Curiosity is a state of mind, knowledge its reward

It goes without saying that realising that I would miss a third “start the week”: meeting in a row left me distraught, but somehow I managed to carry on.  In fact because of the twin drivers of saving about £800 a ticket and not flying on 9-11, Healthcare Man and I flew out to Boston on the Saturday.  Since HM had never visited the East Coast of America before, on Sunday I made him go on a forced march around the historical, cultural and retail centres of interest in Boston on the day when most of America was remembering a event 10 years earlier, but the insensitive tourists were contributing the US balance of payments!

Monday dawned bright clear and warm (you had better get used to references to how nice the weather was) and we made our way by taxi (it’s the only way to travel in a US city) to the British Consulate General.  The overall trip was the culmination of two streams of thought.  The first was born in the snow afflicted margins of the Prize meeting back in January when I discussed with the SIN team in Boston how they could help us meet interesting and relevant people in the US to help advance our thinking.  The second was the idea of HM and I exploring the East Coast healthcare cluster, moving from location to location in either a convertible Mustang or on a pair of Hogs.  Although we ended up with more conventional travel plans, this meant that HM got wistful every time we walked past a convertible car!  The first activity was to go through the agenda for the week and get up to speed with the last minute changes that had inevitably occurred.  Laura Maliszewski (who had done all the heavy lifting in the US and worked with Jools to ensure we did as much as humanly possible) and Chris Ilsley took us through the plan for the week.  Our first main meeting was with Fiona Murray (see – http://fmurray.scripts.mit.edu/), who was on sabbatical and suffering from pneumonia but still thought it worth meeting us.  We discussed the prize meeting, and I described how the discussions had fed into our thinking on the LaunchPad process.  She coughed and sounded impressed.  HM then left me to make phone call (sure!) whilst I ran through the “not the corporate” presentation with the local UKTI and SIN staff – although we have apparently met some of them before and they have had briefings on our activities by various people, it amazes me at the inaccuracy of what they think we do.  It was lively discussion and we hopefully left them better informed, not just about our activities but also our attitudes.

Then it was off to meet a pathologist at Massachusetts General Hospital (MGH, see – http://www.massgeneral.org/) to discuss stratified medicine.  It is worth noting that without Laura we would never have found John Lafrate (both philosophically and geographically) but the discussion was very much aligned with our growing understanding of the practicalities of moving from the present system of therapy to one based on stratification (which the Americans insist on calling personalisation!).  The challenge is to get enough data to be able to “prove” the value of the change and John’s suggestion of a comparative study of 2 patient cohorts was as elegant as it was ethically challenging.  John is the sort of thinker who we could use to advise us on overseas implementation of whatever we develop within the UK – the differences between the UK and US health systems became a key theme of this week!

Crossing Boston to the orbit of one of the other hospitals – Children’s (see – http://www.childrenshospital.org/) our next visit was to the Wyss Institute (see – http://wyss.harvard.edu/) another way to “do” a centre, but certainly one in the “put them all together in a box” model.  We were favoured with an audience with the charismatic founder and his two (Greek) lieutenants.  The “mission” of the centre is to take lessons from biology and implement them in a more engineering fashion.  It is the natural development of the “biomimetic” stuff that went on 20 years ago, and the systems thinking impact is clear.  He explained his personal philosophy of chaotic organisation, talked about his very large pot of money, the need to get beyond the constant need to justify your research to peer review mechanisms and generally said the right things about empowerment, but I was left with the feeling that he ran most things personally and autocratically.  Nevertheless, an interesting visit. 

Then it was “across the river” to the Harvard Stem Cell Institute (see – http://www.hsci.harvard.edu/), led by Brock Reeve (see – http://newsblog.projo.com/stemcell_reeve.jpg and yes, he is the (half) brother of Christopher Reeve whose spinal injury led him to start a foundation to investigate the treatment of spinal injuries with stem cells!).  We keep meeting Brock at stem cell meetings and he is obviously keen to add whatever we do in the UK to his network, but it is not clear exactly what either of us would get out of the connection.  This meeting focussed on the HSCI link with GSK, and we were joined by Aaron Chung who described what was in it for GSK.  Like many big pharma companies, they seem to have stand-alone and often seemingly disconnected stem cell activities and I am not convinced that they are serious about incorporating cell therapies into their businesses in the future – it feels like they just don’t know!  Brock had to leave and since Aaron is one of the assessors for the Cell Therapies TIC, we decided to have dinner with him and discuss the state of play.  Afterwards, I needed to call another of the assessors (based in California) who seems to be so impressed with what we are doing he wanted to talk to me about whether there might be a job for him in the new structure.  Since he has many of the experience attributes we have identified for the CEO, I spent a long time with him on the phone discussing “options”.

The next day, I had committed to take part in the Stem Cells USA conference that we had built the trip around.  HM went off to another meeting so missed me mangling his elegant work and being less than conciliatory on the panel that followed, but it did mean a lot of the business and funding people talked to me afterwards!  Once again, the big pharma reps made excuses and the most aggressive programme was AFIRM (see – http://www.afirm.mil/) who go out of their way to point out that their patients are young, fit and suffering from complex and traumatic injuries and that growing a new leg is very different from treating chronic degenerative diseases, but they do fund some interesting projects (and outside the US it appears!).

After lunch HM and I met up to visit John Quackenbush (see – http://134.174.190.199/faculty/john-quackenbush/) at the Dana Farber Cancer Centre for Computational Biology (see – http://www.dana-farber.org/Research/Departments-and-Centers/Department-of-Biostatistics-and-Computational-Biology.aspx). Although John’s personal approach (and appearance) make him memorable, once again we might not have met him if it weren’t for Laura, and our discussion about data in healthcare was amongst the best we had on the trip. My take on it was that genomic analysis was coming down in cost so fast, that it would be work carrying out a demonstrator project in a year or so time where we carried out a complete sequence for a patient cohort and made the data available to their doctors, treated them using the latest (early-stage) therapies and compared their health to the rest of the population.  If stratification (sorry, personalisation) works then the results would be truly mind-blowing.

Although it was a muggy high 80’s in Boston, our inability to buy a ticket on the T meant that HM and I walked the 2 miles back to our hotel – it was cheaper than a sauna and we were enjoying the fact that we probably wouldn’t see temperatures this high for another 6-7 months!  After drying out, we caught a cab up to the HSCI for a reception put on by the Consulate to “build relationships” with the stem cell community.  Brock said a few words and I mumbled something about the Technology Strategy Board and what we are doing in cell therapies.  Once again, we seem to be popular!  Afterwards, we went off to dinner with Michael May and Greg Bonfiglio of the Centre for Commercialization of Regenerative Medicine, yet another potential model for the cell therapies TIC (see – http://www.ccrm.ca/).  We also learned a lot about the impact right wing American politics is having on the development of the stem cell industry in the US!

Wednesday saw HM calling into an assessment panel (Regenerative Medicine: Tools and Technologies) in the morning, so the first meeting – with the leadership of Center for Integration of Medicine and Innovative Technology (CIMIT) (see – http://www.cimit.org/) – it was just me and the SIN chaperones.  CIMIT is a good example of an integrated funding and delivery agency in healthcare.  They use what they call “site miners” who work in the various health organizations, identifying unmet needs and barriers to improvement.  These are then communicated around the network, with seed funding and a stage-gate that develops up promising leads into projects and even spin-out companies.  They latched onto our description of challenge-led innovation, applauded our attitude that support mechanisms had to be tailored to the specific circumstances of the market needs and potential solution provider and were gob-smacked by our ability to connect technologies between markets.  They have effectively franchised their approach to MIMIT in Manchester (see – http://www.mimit.org.uk/) (and, no, I hadn’t heard of them either) and to A-Star in Singapore.  I think they think Manchester was the wrong city to choose and that the culture in Singapore might not be “quite right”.

Back at the Consulate, HM had finished his teleconference – the webcast didn’t work so his phone bill will be humongous – and we joined up to meet Ed Crawley of MIT (see – http://esd.mit.edu/Faculty_Pages/crawley/crawley.htm).  This was apparently at Ed’s request, and he spent the first 30 minutes or so telling how important he was, and how he had saved the CMI initiative from failure.  We eventually got him to talk about complex systems, it was a better discussion.  We asked him specifically about the best way to develop and implement solutions in this space and – after only a short pause for thought – he suggested imbedding the capability in domain areas would be far more effective.

At this point HM once more left me – this time to meet with another one of his Cell Therapy TIC assessors – and I tackled a lunch with Philips Healthcare alone.  Their team consisted of their Global Health Economics and Reimbursement Director and (to be honest, more interestingly) one of their imbedded medics, a cardiac guy.  Their intention was seemingly to get us to put more money into diagnostics, but the medic got our approach to stratification and we spent most of the time discussing how the US would implement stratification – because the various health providers would need to agree approaches, and big pharma might not play ball.

Next it was back across the Longfellow Bridge to see the head dudes at Partners Center for Connected Health.  I got the impression that our friend from UKTI hadn’t sold what we did that well because we only had 30 minutes and the initial response was a mite frosty.  However, once we got into what we did and how we did it, we got warmed up and we over-ran our allotted time and had to leave because we had another meeting.  We are now on his mailing list, so ….

As it happens, we should have stayed because our next meeting was a waste of time.  An ex-Army guy claiming to have pioneered tele-health bull-shitted us for 30 minutes before revealing he wanted to sell the NHS a videophone!  Doh!!

At this point, we caught a cab to the airport, feasted on haute cuisine pizza and made our way down to New York.  We are still not sure who is responsible but they booked us a flight to JFK (the farthest out of the New York airports) and then (because there were no hotels in New York cheap enough to satisfy our expenses policy) booked us into an airport motel.  It took us about 2 hours to get to the motel by a combination of air-train and hotel bus. 

The next morning HM once again had an assessors panel, but in a cruel twist of fate (I had not been able to make the motel alarm-clock work and so had used my phone as a proxy) FL woke me up with a text about the time HM should have been getting up.  We ended up breakfasting early and getting a cab into the city (incidentally costing twice what the flat rate fare from the airport into the city would have been), took longer than planned but still had time to sit in Central Park and enjoy the early morning joggers and dog-walkers! 

Our first meeting was with Teri Willey of the Mount Sinai School of Medicine.  Teri was new in the job and her last post had been at Cambridge Enterprise (the UK Cambridge) so she spent most of the time telling us how well connected she was. (incidentally, one of the people she claimed to know well, when told we had visited her, asked “Why?”).  What she did actually tell us about the New York hospital scene made for an interesting contrast with Boston.  Whereas the Boston hospitals apparently sit in meetings agreeing with one another and then renege outside the meeting, the New York hospitals compete tooth and nail in public and then have quiet dinners together to ensure overall effectiveness.  Other than that insight, I am not sure what we got from this hour!

At this point, HM and I headed south “on the island” but split up.  I was dropped at the Residence and he went on to the Consulate.  The Residence is a penthouse on East 51^st Street and the event was a lunch with the New York chapter of the Deloitte Fast 500 (the fastest growing companies in the US, see – http://www.deloitte.com/us/fast500/).  It was a fascinating hour.  Obviously, Deloitte were using the cachet of a lunch in a nice house as a treat for the companies, the Consulate were shamelessly plugging the whole Tech City angle (hence my involvement) and the companies got to network over a nice lunch. Several of them were the usual providers of digital services in healthcare, finance and so on, but a few stood out.  Yodle (see – http://www.yodle.com/) were obviously the ones everyone wanted to be friends with – they seem to be an online adverting company that specialize in localism (surely part of the Big Society?).  SecondMarket (see – https://www.secondmarket.com/) are different – they offer a way for private companies to “trade’ their stocks and establish a value for them.  They were obviously in competition with a resurgent New York Stock Exchange who were obviously trying to work out how to compete in this space.  Terra Technology (see – https://www.terratechnology.com/) was again a bit different.  As I understood their marketing guy, they can analyse real-time information about the stock levels in the supply chain to optimise manufacturing and logistics.  This one bears a second look for several of our programmes.  Finally on my list was Vigilant (see – http://www.vigilant.com/) who seem to be doing something new in security, although I might just have not understood the explanation of their service!

I walked back to the Consulate with the Consulate General himself and met up with HM, who had done the “this is what we do” talk to the local UKTI and SIN people.  We then spent some time with the Deputy Head of Mission, who explained that, as the senior diplomat, he ran an upmarket travel agent for members of the government but obviously understood more than he gave away, and the ranking UKTI person, who seemed curiously ill-informed about what happened in the UK!

We then caught a cab to the West Side to meet with the New York Stem Cells Foundation (see – http://nyscf.org/).  We weren’t important enough to meet the Director, but snagged a brace of Vice-Presidents and the intermittent presence of their External Relations person! It was an interesting discussion – they had started tracking us and were complimentary about our activities but asked a question that we could only unofficially answer – “who are our poster children?” – this is primarily about the US need for celebrity endorsement but does relate to how we might use our “case studies” when we eventually get them working properly.

We had sensibly asked the driver who brought us in that morning to meet us at the end of our meeting to take us back to the hotel to pick up our bags and then on to the airport.  During the day we had been told that catching a New York cab was all but impossible at 4.30, so this planning was more important than we realised!  We had trouble with traffic on 57^th Street, the Queensborough Bridge and then all along Queens Boulevard taking over 2 hours to reach the junction with the Long Island Expressway, when the traffic cleared.  It was in this time that I discovered HM’s incipient narcolepsy when he would suddenly zone out – but he doesn’t snore!  We reached the hotel, retrieved our luggage and made it to the check-in at JFK with 5 or so minutes to spare, and once again tasted the very best of airport food.  Having bagged the window seat, HM proceeded to fall asleep again, the plane got delayed and the evening went generally downhill!  When we got to Ronald MacDonald Airport, we caught a cab into central Washington and decided that even though it was late, we ought to glimpse the iconic view of 1600 Pennsylvania Avenue before we passed out.  The police showed interest in the 2 guys hanging around this late but actually let us pass!

Next morning, we had our last Crunchy French Toast breakfast (and some exotic fruit juices) before meeting up with the local SINner in the hotel lobby Starbucks.  After a briefing about the bizarre political process that they use in America, we were into our first meeting – with the Alliance for Regenerative Medicine.  The guy had actually been at the Boston meeting, but since we hadn’t actually spent much time there and he had been similarly busy, this was a better chance to spend quality time discussing the political challenges that regenerative medicine faces in the US – the fear of the right wing of the Republican Party (itself a scary prospect for most Europeans) apparently means that federal funding and support for stem cell research and development will be limited until such time as the first “cure” is delivered!

Next we got to meet a pair of people from the U.S. Department of Health and Human Services (actually one was an Associate Deputy Secretary and the other was the Deputy to the Deputy Assistant Secretary, but I couldn’t work out the logical difference in roles!)  We spent most of our time establishing that we shared common goals and attitudes (see – http://aspe.hhs.gov/_/office_specific/daltcp.cfm) and that we were a bit ahead of them in implementation – and likely to get more so in their current political environment.  This was a great meeting and we need to follow up.

Then it was up to the Embassy to meet the First Secretary for SIN US, the US RCUK representative and the guy who “does” aerospace for UKTI who never gave me his card and didn’t say much.  The SIN person was new and asked a lot of very good questions, but was almost totally ignorant about what we did and why.  The RCUK guy took us to the canteen (but made us buy our own food) and generally gave us the impression that he didn’t know what his job was.  After lunch, we met with the Head of the Global Issues Group (if you haven’t worked it out yet, every place we visited seemed to have a different structure and set of job titles!) but were interrupted by his need to go and support a meeting of the whole Embassy – so we caught a cab to our next meeting.

This was with the Vice-President of Research and Development for Medco (see – https://host1.medcohealth.com/consumer/site/home).  We had met Felix at the Economist Pharma Summit, where he seemed to be the only one who was doing anything about stratification (although, as I said, the US insist on calling it “personalisation”!).  They started by getting me up to speed on the Warfarin issue.  Warfarin is commonly prescribed as an anticoagulant (particularly to older adults) but is a good example of stratification.  Too high a concentration in the bloodstream can lead to “bleeds” (don’t think too hard about this or you will feel bad) and too low a concentration can mean the embolisms that lead to stroke and similar still happen.  Getting the dosage right takes time and can cause discomfort and worse to the patient.   The ability of the patient to metabolise Warfarin (which balances out the amount prescribed) can be fairly well predicted on the basis of a simple genetic test but that test is not used because of cost.  We also discussed arthritis (because Felix had a bad back) and the inter-relationship of stratification and the treatment of older adults.  Because Medco have access to millions of patient records, they can use the sort of analytics the digital dudes take for granted to understand what the effect of different treatment regimes are, they can identify patients who might be keen to participate in trials of new therapies and so on.  We ran out of time, but Medco is keen to work in the UK and we will be very, very nice to them!

Another cab ride and more traffic meant that our opportunity to explore Dulles Airport was curtailed but we managed one last great meal at an airport and took our seats in the back of the Airbus 340-600 to enjoy the magnificent leg room and comfort that you get with a cheap flight.  HM wrote up the Assessment Panels in preparation for the Funder Panels and I watched Thor. Guess who had the better time?