfizer building a group

21:17

that was a reorganization

21:20

of an existing structure within AstraZeneca very

21:22

experienced drug developers , phd drug

21:24

developers and a few MDs

21:27

as well and he

21:29

took a flyer on hiring

21:31

me who had absolutely zero industry

21:34

experience and the only one in the group that had zero

21:36

industry experience . But

21:38

what I thought to myself at the time

21:40

was okay , this isn't , this isn't venture , which

21:47

is where I thought I would end up , but I am going to learn how to develop a drug from these

21:49

individuals , from Don and from the team , um at AstraZeneca , and so my

21:51

solution to that problem , um

21:54

and that conflict , was uh , try to align

21:56

myself with um , with

21:59

the best in the business .

22:00

Yeah , it's an interesting . Uh , it's a

22:02

beautiful segue . Rahul , you just gave me the

22:04

most beautiful segue because in

22:08

my digging right Like my PI work before

22:10

I got on the phone with you I

22:12

found your title at AstraZeneca , and

22:15

you know I love the way you put it . You know , don sort

22:17

of like scooped you up and said hey , here's a place

22:19

for you to get some footing

22:21

while you get your family started and decide whether

22:23

you want to practice for the rest of your life . Um

22:25

, you were director

22:28

for emerging innovations , scientific

22:30

partnering and alliances . It's

22:33

that's probably a one of a kind title

22:35

, right Like you're talking about the

22:37

position that you were , you were , you were , uh

22:39

, working your way into there as being sort

22:41

of a first of its kind position , and that

22:43

sounds like a title that's given to someone who's like

22:45

hey , this is a first of its kind position . What

22:48

did that all mean ? What were you doing ?

22:51

Yeah , astrazeneca was building a

22:53

drug repurposing group , which basically means a

22:55

group that was tasked with looking at all

22:57

the molecules across the portfolio

23:00

of the organization and we really

23:02

had a broad remit uh , molecules that were parked

23:04

, molecules that were still active , um

23:07

, and looking orthogonal , which

23:09

is to say , if a drug like

23:11

the drug we spun out , the anti-il-6

23:13

, many , five on one , seven , it was in the

23:15

metamine portfolio , um , which

23:18

obviously metamine was acquired by AstraZeneca several

23:20

years ahead of this was

23:23

active in development for rheumatoid

23:25

arthritis . And

23:27

you know , partly based on

23:30

my interest in inflammatory

23:32

mechanisms of cardiovascular disease , myself

23:34

and another scientist thought

23:36

, wow , this molecule might be really

23:38

interesting for cardiovascular disease . And we

23:40

did some preclinical work . We had some budget to do mouse

23:43

studies and to retrospectively

23:45

analyze some of the

23:47

large cardiovascular trials that

23:49

AstraZeneca had run and to form

23:51

this hypothesis around could IL-6

23:54

be an interesting cardiovascular drug

23:56

? But that's really what this group was designed

23:58

to do . It was designed to look at molecules that were

24:00

in the portfolio and find

24:02

indications and diseases which

24:05

were rational but never

24:07

originally envisioned by

24:09

the scientists that developed the drug in the first place

24:11

. And we had several

24:13

successes of drugs that showed

24:16

positive phase two data

24:18

. I think the

24:20

flaw in the ointment or the fly in the ointment . The

24:22

flaw in the model was , if

24:25

we hit a positive

24:27

endpoint , positive trial , whether it was preclinical

24:29

study or clinical study what

24:32

do we do with it ? Astrazeneca wasn't committed

24:35

to then advancing that

24:37

drug forward just because it was positive

24:39

, and so I think it was a group that continues

24:43

in a different form today . But

24:45

I think I was there during some of the most

24:48

creative and exuberant time for

24:50

that group when we had fresh budget

24:53

, fresh ideas . But

24:55

I think the flaw in the model was

24:57

when our positives

25:00

hit the organization didn't know

25:02

what to do with it , and that was sort of why

25:04

Corvidia started , because the IL-6 program had

25:06

a lot of good scientific evidence for

25:08

it , but the cardiovascular group at AstraZeneca

25:11

it was completely off the strategy for them , so we had to

25:13

spin it out to move it forward . There's plenty of ideas

25:15

that just unfortunately didn't

25:17

go anywhere because they couldn't be spun

25:19

out and they couldn't be spun in .

25:26

Yeah , go anywhere because they couldn't be spun out and they couldn't be spun in

25:28

. Yeah , and that's a . That's a , it's . It's a greater problem than just the problem . It was

25:30

that AstraZeneca . Are you familiar with David Fagenbaum ? At every cure , I mean you know it's

25:32

a , it's a fascinating concept . I mean , here's

25:34

a guy who had a rare disease that

25:36

he functionally cured himself

25:39

in a in an end of one trial by

25:41

trying different things out , and now it's his life's

25:43

mission to repurpose

25:46

drugs , you know , to get a headstart . But

25:48

I imagine that in more organizations than

25:50

AstraZeneca , that sort of functional

25:52

hurdle would be the big hurdle of chase

25:54

, like who wants to take this ? Like we think we've got something

25:56

we're not equipped or you know

25:58

we can't facilitate us development . Who wants

26:00

it Right ?

26:02

Yeah , now you're absolutely right . It is an industry

26:04

wide problem and it has been an industry wide problem for

26:06

over a decade , and there

26:08

are success stories , to be clear . But

26:10

those are the exception , not the rule .

26:12

Yeah , yeah , this is

26:14

another nice segue to the

26:17

next set of questions I wanted to ask you about because

26:19

you mentioned that sort of got Corvidia off

26:21

off the ground of questions I wanted to ask

26:23

you about because you mentioned that sort of got Corvidia

26:25

off the ground .

26:26

You went on to found Corvidia . Yeah , I was founder and chief medical officer

26:28

.

26:30

Yep , and we can talk about that for a little bit . But from Corvidia

26:32

you went on to , let's

26:35

see , you

26:37

went on to that was acquired by Novo

26:39

Nordisk , correct ? So we were at Pandion

26:41

before that , before Corvidia .

26:44

Or was it the other way around ? We were at Pandion

26:46

before that , before Corvidia , no , or was it the

26:48

other way around ? It was the other way around . So Corvidia

26:50

was acquired by Novo in 2021 . Sorry

26:53

, 2020 . I'm

26:55

holding my breath because that compound

26:58

is now in phase three in a large

27:00

cardiovascular outcome trial , and

27:03

so we'll know in a couple of years

27:05

whether that first foray

27:08

, that first hypothesis you

27:15

know , generated between myself and another scientist at AstraZeneca

27:17

who founded Corvidia with me , actually will do patients any good

27:19

. Hypothesis was hatched in 2012

27:21

. And by 2026

27:24

, maybe 2027 , we should know

27:26

if it actually bears fruit . But but

27:28

, my hat's off to Novo for really seeing

27:31

and believing seeing our seeing and believing our

27:33

data and the promise of the drug . But in 2019

27:36

, at the end of the summer 2019 , I

27:39

was asked by Alan Crane and Polaris to become

27:41

CEO of Pandion Therapeutics .

27:44

Yeah , Okay . So , and this is where

27:46

I'm going with the questions . So Corvidia

27:49

was working in antibodies and you went to Pandion

27:51

, which was acquired by Merck for a

27:53

couple of billion dollars . They were an immune modulator

27:56

company and you know I'm interested in

27:58

that story as well . But then the big

28:00

question is , you went from there to Tome , which is

28:02

selling gene therapy . So now , like

28:04

you're checking off , you

28:06

know you're checking off boxes in terms

28:09

of modality

28:14

, right . What

28:16

is your

28:18

, I guess

28:20

, rationale between modalities

28:22

and indications in terms of what

28:25

Rahul Kakar decides he's going to do with his life

28:27

next , Because you're kind

28:29

of chucking them all off right now .

28:31

You're absolutely right . So Corvidia was a biologics company . Pandion was a biologic

28:34

immunomodulatory biologics company working in autoimmune

28:36

disease , whereas obviously Corvidia was a biologics company working in cardiovascular

28:39

disease disease , whereas obviously Corvidia

28:41

was a biologics company working in cardiovascular

28:43

disease . So a big shift in therapeutic

28:45

area . But I think the theme here

28:47

has been Corvidia

28:49

was really a single asset company . Yes

28:55

, there were a couple of other things we were working on , but functionally the lion's share of

28:57

the capital and why the company was acquired was the lead asset . I

29:00

did try to make

29:02

Corvidia a platform

29:04

company . We had done some

29:06

interesting work using human genetics to validate

29:09

IL-6 as a target in cardiovascular

29:12

disease and we recognized that the way we did that

29:14

validation was by

29:17

triangulating the function of different genes

29:19

. It wasn't a simple like nature has mutated

29:22

this gene and that tells us it's really

29:24

important in this disease . It was actually the triangulation

29:26

of a pathway involving

29:29

multiple different genes that led

29:31

us to believe that IL-6 was going to be important in cardiovascular

29:33

disease and we

29:35

had this idea that this

29:38

is very , very complex

29:40

, multidimensional biology that

29:43

is very different than the linear , reductionist

29:45

biology that we usually prosecute

29:47

. And would a computer

29:49

program looking at transcriptional

29:52

data allow us to find more

29:54

evidence of nonlinear

29:57

multidimensional genetic mutations

29:59

to validate other targets

30:02

. It's

30:04

effectively AI before we

30:06

were calling it AI right . This is back in like 2013

30:09

, 2014 .

30:11

We actually made some , but the idea was there , there's , there's

30:13

a , there's a platform potential there .

30:15

Yeah , yeah , and we actually did some early work

30:18

with a CRO that worked in early

30:20

ML models , very , very early ML

30:22

models , to try to mine publicly

30:25

available transcriptional data to find

30:27

more evidence of these multi-dimensional

30:30

um genetic mutations that nature's

30:32

created . Uh , that would validate certainly

30:34

certain targets , and the board wasn't supportive . We

30:37

never actually resourced it beyond you know a couple hundred

30:39

thousand dollars to do some pilot work , um

30:41

, and and so when I got

30:43

to pandion , um

30:46

, what , what attracted me about pandion

30:48

other than the fact that , yes , it

30:50

was still in the world of immunity

30:52

, right , my first company was immune mechanisms

30:55

and cardiovascular disease . This was immune mechanisms

30:57

across autoimmune disease . Um

31:00

, I think a couple

31:02

, a couple of things were attractive . One , fascinated

31:04

by inflammation and immune mechanisms

31:06

. Two , I got to work with one of the world's

31:09

best drug developers , joe viney uh

31:11

, a far better scientist than I am

31:13

, which allowed me to really focus on

31:15

the business side of the business , because

31:18

I was never going to be a credible

31:21

scientist in her shadow by any means

31:23

. But

31:26

that was a multi-asset

31:28

company it was . We

31:31

called it a platform company , but in the strictest sense it

31:33

wasn't a platform , it was more a

31:35

design , a protein design , philosophy

31:37

that had the potential to create multiple

31:39

targets across numerous autoimmune

31:42

disease . So , single asset now to

31:44

multi asset . And

31:46

so when Pandian was acquired , I

31:48

actually wasn't sure I was going to jump into another company

31:50

. To be perfectly honest , I was like maybe

31:52

now is my time to go back to venture , which is where

31:55

my heart was back in 2011

31:57

, when I was doing that consulting

31:59

slash intern work for Brian yeah

32:02

, when I was doing that consulting slash intern work

32:04

for Brian . And then I saw the paper that underwrites what Tome

32:06

has become coming out of MIT , from our founders , and

32:09

I realized , one , this is a true platform

32:11

. But two , this

32:13

technology solves the

32:16

outside of delivery restrictions

32:18

, solves the key

32:21

technical limitations that we have today

32:23

. Um , in

32:25

the gene editing world and I've

32:28

never been a rare disease drug developer , I've

32:30

never done cell and gene therapy before um

32:33

, but I saw that this was

32:35

a in order of magnitude more

32:37

in scale . So , single asset , multi-asset

32:40

, and now tome is really

32:42

a step forward into cell and

32:44

gene therapy right , very , very broad

32:46

pipeline . But it also allowed me to

32:48

do something that I

32:51

wasn't really able to do with my first two companies

32:53

, which was craft a truly

32:56

productive and innovative culture

32:59

within a company . My first company I was

33:01

not the CEO

33:03

. It was run by a

33:06

commercial head . It was a small company

33:08

. Clinical stage there wasn't a culture

33:10

, to be sure , and

33:12

in my second company I was the second

33:14

CEO of that company there was a culture in

33:16

place that was largely led by Joe , a

33:19

phenomenally productive culture

33:21

, but not one that I had much of

33:23

a hand in crafting . So

33:26

, coming to Tome , it was a chance to

33:28

work with a technology

33:31

that could truly revolutionize

33:33

and move past the limitations of

33:35

current cell and gene

33:37

therapy tools , but

33:39

also a chance to build a culture

33:42

drawing from all

33:44

of the lessons I had learned both

33:46

in biotech but also

33:48

in the clinic .

33:49

Yeah , yeah . I'd like

33:52

you to hover there for a minute and

33:54

maybe extrapolate some of those experiences

33:56

that made you an effective culture

33:59

builder . Because

34:01

you know you

34:04

mentioned a minute ago you talked about like having

34:06

a having an opportunity in one of your positions to

34:08

take a break from the science and go build the business

34:10

Right , and that's , that's a learned skill

34:13

. You know that's a learned skill , especially for someone

34:15

who's coming out of the science world or the or the practicing

34:17

world . So was so was culture

34:19

building right . Like , I mean , I've had

34:22

enough experience with physicians to know that culture

34:24

and bedside manner are maybe secondary on

34:26

the list , which is fine , you know , hey , as long as you keep me

34:28

alive and healthy , I don't care if you're a nice guy

34:30

or not , I don't care if you give me a warm

34:32

, fuzzy feeling or not . But

34:35

what were some of the I guess , more specific

34:37

sort of points along this journey

34:39

? Where , come to Tome , you

34:41

feel equipped to not just build

34:43

a business you learn that along the way but

34:46

also to build a unique and thriving

34:49

culture .

34:51

So let's be clear , matt I don't feel equipped to be a physician

34:53

, a CEO or a culture builder

34:55

at this point .

34:57

You're a Renaissance man , you know clearly

35:00

.

35:01

I think there are a couple of things . One , um

35:04

I've

35:07

I've had some true

35:09

challenges in my life along the way , um

35:11

things in my family , things

35:14

, uh , my extended family and my in my immediate

35:17

family , um hell , just raising

35:19

three kids , it's a challenge , um

35:21

, and I think that

35:23

um I always

35:25

think about a tagline that

35:28

is underneath the email

35:30

, the personal email of um

35:32

one of my mentors I mentioned a few of them so far

35:34

brian roberts , alan crane but

35:37

under the tagline of michael dav Davidson , who was

35:39

my first CEO at Corvidia and remains

35:41

again remains a , a , a

35:43

a friend and a true mentor to this day

35:45

. Um is things

35:47

work out the best for those who make the best of the

35:50

way things turn out . Um , and

35:52

and I think Michael also has

35:54

um seen some slings and

35:56

arrows in his day Um , and

35:58

I think and

36:00

I actually was sitting down with

36:02

Brian a few weeks ago when I was in California

36:05

over a cup of tea and

36:07

we were sort of aligning on

36:09

this idea that

36:12

one

36:15

of the most dangerous things for the

36:17

human um

36:19

sycophancy

36:21

and one of the best things for

36:23

the human mind um is

36:26

struggle . Um

36:29

, you'll learn the most about others and

36:31

yourself when you're tested in

36:33

some way , whether it's a difficult relationship

36:36

, whether it's the unknowns

36:38

of raising a child , um , whether

36:41

it's a different , difficult patient , their family , who

36:43

are really struggling with the disease . I've

36:47

had a lot of struggles in my life , I think , both

36:50

personally and just being

36:53

a physician in a , you know , in the realm

36:55

of cardiology where nearly

36:58

every time I practice medicine someone

37:00

is passing away . I mean , cardiovascular is serious

37:02

disease and just having

37:05

to learn more about yourself and how

37:07

people react to adversity

37:09

, what brings out the best in them and

37:11

what makes the worst even worse . I

37:31

think at some point , unless

37:33

you stick your head in the sand , you can't come out of those experiences as an

37:36

adult human being without recognizing that there

37:38

are certain themes that bring the best out

37:40

of people , and a lot of the words that we use to describe those themes are somewhat

37:42

trite compassion , genuineness , vulnerability . I mean , some of

37:44

these are buzzwords today , but

37:51

they're buzzwords for a reason . I have found that and this

37:54

is not me , this is really me in partnership with our chief

37:56

of people here , who , tome , would not be what

37:59

it is without her hand on

38:01

the cultural tiller , as it were , without

38:05

sharing that philosophy of

38:07

if you truly show up as genuine

38:09

to individuals . Unless

38:14

they really have a personality issue , they'll

38:16

generally be genuine back with you .

38:18

Yeah . Yeah , I was going

38:20

to say some of those , what you're referring to , buzzwords

38:23

. You know , totally get that . But I

38:25

think they're no longer buzzwords when they're demonstrable

38:28

, right Like when they're demonstrated .

38:30

Well put , well said Well said

38:32

and , and people come to Tome for that

38:34

reason . Every every month , I sit down with all of our

38:36

new hires , um , from the previous month or

38:38

so , um , and just ask them why they're here . You

38:40

know where are they coming from . What did they hear about

38:42

Tome before they got here ? And

38:45

then , for the weeks that they've been here , have

38:47

we lived up to that expectation

38:49

. And really , since

38:51

our second year in existence and

38:54

we're now in our third , so for the

38:56

last year and a half , almost two years

38:58

, people

39:01

come here not just for the breakthrough

39:03

technology , but they come here because

39:05

somebody they know works here or somebody

39:07

they know knows somebody they know who works here

39:09

, and they talk

39:11

about how wonderful it is to

39:14

work here . People are helpful , genuine

39:16

, collaborative , and

39:19

that these are things that many , many companies talk

39:21

about . But even just through interviewing

39:23

, they really felt it and the most

39:25

gratifying is that when they're

39:28

several weeks in , they're like , yeah , it absolutely

39:30

lived up to the hype . I was skeptical

39:32

, but it absolutely has lived

39:35

up to that reputation , and

39:37

so that's why I know , even though we're 150 people now

39:39

, we're still doing something right and

39:42

I think it really just us , as

39:44

leadership , showing up as transparent

39:46

and genuine

39:49

.

39:52

Yeah , I like your reflections on

39:54

the value of struggle

39:56

and I want to shift

39:58

gears here a little bit and talk about some of this groundbreaking

40:00

technology because , like , the value

40:03

of the struggle is on full display and

40:05

selling gene therapy right now , right , like , everyone

40:07

knows that the struggle is a , it's a , it's

40:09

a valiant struggle . Um , the

40:11

last time you and I talked a few weeks ago , you

40:13

you talked a little bit about inflection points and

40:16

I think you mentioned that , like we're we're approaching

40:18

one , maybe not , you know , maybe not

40:20

on the precipice , but approaching an inflection

40:22

point right now . So I guess , frame up

40:24

for us , like , what

40:26

is the struggle , the technical or scientific

40:28

struggle that your company

40:31

is , you know , in

40:33

lockstep addressing right now

40:35

, and perhaps you know

40:37

what are some of the holdups around declaring

40:41

victory in the struggle .

40:43

Yeah , I was actually just having this

40:45

conversation with John Finar , cso , this morning . There

40:48

are a series of struggles that we will

40:50

face over the coming years . The

41:00

first one to answer your question is proving that this DNA

41:02

editing technology is worth anything , and what I mean by that is it's not

41:04

novel

41:07

. Technology , with all

41:09

due respect to academic , academic

41:11

, scientists , is not important . It

41:14

really isn't , unless it underlies

41:17

and underwrites a

41:20

drug that will help a patient in a way

41:22

that they cannot be helped with any existing

41:24

technology . I don't , frankly care

41:26

and this is , this is again the physician

41:28

and and the physician and

41:30

non-scientist in me I

41:33

don't care what , what the mechanism

41:36

of editing a piece of DNA is . I

41:38

really don't . What I care about

41:40

is whether that mechanism can lead to a drug

41:42

that's going to help someone in a way that

41:44

no other editing technology , no

41:47

biologic , no small molecule , no

41:49

RNAi ever could , and

41:52

that's why I get somewhat frustrated when I see so

41:54

many companies going after so

41:56

many of the same drug targets . To

41:58

me , that means that your editing technology , no

42:00

matter what you say , isn't actually all that interesting

42:03

, because it's only interesting if a

42:05

patient will benefit . Um , and

42:07

so for us . I

42:10

think you know our first struggle that we've overcome

42:12

is actually identifying a list of targets . A drug

42:14

drug , sorry , a list of diseases

42:16

, um , that really we're

42:19

addressing in a way that nobody else can . That was struggle , one

42:21

that's behind us and we'd love to talk way that nobody else can . That was struggle , one that's behind us and we'd

42:23

love to talk about that more . As we get to the second half this

42:25

year , we start talking about our pipeline more openly

42:27

. The second

42:30

is really proving that the technology

42:32

can work as

42:34

a drug development platform

42:37

. Right , because when it comes out of

42:39

MIT it's a paper

42:41

and it's some plasmids and it works in a in

42:43

a dish and maybe it

42:46

seems to work a little bit in early mouse

42:48

studies . That's all been published , it's all public domain . What

42:51

we need to do is industrialize and industrialize

42:53

it in a way that , with a speed

42:55

and a cost , it can actually

42:57

start creating these drugs in a

42:59

bona fide manner . We don't

43:01

ask those questions of protein engineering

43:04

techniques . We know they've been working for decades

43:06

, but you don't always know

43:08

that about a new DNA editing technique

43:10

, and so that is where

43:12

we are now and as a preview of data

43:14

that we will be showing at the end of this year , towards

43:16

the second half of this year , excuse me , and into 2025

43:19

, me

43:25

and into 2025, . We are at the point where the data that

43:27

I'm seeing , I have no doubt that programmable genomic integration is a bona

43:30

fide drug development platform and

43:32

, frankly , as I see what we're

43:34

achieving in the preclinical world , it's

43:37

hard for me not to look at other DNA

43:40

and technologies as somewhat obsolete

43:42

at this point , and I'm incredibly excited

43:44

for where we're going . Our

43:46

next struggle , quite frankly , there's

43:51

a struggle I'll talk about in a minute . The ultimate struggle , then

43:53

, is going to be going into the clinic and showing that what

43:55

we're doing in animal models we can actually

43:57

do in patients for their benefit . I mean , that's sort of an

43:59

obvious one , but there was an intermediate

44:01

struggle , and that is an intermediate

44:03

struggle between where we are now and where

44:05

will we be then in

44:07

the clinic . That is

44:10

unique to our time and that is

44:12

the risk of capital . Expensive

44:18

DNA editing platforms are out of favor in our industry right now for

44:20

pharma , for investors , and

44:23

so as we talk to

44:25

investors and bankers and

44:28

people ask me a somewhat variant

44:31

of the question you're asking , which is what's the

44:33

biggest risk in front of you , they're usually asking for

44:35

a scientific answer and I'll say if you

44:37

actually understand our data , you'll realize

44:39

that we've discharged most

44:41

of the technical risk not all , but most

44:44

. Our biggest risk is

44:46

being able to raise enough money to keep doing what

44:48

we're doing .

44:50

Is that softening at all ? I mean

44:52

, you know , coming out of JPM there

44:55

was a lot of pomp and circumstance about biotech

44:57

coming back and capital markets

45:00

loosening up again . Or

45:03

is there specific to

45:05

this niche gene editing is

45:07

it still a pretty hard market

45:10

to operate in ?

45:16

market to operate in . No , I think it definitely is softening . Um , these things run

45:18

in cycles and when I talk to um , when I , when I talk to individuals

45:20

who've seen more cycles than I have , um

45:22

, so again I go back to Brian quite a bit Um

45:25

, some bankers that have formed a very close relationship

45:27

in in , uh , one particular

45:29

banker who worked very closely with me on

45:32

the pandion um , sale , um

45:34

, and , and they , they , they

45:37

helped me think through what this . The

45:39

phase of the cycle that we're in . It

45:41

generally goes like this the

45:43

, during these periods of downturn

45:46

, valuations become depressed

45:48

and large pharma comes in and starts

45:51

buying things on the cheap , and

45:53

when that starts happening now , the

45:55

IPO window starts to open and

45:57

then that trickles back down to the private markets . We

45:59

saw robust M&A

46:01

right through the most

46:03

difficult periods of private investing in

46:05

our industry of the last couple of years . We're now

46:07

starting to see IPOs

46:10

move forward . Some do well , some

46:13

do not . So thawing I think you

46:15

use the word thawing is an excellent word

46:17

for it . We're not liquid yet , but we are

46:19

thawing .

46:21

I think I said softening , but that's akin

46:23

to thawing .

46:24

I'll give you a thought , absolutely . But

46:27

I think it's

46:29

thawing in two ways . It's thawing

46:31

for clinical stage assets , which is

46:33

where most of the M&A has been , frankly , and

46:36

it's taking the

46:39

really more visionary investors

46:42

, the really forward-looking investors , to

46:44

say , okay , I'm going

46:46

to pull a Wayne Gretzky , I know where the puck is going

46:49

. If everyone's focused on clinical

46:51

stage , the next exuberance

46:53

is going to be in preclinical

46:55

, so I'm going to start investing there now

46:57

. And so when we talk to investors

47:00

, the interest we're getting are really for the more

47:02

visionary investors and not

47:04

the momentum investors who are still focused on

47:06

clinical stage . So it's thawing , it's softening

47:08

. It's going to take another

47:11

several quarters for us to get to

47:13

a place where there's true , true liquidity

47:16

in the not the capital sense

47:18

, but liquidity in the investing markets , particularly the private

47:20

investing markets .

47:21

Yeah , yeah , that's yeah

47:24

, opportunities

47:39

and entertaining investor interest

47:41

in your company . How important is it for you to be discerning , right

47:43

? I've had several conversations with biotech execs and finance folks

47:45

, people who are in the investment community , who talked about

47:47

how the fact that we were as an industry biotech

47:50

was overcapitalized leading up to this

47:52

crash . Right , there was just too much money going

47:54

into the wrong hands , going into the wrong programs

47:57

and , unfortunately , a byproduct of that

47:59

is some good programs getting , you

48:01

know , put on the back burner , shelved , going by the

48:03

wayside , but

48:05

, as you sort of course , correct

48:08

, away from that you know in your corner

48:10

of the world , as leader of Tome , how important

48:12

is it for you to be discerning about ? like you

48:14

mentioned ? Like you know , do I see

48:16

differences in the momentum investors and are

48:19

they going to be a better bet for us

48:21

long-term than you know ? Perhaps

48:23

the retail investors , for lack of a better

48:25

term , that got us into a bunch of trouble a few

48:28

years back .

48:30

I completely agree with the sentiment that we were over-capitalized

48:33

when interest rates were effectively zero and

48:36

there was , there was

48:38

a lot of sort of there

48:41

was investment that wasn't based on fundamental

48:43

principles , that was being done in our jammies

48:46

over Zoom . Completely

48:48

agree , and we're working through the ramifications

48:51

of that overinvestment , to be

48:53

sure , through

48:58

the ramifications of that overinvestment , to be sure , when I think about a company like Tome

49:00

. However , we have very high capital requirements . We've actually recently done an analysis

49:02

looking at our timeline to various

49:05

inflection points that we were talking about before

49:07

, the number of people it's taken us to get

49:09

to each of those points and the amount of capital

49:11

burnt to get there . We

49:13

are the most efficient

49:16

crisper based company in

49:18

history in terms of amount of capital it's taken

49:20

us to get to certain inflection

49:22

points in the pre-clinical world and the number of people

49:24

taking us to get there . So we are doing

49:27

our diligence of building a

49:30

, a dna editing company

49:32

, for this age and

49:34

not the over-exuberant age of a

49:36

few years ago . That being

49:38

said , it's still an expensive business to run

49:40

and we will need investors

49:43

of different backgrounds . We will need a . I was

49:45

just having this conversation with an investor yesterday

49:47

. We are going to need a diversified

49:50

shareholder base to

49:52

drive this forward Traditional

49:55

blue chip venture capitalists

49:57

, crossover investors , sovereign

49:59

wealth and even retail at the right time . And

50:06

so this idea of

50:08

you're constructing your capitalization table

50:11

with the right mix and the right diversified

50:13

mix of investors who can invest

50:15

over time is is an art

50:17

, but there's definitely an art to your

50:20

your capitalization table moving

50:22

from certain phenotype investor to certain

50:24

type of investor over time

50:27

until eventually you're publicly traded . Um

50:29

, and so this is just something that we think about

50:32

as a . You

50:34

know , we

50:36

released our , we came out of stealth earlier this year

50:38

, we released how much money we raised off of

50:40

our A and our B round , and as we think about our next

50:43

round as a startup , biotech

50:45

, you're always thinking about your next round . We do

50:47

think , and I think a lot , about what's

50:49

the right makeup for this stage of

50:51

the cap table on our path

50:53

towards eventually , one day , becoming public .

50:55

Yeah , you talked about quite

50:58

a bit earlier in the conversation you talked about , you

51:00

know , a point in your career where you thought

51:02

perhaps you wanted to go back to the venture

51:04

capital . Do you feel like the role that you're in now

51:07

, like operating with such intentionality

51:09

around your capitalization

51:12

structure , moving forward , does it scratch

51:14

a bit of that itch for you ? Just personally , like , do you feel

51:16

like you're , from

51:19

some perspective , still in the game ?

51:22

What scratches that itch actually is my work with Polaris . So

51:24

as an entrepreneur partner at Polaris , where

51:27

I've been able to work actually

51:29

with some of my existing investors on

51:31

new companies as well , not

51:33

just helping the other partners at Polaris when

51:35

they feel I can help them with evaluating

51:38

a potential investment , but even

51:40

working on one new company myself

51:43

, a stealth company , where

51:45

I'm now on the board , and I

51:47

am on the board of another

51:49

company , atralis , which is a

51:51

company I've been on the board on for some period of time

51:53

now as an independent , well before

51:56

my Polaris days , and

51:58

so I scratched

52:00

that itch through my through my board work and

52:03

particularly through my work through Polaris . I've

52:05

found that the individuals of Polaris

52:07

are exceptional human beings

52:10

, really have their heart in the right place , share

52:12

the same values that I do when it comes to

52:14

, um , you know , building

52:16

companies uh , for the right reasons , with the

52:19

right philosophies , um

52:24

, but it but it does . It is a different viewpoint , it's a viewpoint of an

52:26

investor , and so I do feel like that's incredibly valuable . I actually really appreciate

52:28

that they uh that they let me uh work alongside

52:31

them .

52:31

Yeah , very cool . Um , we are

52:33

running short on time . Can you believe how fast time

52:35

is flying right now ? I'm enjoying this conversation so much

52:38

I could keep you on the phone for another half an hour or so

52:40

, but I don't want to do that . I want to be respectful

52:42

of your time . But I do want to shift gears a little

52:44

bit and get your perspective on this . I I

52:46

I just cause I've been thinking about it lately

52:48

. I wrote a reflection recently on on

52:50

on pharma's pharma in general's

52:53

PR problem , right , and I'm

52:55

curious about your take on . You

52:58

know , I mean , it was Nielsen data that

53:00

basically said the pharmaceutical

53:03

industry is held

53:05

in a lower regard than lawyers

53:08

, airlines , the federal government

53:10

. You know we're keeping some pretty rough company in

53:12

terms of public perception , and public perception

53:15

is patient perception right , like we're working ultimately

53:17

to serve the public , and I know that a lot of

53:19

that reflection is rooted

53:22

in , you know , payer experiences

53:25

, big pharma , but we can't pin it

53:27

all on them . I'm curious about whether

53:29

you have any opinions on the role

53:32

that biotech could and

53:34

should play , given the fact that , like that's where

53:36

the most exciting , most innovative

53:38

, most patient centric work is happening

53:40

. You know , like I said

53:42

, your opinions on the role that the

53:44

biotech could or should

53:47

play in sort of changing the PR

53:49

paradigm of this industry .

53:52

You know it's absolutely correct . It's been correct for

53:54

a very long time that we

53:56

are not well regarded . It's really interesting . Patients

53:59

don't generally hate their doctors and they don't generally hate the medicines

54:01

they take , but they

54:03

hold in very low esteem the

54:05

companies that invent

54:08

, design , develop and launch those medicines

54:10

. There's a bit of cognitive dissonance there and

54:13

I think you're right , there's a reason for

54:15

it . I

54:17

think , unfortunately , the pharma

54:19

industry gets politicized . There are many

54:21

, many more players in

54:24

the pharmaceutical industry insurance companies

54:26

, pbms , etc . Each

54:29

has its own entrenched interest . It's

54:32

incredibly convoluted um

54:34

, and what the

54:37

public discourse has done with

54:40

I don't fault anyone for this is

54:42

, uh , simplify that for

54:45

the , the , the , the reading

54:47

, the reading populace , um , you

54:49

need a scapegoat , you need , you need an enemy , um

54:51

, and pharma has done itself

54:54

no favors in the way it

54:56

prices drugs and some

54:58

of the scandals that have happened over the years . So so

55:00

I understand where it comes from . Yeah

55:02

, your question about can biotech

55:04

do something ? In

55:07

my mind , biotech in general is on

55:09

the earliest stages , right startup

55:11

, early r and d , um&d

55:14

early to late R

55:16

and then into early D , right Into clinical

55:18

and

55:21

in my experience so far , by

55:23

and large the folks

55:25

that work in biotech

55:27

do it for all the right reasons

55:29

and are equally flummoxed by you

55:31

know why we get such a bad rap . But can

55:34

biotech really help the

55:36

perception of the industry

55:39

that is driven largely

55:41

by the public's understandable

55:44

anger over commercialization of

55:46

drugs ? The honest answer , matt

55:49

, is I'm not sure . Not

55:51

sure . That's not the realm in which we

55:53

play .

55:53

Yeah , I just feel like you know , and this is a raw thought , like it's a raw

55:55

thought , right . Like Sure , not sure . That's not the realm in which we play . Yeah

55:59

, I just feel like you know , and this is a raw thought , like it's a raw

56:01

thought , right . Like I just feel like so much of the positive news , so much of the excitement

56:04

happens in biotech and maybe you

56:06

know , maybe it's a matter of you

56:09

know , you share the good news that's happening

56:12

in early R&D and biotech

56:14

and there's such a dichotomy between that

56:17

and the current standards of care that it

56:19

just creates more ill will . I don't know . You

56:21

know what I mean . Like it's just . I

56:23

feel , like to your point , like I live in that bubble

56:25

too . Like I live in this bubble where I talk to guys like

56:27

you and women like you all day , every

56:29

day , day

56:36

, and I'm like what is , you know , where's the good news and the hard work and the altruism getting

56:38

lost in the , in the translation . You know , but you know , perhaps

56:40

your point , it's it's just too soon .

56:42

No , I think you're , I think you're right , cause even when we go out

56:45

there and talk about the promise

56:47

, I do

56:49

wonder if people look at that and say , oh , that's

56:51

just spin , that's just a way

56:53

for us to buy for us , because my experiences

56:55

with my loved ones and my own health have been

56:57

, you know , the same for the past 30

56:59

years . My

57:02

loved one can't afford like I was talking

57:04

about with you know putting a patient on a blood thinner . My

57:06

loved one can't afford X medicine because

57:08

the pharma companies price it too high , and the

57:10

reality is so much more complicated than

57:12

that . But I do

57:14

to me

57:17

when a patient's day-to-day experience

57:19

is difficulty affording

57:21

their medicines . Until

57:25

we fix that , we're not going to be able to punch through that . What's

57:28

really happening in biotech , which is truly

57:31

groundbreaking and revolutionary science that

57:33

will extend life .

57:36

Yeah , yeah , all right . One last question for you and then I will

57:38

let you get on with your day . As

57:40

I said , the physician turned founder

57:43

, turned biotech builder is always super

57:45

interesting to me . You're continuing

57:47

your practice in

57:50

the clinic and also leading a biotech , but

57:52

that's , more often than not , a difficult

57:55

transition for physicians and scientists

57:57

to make . So if you were , if you were speaking

57:59

specifically to you know , mds

58:02

and scientists turn biotech

58:04

builders or aspiring to . What

58:06

would be your pithiest advice for those folks

58:08

? To to , I guess , encourage

58:11

them and inspire them along that transition

58:13

?

58:15

There's not enough of us . I look , I

58:17

think back to my away medical

58:19

rotation in Tanzania , where

58:31

I would spend the day seeing children die of cerebral TB something that doesn't even happen

58:33

in our country and spend my evenings reading Ayn Rand of

58:35

all things , and

58:38

what came together during that sort of dichotomous

58:40

period of experiences during

58:43

the day versus reading at night was the

58:45

people that really changed the world . Are

58:47

the Howard Rourkes , who know how to rivet

58:50

and then go on to design buildings , or the Hank Reardons , who know how to smelt and then go

58:52

on to design buildings , or the Hank Reardons

58:54

, who know how to smelt and then build

58:56

a successful business on breakthrough technology

58:58

? We need more people who

59:01

have their boots on the ground in

59:03

medicine , who know how

59:05

to rivet and smelt but

59:07

then move in to actually build the businesses

59:09

that change the world . There's not enough of us

59:11

, and I think that

59:14

the industry would be better served

59:16

by more of us making that . I

59:18

wouldn't even say transition , but straddling

59:21

the boundary between both practicing medicine

59:23

but also working

59:25

in the wonderful business

59:27

of making new drugs for patients

59:30

.

59:30

Yeah , all right , I lied . One last question

59:33

to follow up on that . Please

59:35

, where would you point those people ? To , uh

59:37

, to , to surround themselves

59:39

with the right people , to be equipped to

59:42

not just rivet and smell

59:44

but develop businesses

59:46

, build businesses that that then create

59:49

medicine .

59:50

Yeah , um , I

59:52

did it the hard way , um

59:55

, I I found people

59:57

that believed in me . That doesn't always happen . There

1:00:00

are ways to do it . The most tried

1:00:02

and true way are going through

1:00:04

consulting agencies like the McKinsey's

1:00:06

of the world and the Boston Consulting Groups , which

1:00:09

are fine , because you really do learn valuable

1:00:11

, valuable lessons there . My

1:00:14

only advice would be don't give up practicing

1:00:16

along the way , because you lose something . If you

1:00:18

do , yeah , very good .

1:00:21

Well , it's been a pleasure , a real pleasure , to talk with

1:00:23

you , rahul . I appreciate you taking the time with us . I

1:00:25

think I really enjoyed our time . I

1:00:27

hope we get to do it again . You actually

1:00:29

mentioned maybe toward the back half

1:00:31

of this year , so I'm going to hold you to that

1:00:33

. Maybe towards the back half of the year we'll have you back on for

1:00:35

an update on what's going on at Tome .

1:00:37

I've enjoyed our conversations to date . I would love to

1:00:39

do it again later this year .

1:00:41

Fantastic , thank you . Take care , sir

1:00:43

. Thank you . That's Tome Biosciences

1:00:45

President and CEO and

1:00:47

Brigham Women's Hospital Physician

1:00:50

, dr Rahul Kakar . I'm Matt Pillar

1:00:52

and you just listened to the Business of Biotech

1:00:54

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