2016Weeknotes

Resolving Complexity in the System: Bottom-Up Fundamentals and Top-Down Insights

Recently, our team had the privilege of interacting with two key stakeholders in the system. Not only are both of these stakeholders relatively new players in the clinical trials world, but they both bring new methodologies to resolving complexity in the system: separating signal from noise by focusing in on successes, minimizing systemic risk by spreading out individual chances of loss, and having a long-term focus towards meeting the broader goals of society and health. In many ways, both these stakeholders embody some of the insights our team has had over the past year and a half, and the exciting thing is that they act on those insights in very different ways.

Led by people who have extensive experience in the clinical trials system, the first stakeholder is backing the fundamental idea that a treatment needs to work on human beings and be safe at the same time for it to make it through the system. Agnostic to a particular disease or therapeutic technique, they go after treatments that they feel are under-resourced but can have a big impact if and when they go through the system. Their models are based on tried and tested fundamentals, but they still use modern data techniques to build their portfolio. By being agnostic to disease area, their portfolio minimizes risk. They also have a long-term investment strategy that enables them to not be hurt by short-term losses. However, one of the key factors is that they seek to build partnerships with other stakeholders, and are intent on educating other stakeholders about what does and doesn’t work in the system. Their bottom-up approach reminds us a lot of Warren Buffett’s approach to investing, look at the fundamentals about the company you want to invest in, and also look at what the potential could be. Then run the data, remove the biases, and build a strong portfolio. Along with good clinical strategy, they are a player who can work to drive the system in a direction that does focus on success and removes some of the inefficiencies that currently plague drug development.

On the same day, we had the luck of meeting people from Google and Verily, both part of the Alphabet family. This meeting was insightful for a number of reasons, but the major takeaway was that they are also working on ways to resolve the complexity of the system. Google takes a more top-down approach, they want to understand how data and technology about the broader system can help us resolve the complexity we see even at the stage of drug development. The team at Verily is focused on building hardware and software that can both collect and analyze data for insights. Like our first stakeholder they are intent on collaboration, and are making sure stakeholders are educated about how to interact with the customers of the future. This strategy of driving both the supply of technology and data as well as making sure the demand is ready for it will enable Alphabet to be successful as it moves forward.

Both stakeholders offered promise, and both of them also offered innovative solutions. However, we also heard a number of similar issues that are hampering their progress, and are system-wide problems that need to be resolved. The availability and use of data and information was a big one. Each stakeholder we talk to states how much more efficient this system will be if we find a way to share more data. They also talk about aligning each stakeholder towards a common goal of promoting health. And finally, all of them are true to science. And that is a great sign for the system. One of the goals for us, then, is to figure out how to resolve the complexity of stakeholder interaction so that we can let these individual stakeholders thrive.