Barry Ticho - Part 2: Zebrafish Hearts & Transformative Medicine: Chasing Patient Impact

Intro - 00:00:01: Welcome to The Biotech Startups Podcast by Excedr. Join us as we speak with first-time founders, serial entrepreneurs, and experienced investors about the challenges and triumphs of running a biotech startup from pre-seed to IPO with your host, Jon Chee. In our last episode, we spoke with Barry about his upbringing in a family of physicians and how he developed resilience and a passion for education. We also discussed his academic journey from Haverford College to the MD-PhD program at the University of Chicago. If you missed it, be sure to go back and listen to part one. In part two, we continue our conversation with Barry as he reflects on his time at the University of Chicago, where he advised on My Choice, a program helping trainees explore careers leveraging their research training. We'll also dive into his fellowship at Boston Children's and Massachusetts General Hospital, where his research on zebrafish cardiac development uncovered the complexities of heart formation. Lastly, Barry discusses the realities of practicing medicine today, lessons learned transitioning to biopharma, and how he combine clinical care with research to create broader patient impact.

Jon - 00:01:27: So as you're wrapping up your grad school experience, you know, I know you ended up going to Harvard and, you know, Boston Children's Hospital to do your basically your postgraduate studies and training. Can you talk a little bit about how that opportunity came about? And I know you're also at MassGen. Can you just talk a little bit about that part of your journey and how you decided to commit to being in the Northeast?

Barry - 00:01:55: Yeah, so after I finished med school, then I was still sort of on this academic path. And for me, that was part of what was ingrained to me, really, at UChicago, was to be on that academic path. And in some ways, it's actually something that I thought at the time needed to change a little bit at UChicago. There was very much of a disdain for people who took a non-academic path there.

Jon - 00:02:29: Interesting.

Barry - 00:02:30: And it came home to me because one of my thesis advisors ended up going into industry. And he was one of the absolute brightest people that I knew and decided to go to industry, into big pharma. And his reputation in Chicago was not kept up because of that. And I didn't really think that that was the appropriate way. But I still had this track. But it did help me in the end. There was a program that I actually helped set up at University of Chicago later on called My Choice, which was a program that got NIH and NSF funding as now a well-established program at UChicago to foster an interest in non-academic careers. So that program actually brings students out to Boston, for instance, and I've hosted them here. They go and visit various biotechs, and I've sat on panels for them where people who've pursued a non-academic career have talked to the students and explained to them first what's possible. If you don't do a postdoc and get an academic position, where else could you go and then how to do that? And so for me, that was an important thing coming out of Chicago is that at that point, I was on this academic track. And so the next step is to do a residency. I chose a pediatric residency partially because of my interest at that time, and again, in hemobiology and development, how does the body develop? And then after completing my residency at Northwestern University, I went on to join the cardiology program. At Children's Hospital here in Boston. And that was, again, based on my interest, especially in refining even more my interest in development. How does the heart develop itself? Because for me, it's just a fascinating part of biology is, you know, the heart really starts initially in the embryo as four cells. And then those four cells develop into a tube. And that tube folds on itself and forms four chambers, and then sends out the vessels that go some to the lungs, some to the rest of the body, and then the vessels that come back from the body. Just thinking about how does that all happen? And then there's a right side, and there's a left side. And then there are valves that have to grow, which are separate. And then there's a whole conduction system that grows within all of that. It's just to think about how that all comes together, and how the body, the cells are actually, coding for that and telling all that to happen. It's just mind-blowing. Just to think about how the heart actually forms, not to mention how the rest of the body forms. So that interest in cardiac development... Got me to the cardiology program at Children's here in Boston, where the head of the Department of Cardiology then was a microbiologist himself and had his own research lab on studying cardiac development. So I really came to Boston Children's as much for the clinical training in cardiology, but even more so for the opportunity to work in this molecular biology lab.

Jon - 00:05:59: That's so cool. It's like, it reminds me when you're talking about just like as a kid, like being in the microscope, looking at the onion. And it's like that original, you're just like, and it kind of like, it comes back, like kind of like full circle at a, you know, obviously after, you know, much more experience, obviously not just looking at onions anymore.

Barry - 00:06:16: Exactly. I should say an important part of how I did get here to Boston, since you asked, was I actually did some rotations while I was in Chicago. I came out to Boston and spent several months here working with people. And that's that's something I encourage people to do is to go and and spend time at another place. You know, it's sort of like doing your junior year abroad.

Jon - 00:06:39: Yeah.

Barry - 00:06:40: Or even when somebody is at a company, sometimes they'll go in and take time working in a different department. That's something that I encourage people to do frequently is to go and just spend time in a different place, in a different institution, in a different line of work and get a sense. It starts actually with in graduate school where you have to go and do rotations in different labs in order to choose which lab to do your thesis in. But but that can continue throughout life. You can continue doing rotations to find out what you're interested in or or at a minimum just to to network and make connections and learn new things. And that's how I ended up at the Children's is partially because I had made connections with the with the people here, but also because I saw firsthand what was going on there. And really, to me, that that solidified my interest in that place.

Jon - 00:07:35: That's such great advice that the rotations don't have to stop at grad school. Because sometimes you just think it does. You're like, all right, I'm on the track. I guess we're just going to go like cruise control, like all the way through. But, you know, you don't know what you don't know. And the only way you can kind of get that learning is just like by just putting yourself out there and getting exposure. And not to say that everything is going to be perfect, a perfect fit, because I'm sure they're probably like as you do rotate and that you're just going out there's like, yeah, that wasn't wasn't a good fit for me. So like and you just like you at least can do a process of elimination. It's like at least I know what I don't like. 

Barry - 00:08:11: Exactly. Which is equally as important as knowing what you do like. 

Jon - 00:08:15: Yeah, exactly. And to go back to UChicago just for a moment, too, resonated with me, at least when I think and I always have to preface, Berkeley has changed a lot. But it was very much a similar kind of like separation of church and state, like where it's like industry and business should never co-mingle. Like even if it smells like business, it is it just is like offensive. Because, I know like even just like like shooting around the concept of Excedr just to do like my, you know, just like some market research. I was like, is this could this be valuable to you guys? I remember some of the conversations I had, some were like, yeah, that's great. But then some of the other ones were just like, oh, you're going to the dark side. And I was like, oh, I'm just trying to help. I'm just trying to help, not trying to, you know, extract anything from you. Mostly, do you think this could be helpful? But obviously things have changed now, you know, where there's much more, obviously there's stuff where it's like pure academic basic research should stay such, but there's like, I think it's much more of a gradient rather than the zero and one where it's like binary. And I think there's a lot of them, probably like existential dread for grad students where you're like. Uh, like, if the only path is to become a tenured professor, that's like harder than getting into the NBA. And there's only so many, you know, spots. And then you're just like, what am I, chopped liver after this? Like, if I don't get this position, like, what do I do? So I love that, you know, the My Choice program is kind of like, hey, like, everybody, there are more options to, you know, you're not going to be destitute if you don't get that position.

Barry - 00:10:00: Exactly, exactly. And I think, as you said, things have definitely changed. I mean, there's been a shift. I mean, industry is no longer the dark side. I always joke because, you know, for an established professor, their main accomplishment used to be to write a textbook. But now an accomplished professor hasn't made it until he started his own company or he or she. So that's how the mind shift has gone. But it's also, as you said, for right now, for graduate students, two thirds of them are going to end up in a non-academic career. So it's almost been forced on the universities to acknowledge that there is life outside of the Ivy Walls.

Jon - 00:10:44: Absolutely. And it's like, yeah, like we all need to earn a living, too. We have bills to pay. And that's okay. Like that's like a reality of life. That's okay. We need to pay the bills. So you're now at Children's, and I know you had a very long career there. Could you talk a little bit about kind of like maybe if we subdivide them into like, and I think it was around like 15 years at Children's. Can you talk a little bit about kind of like the early days, what that experience was like, and maybe we can move into like the kind of the middle portion and then the latter end? Can you talk a little bit about that?

Barry - 00:11:20: Yeah, so my experience at Children's was as a cardiology fellow there. But the way the system was set up there, I could spend quite a bit of time in the lab. So that's where it was. It was basically doing a postdoc there in the lab. And we were working on zebrafish. And zebrafish cardiac development there. I don't know how much you know about zebrafish, but zebrafish, when they develop, they're actually transparent for the first week or so of life. And so you can actually put the zebrafish under a microscope and see the heart physically beating transparently through the skin. And so you could actually watch the entire development of the heart. The zebrafish became a great model. So that's how I got started there. I was doing... Clinical work as well. And getting trained as a pediatric cardiologist. But my primary interest was still in the lab and how do I start to use what I'm doing in the lab to help me in the clinic. Then from there, I got an academic position at Harvard Medical School and then also at Mass General and joined Mark Fishman, who had a large... Zebrafish facility there and was one of the most established zebrafish labs in the world. So I got to work there, but then I also had a clinical appointment at Mass General in the Department of Pediatric Cardiology. So there, again, I was spending half my time in the clinic, seeing patients and teaching residents, and then half my time in the lab. Running experiments and supervising technicians and others. And then the third half, of course, the third half of my time was spent writing grants and trying to write papers and keep up on the literature. So obviously, that's a typical scenario of being stretched pretty thin.

Jon - 00:13:26: Yeah. Yeah. And I was going to say, the first question, I was like, did you sleep? Did you get any sleep? He said, no. Each of those sound like, you know, massive initiatives on each front independently. And I guess for kind of if we think about like the lab work and the clinical work. As you started like practicing medicine, you know, I've never practiced medicine. What was like the things that you like least about it? And maybe what, what do you find the most fulfilling aspects of practicing medicine?

Barry - 00:13:55: Well, certainly the interaction with patients and the opportunity to have a direct impact on their lives is immeasurable and is extremely motivating. And I had... The opportunity to work with babies that were born with very malformed hearts and work with the surgeons who could then correct that or work with. Children who had other congenital malformations of the heart that we had to help them get to the next step and medicate them. So there were very gratifying times. This is now in the time when prenatal diagnosis is starting to happen. And so families could already know when the child was still in the uterus that there might be a cardiac problem. So to be able to take a newborn there and get them through, especially that most critical period, and have the family then so grateful that we were able to really save their child's life, there's no comparison to that feeling. So that was very motivating. I think the other thing about being at Children's Hospital, which is probably one of the best, certainly one of the best, if not the best, pediatric hospital in the world, but also at Mass General, which is another, you know, the other name for it is Man's greatest hospital. But just to be around so many smart people. Is a great opportunity. And it's sort of a lesson for life. You always want to be around people who are smarter than you and who can teach you. And it takes a little bit of strength to be in that circumstance, because if you're around people who are smarter than you all the time, then sometimes you feel a little bit dumb. And you have to flip that around and say, well, it's not that I'm dumb. It's that I'm around all these great people who are inspiring and motivating and showing me the direction. But being around all those smart people was a great opportunity as well.

Jon - 00:16:08: Yeah, I always, the saying that always comes to mind for me is like steel sharpens steel. But for me, I was probably not steel, like to begin with, far more malleable kind of material. And I was just like, oh my God, I'm like, I'm getting just trounced here. They're running laps around me. But always, I always think about like exactly what you said. It's almost like you can like soak it up. There's like this like osmosis, like this knowledge osmosis where you're just like, God, these people are so bright and it's so inspiring. It makes me want to work harder to kind of get to their level because I want to be, I want to be there. It's like, it's aspirational, honestly.

Barry - 00:16:46: That's brings to mind, it's saying that, I think it was attributed to Teddy Roosevelt, I don't know if it's true, but he said that comparison is the thief of joy. So especially in those circumstances, when if you're comparing yourself to everybody around you all the time, and you have all these feelings of inadequacy, that's not a good way to function. So you have to be careful about comparing yourself all the time. And you have to learn, even though you're around people that are smarter than you, you don't have to match them. You don't have to be doing exactly what they're doing. You can do your own thing and use them as inspiration and use them as examples, but not use them as comparators.

Jon - 00:17:29: Yep. And I love that. Like, that's a very important distinction is to not measure your self-worth by that comparison and kind of use it as more of like a. Kind of a motivational tailwind more than anything. And I think also too, it's just like to bring it back to sports, it's like, and I was talking about like, you know, being a professor is kind of like getting into the NBA. It's like, not everyone can be LeBron. That's okay. Like, that's also okay.

Barry - 00:17:58: It doesn't mean you should stop playing basketball, right?

Jon - 00:18:00: Exactly. It is totally okay. And you're not, you know, you're not inadequate because of that. And for those who are, you know, coming out of medical school and... Embarking on this, you know, the practice, like actually practicing, are there any just like tactical tips or maybe that you can give for to succeed in that kind of high paced environment, um, or maybe some common pitfalls, um, that they should avoid.

Barry - 00:18:26: Well, it's especially a challenge for physician scientists. And this is, it's becoming even more and more difficult to be a physician scientist these days, especially people who wanted to do either an MD, PhD combined or have an MD, but going into primarily a research field. It's becoming more and more challenging just because of, first of all, the demands of the clinical work, but also the challenges in getting, as you said, either an academic position or research funding or knowing exactly where to fit in and getting the adequate support. So I think one piece of advice is to find mentors who can help. Keep you on track, and also give you support on those difficult days. But also serve as a way to have an example of how things can be and keep that in mind. So I think there are plenty of reasons to get discouraged and not always good sources of encouragement. So when you find someone who gives you encouragement and is a positive example. Hold on to that. Just don't let that slip away from you. 

Jon - 00:19:42: Yeah. And I always think about kind of the impact mentors have had on me. It is, I can't even understate it. Like, it's just like, so critically important to find those right mentors who can kind of like, kind of like a Sherpa, like kind of guide you through, because there's like, Without that, it can be difficult, like immeasurably difficult to navigate. So I love that advice.

Barry - 00:20:10: Other thing that I took out of being in the clinic was a perspective on what is an emergency. Because, you know, especially being a pediatric cardiologist, there are patients who literally were dying in my hand that I had to resuscitate. And as being a senior doctor in the hospital, when a code is called, so a code is when a patient has a cardiac arrest, the cardiologist is the lead of the team and has to run the code and tell the rest of the team members what to do. So that, first of all, that leadership experience under that intense amount of pressure is a learning experience. But it also has helped me in the business world because it's given me the perspective of what is a stressful situation. And it's helped me stay calm in situations where some people tend to get. Very anxious, and I say, you know, this isn't really that much of an emergency. This isn't that critical of an emergency. Let's settle down here and figure out the way. But in my mind, I'm thinking, you know, I've been doing chest compressions on a patient. Now that's an emergency. This maybe doesn't quite qualify.

Jon - 00:21:30: Yeah. Yeah. And I think, too, is if you let it happen in the business world or just like an organization, like a business, everything can seem like a fire. Or at least like everyone's like, it is urgent. And when everything's urgent, nothing is urgent because it's just like all the same. So I love that. Just like the ability. And I think for business leaders, this is like. And it's important to stratify that, the priorities, because there's only so many waking hours in the day. And you got to go to sleep eventually. So you got to figure out what is it on that hit list that actually gets done and needs to get done. And kind of like sifting through. Exactly what you said. Maybe we can let this simmer for a little bit and then not like, you know, be too kind of like too quick to just like pull the trigger on this. So that's great advice because I think especially for like folks who are like early in the entrepreneurial journey, everything can feel like a fire drill. And that's, that's no way to, that's not scalable. Let's just say it's not a scalable practice. So I know after your experience practicing medicine, you end up going into industry. Can you talk a little bit about how that, you know, it sounds like you're having, you're learning a lot, surrounding yourself with great mentors, colleagues. What was it that kind of was like, I need to get to industry and kind of what was the kind of catalyst for that? 

Barry - 00:22:57: Yeah, the main driver was... An opportunity for me to be able to combine my basic science training and knowledge. With my clinical interests. And I wasn't able to do that in an academic setting, as I mentioned. I would spend part of the time looking at zebrafish hearts and studying why does the heart form on the left or on the right. And then I would go to clinic. And I was actually at the time running a preventive cardiology clinic where I was helping children who had elevated lipid levels and hypertension, but also seeing regular patients. And the two were so disconnected. And I almost had to, you know, when I would walk across the street from the lab to the hospital, I had to change my mindset. So I really was looking for a place where I could combine those two. And there is this part of biopharma industry, this translational medicine part that allows some people to work with the scientists in the lab and take what they're learning in the lab. And apply it to the clinic into making a medicine. And for me, that was, it was just such a great opportunity. I had colleagues who were in, who had made the change to industry, and they were telling me the benefits of it. And I realized that that was a perfect combination of my skills and to have also a broader impact, you know, rather than on an individual patient basis to really have the ability when making a new medicine to have an impact, perhaps on thousands of people. So that was the main driver. I must admit that there were aspects of academic medicine and clinical medicine that were less appealing to me. And in the heyday, you know, being a department chair was a great thing. And to have access to discretionary money for the labs and to have time to be in a lab and to be able to train, that's all disappeared. And clinical medicine has changed quite a bit as well. Now, so many of my med school colleagues do complain about having to navigate with insurance companies and productivity targets and prior authorization and all these things, electronic records. And all these things that have sort of taken the joy out of clinical medicine. So looking back on what medicine has started to become, I must say I never regretted my decision to go into biopharma.

Jon - 00:25:38: Absolutely. Yeah. It's like, I can imagine as everything that you just described, it's kind of like, I didn't sign up for this. This was not part of the bargain. Like, I feel like duped here. I want to get back to actually like helping patients and not doing this other stuff.

Barry - 00:25:56: Exactly. But for the most part, I was much more drawn into biopharma than trying to run away from academic medicine. I think that's a much better way to frame one's career is to pivot to something that's an attraction that's drawn rather than trying to run away from a bad situation. So for me, that was very much the case. Biopharma had so much to offer and had such a draw to me that that's how I ended up there.

Outro - 00:26:29: That's all for this episode of The Biotech Startups Podcast. We hope you enjoyed our discussion with Barry Ticho. Tune in for part three of our conversation to learn more about his journey. If you enjoyed this episode, please subscribe, leave us a review and share it with your friends. Thanks for listening. And we look forward to having you join us again on The Biotech Startups Podcast for part three of Barry's story. The Biotech Startups Podcast is produced by Excedr. Don't want to miss an episode? Search for The Biotech Startups Podcast wherever you get your podcasts and click subscribe. Excedr provides research labs with equipment leases on founder-friendly terms to support paths to exceptional outcomes. To learn more, visit our website, www.excedr.com. On behalf of the team here at Excedr, thanks for listening. The Biotech Startups Podcast provides general insights into the life science sector through the experiences of its guests. The use of information on this podcast or materials linked from the podcast is at the user's own risk. The views expressed by the participants are their own and are not the views of Excedr or sponsors. No reference to any product, service or company in the podcast is an endorsement by Excedr or its guests.