Bryan Dechairo - Sherlock Biosciences - Part 2

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 Bryan Dechairo about growing up in Southern California, getting his BA in Integrative Biology from the University of California, Berkeley, transitioning from working for Roche to working for a smaller startup like Sequana Therapeutics, and getting his PhD at UCL while working for Sequana. If you missed it, be sure to go back and give Part 1 a listen. We continue our conversation in Part 2, talking about Bryan's experience moving from a small startup to Pfizer, the crucial nature of big data in modern genetics, working for Medco Health, and the importance of accessible, affordable, and accurate diagnostics resources.

Jon - 00:01:05: It almost seems like the first startup was like this uphill battle, but now it's starting to feel like getting some momentum, some like wind behind your back. Because like, why did my job get like so much easier and interesting? Because like now we actually have not these blunt instruments where we're just like bludgeoning like things in the left.

Bryan - 00:01:22: That's exactly it, right?

Jon - 00:01:23: Yeah. Okay. So you're at Oxygen, you're doing your PhD as well. Could you talk a little bit about the team at Oxygen? Anyone left a lasting impression on you, the friends and the colleagues that you made while you were there?

Bryan - 00:01:34: I mean, again, it was a startup company. And with any startup company, you do feel like a friend. But it was my first time, instead of being a scientist in a team, it was my first time running a team of scientists. And so in that high throughput genetics lab, I had about 15 people working for me. And so instead of being part of a family, you start creating a family, right? In a sense. And everybody's different. You have to care about people as individuals and understand, like, not everybody's the same and they have different ways of contributing. And so that was one of the big lessons for me there. But also, it really made me get to understand about big data. It's another big theme in my career, but I always love big data. And so, first of all, we're using population, like thousands and thousands of families that have sporadic diseases that they inherited or not inherited from family members. And we're tracking that for these big, large families. And so this heterogeneity allows us to start seeing these little signals through all the noise because you have big data, what I also realized was that everything accompanied produces is data, and so, like, what machine you used, what equipment, who did it, what reagents did you use? You can track all those with barcodes. And so I got everything barcoded and labeled and we did that all of ourselves. And it just became this, like, big data engine where we could see where all the problems were and where the inefficiencies were and just start getting, like, faster, better and faster and better. And again, if you remember the sequencing of the human genome at the time, it was like, oh, it's going to take us years and it takes us days. And we were just getting faster. And at the end of the day, we were just getting faster. At the end of my PhD, I then spent four more years at Oxygen running this through. At the end of the time I left, seven years later, my team could do what I did for three years of my PhD in one day. Right? And it was like, at some point, you're like...

Jon - 00:03:21: Oh my God.

Bryan - 00:03:22: Thats fantastic, but it also sucks because you feel like I actually spent three years and now I can do that in a day. Like you felt really happy about it. And I was like a commodity almost.

Jon - 00:03:31: Yeah, yeah, yeah, yeah. I have that same experience too. Just looking back when we started Excedr, I was mentioning like startups not being cool. It felt like we had a lot of headwinds. And finally, the startup ecosystem started to become a thing where like big pharma or just the big players were kind of relying on like startups to do R&D. And, we're like, oh, finally, we can start having these conversations. And then the advent of like the internet and really starting to make these connections was just like, wow, I was like doing door-to-door sales. I really did that. And like no one really does that anymore. I just remember. But very cool. And so something really interesting you mentioned is like this is your first time managing and building the family, creating a family. And 15 is like a pretty like for your first go.

Bryan - 00:04:11: Yeah, for a startup company, that's a pretty big chunk of a company.

Jon - 00:04:14: Yeah, it's a pretty big chunk. How was that experience? I feel like the natural progression is to start managing. But sometimes I think the skill sets as a individual contributor are very different than managing. Did it come naturally to you or was it a learned skill? Can you talk a little bit about that?

Bryan - 00:04:31: I think being able to like be efficient, put pieces in places to build up efficiencies and they get there is something that's natural to me. And I understand where the bottlenecks are, how to like solve those bottlenecks, see where the future bottlenecks are coming before they come. These are all things that I love doing because it's like forward thinking strategy. So that came natural. Dealing with the people at first was a struggle, like different personalities. But then I started caring about that. I mean, I care about it, but like I put energy into like, everybody's different. Like how do we harness the power of different people, put them in the right spots and things like that. And so that took a little bit longer to get better at, but I did over the seven years there get better at the individuals and the people understanding that. And so that was very, very helpful for the rest of my working time. And then the other thing that I really learned was. Sometimes, there's the teams that are like the creative, they're out there getting the new ideas. And then there's the teams like a high throughput genetic facility that I'm running, where they just feel like they're creating all the data that's going to actually make the company a success, but everybody treats them like a commodity. Right. And so what I learned about that was you can get anybody excited about their job. If you actually constantly talk to them about like, what's the impact of the job, like without you, you wouldn't have this, this discovery was because of the work you do and kind of linking back the outcomes, the company outcomes, the macro outcomes back to the day to day that they're doing is so critical. I think no matter what a person does in a company, right. So that they can feel part of the bigger picture.

Jon - 00:05:58: Absolutely. And I think as teams get larger, there's more entropy and there's more and more stakeholders. I think sometimes to manage the entropy and the large organization, sometimes people just opt to like spreadsheet management and people are not numbers in a spreadsheet. And I love that you're making that connection directly. The impact to the work is incredibly important versus just like managing from a spreadsheet, which ultimately kind of exactly what you said. It makes someone feel like a commodity and no one should feel that way. Right. And it's interesting because that's something that I had the same experience as the team got larger and I'm learning to manage a team of very diverse working styles, personalities. And it's a thing where if someone is more introverted and needs a little bit more time and doesn't feel comfortable communicating in a certain environment, making space for that person to like, take the time you need. When you're ready, let us know. And then for someone who's maybe on the other side that's more extroverted and it's go, go, go, go, go and figuring out how you channel that energy without having them kind of butt heads. It's both art and science and something too, that I think for anyone who's like thinking about trying their hand at management is exactly that. Like think about that and know your personnel, which is incredibly important versus, you know, just being too process oriented. We're just like, this is it. Just do it this way.

Bryan - 00:07:18: Yeah, it's definitely not cooking-cutter on one side, it's all, and I think that one of the things that people should all do is think about constant reorg. Like you come in, you make a decision and then people stick with their decision. And what you need to do is you need to constantly be looking back at, like step out of your body, look back at what you're doing and then go, should I make any adjustments? Because like sometimes you find people who are the innovators and you find people who need to do the slow, methodical, but more quality. And like, you can move people around and make space, especially as you're a growing organization, to do that and put people in the right spot and stop looking in the mirror. Like we all have a tendency to reward the people who are most like ourselves because we think, wow, we're doing fine. We're probably not. We're looking at ourselves.

Jon - 00:08:00: Yeah that's exactly it. And just to piggyback on what you said too, is like, not only is it okay to like look back and see where people fit best and put them in the position to succeed, but it's something I've noticed at least too, is that sometimes people change. If you're working with a team for years, you can see skill sets change. You can see people are learning new skill sets. Interests are changing. And there's nothing better than putting someone in a position where they're having a lot of fun and they're really good at it. That's like a match made in heaven versus like, you know, not having both of those. Sometimes it can feel like a slog and being open to the concept that like, what you're doing now, we might evolve it into something different over time.

Bryan - 00:08:40: And have those conversations.

Jon - 00:08:41: Yeah, exactly. And, you know, as a manager, being proactive about it. It's like, where do you see yourself? Where do you see yourself going? And where do you want to be? And so after your time at UCL and Oxygen, you know, you've wrapped up your graduate studies. You mentioned academia was not it for you. How did you know what you're going to get into next?

Bryan - 00:08:57: So again, I always think that when you look at career, you have to look at your career. You got to look at your resume and say, where do you need to be? And so there was a couple things that I learned at Oxygen. One was I had just been at two startup companies, right? And they were both having a hard time getting extra funding. And the reason I had left, Oxygen was because we were downsizing now. Because we were successful using genetics, we were now moving towards therapeutics. And so you don't have ultimate money. So like we had to move away from my team to therapeutics people. I'm not a therapeutics person. So we were downsizing my team and realized the money needs to flow towards the assets that are going to have value. We discovered disease genes. Now we got to go get the drugs for those disease genes and move forward. So I understood that. And I also realized, that like diagnostics are really powerful, but the therapeutic companies put all the money into the therapeutics and not into the diagnostics. But like you have to start with the right diagnosis before you get therapeutic. And so we were always relying on this pharma money to like survive as these small biotech companies. And I was like, you know what? I need some big pharma experience. I need to understand what's going on in the big pharma world. And I also know that diagnostics can really help medications be better. And it's like idea of personalized medicine was just starting to come about, where you could use DNA or genetics to help target medications to the right people, the right population of people. And I've been doing population genetics now for a decade. So I was like, I need to go to big pharma and I need to go into personalized medicine. And so I spent a whole year in the UK. There was only three pharmaceutical companies. There was AstraZeneca, Pfizer, and GSK at the time. I was the only three in the UK. I thought I want to stay in the UK. So I applied to all three of those and I finally got an offer to apply for a job at Pfizer. But the job was going to be back in the US in Connecticut. And so I said, okay, well, I've been waiting for this. Let me apply. I got the job. And interestingly enough, the hiring manager, which I didn't know, was somebody I worked with back at Sequana Therapeutics, back at Torrey Pines. And we didn't know, like, wow, this is amazing. It's like how you just like never burn bridges. Everybody is a small community. And so this guy, Conseco, who I worked with at Sequana, hired me back into Pfizer to really do pharmacogenetics and personalized medicine of therapeutics. And so I moved to Connecticut at Pfizer for the next five years.

Jon - 00:11:20: Holy moly. What a small world. That's the thing. And so now going in, you're like, I need this big pharma experience. I asked you the question about the culture shock of moving from the US to the UK. When you move from a startup to big pharma, and this is like very big pharma, did you experience a culture shock?

Bryan - 00:11:38: This is where you said, Bryan, when you showed up in the UK, did you have panic attacks? No, I showed up back in the US at a pharmaceutical company in development, bridging research, development, and commercial, and being one of the therapeutic area leads, when there's only like six or seven of us for this entire therapeutic area, I was like, wow, am I weighing over my head? I had that charlatan, that posture-enclosed mentality. And I really started having some panic attacks. Like, I believe in myself. But when you're like this big fish in a small pond, you feel good. And all of a sudden you're just like, I have this big responsibility, and there's all these great people and big committees and everything around you. That was a pressure. That was a pressure I was not used to.

Jon - 00:12:22: Yeah, I'm sure. And I haven't been there, but I imagine I would feel the same way. So how did you adjust to that? How did you start to find your place in Pfizer? And can you talk a little bit about the teammates that you were working with and the connections that you made?

Bryan - 00:12:36: Yeah, I'm going to talk about a few different things. So first, I do really care about mental illness. And later on, I went to a mental illness company and I was seriously going through panic attacks at the time. And so I learned one thing that I think the world should know about, which is I was in charge of like neuroscience, molecular medicine and neuroscience and personalized medicine and neuroscience there. So I'm surrounded by like the world leading psychiatrists and neurologists and things. And it was a big facility. So we had our own like doctors and nursing stations or whatever. They would give Pfizer meds for free, like for your benefits package, right? And so I went down there and I went to the nurse and they can't prescribe because they can't prescribe their own employees. But they said, you're having like anxiety. Like, don't worry. Like everybody has this. Like it's common. Like 50% of people at Pfizer are having this issue. Like whatever. Like it's a common thing. Like go here's some connections. And so I got onto some anxiety medications. I'm like, oh, almost overnight. Like I felt a ton better. I'm not saying drugs are the solution for all issues, but like I literally felt better. I felt better knowing that I wasn't alone. Right? And so that was really impactful. And when I was a chief medical officer at Surex, that really mattered to me when I was doing mental health and taking care of patients and talking to them on a daily basis because I'd been through it. But the other thing that I also saw with big companies were there's no such thing as jobs for life. People think they go to a big company, they're going to go to security, but it wasn't the case. Like at that point in time, Pfizer was acquiring big companies like Wyeth and they acquired Lipitor and they were just acquiring company after company. Every single year we had this thing called adapting to scale or something like that. And McKinsey would come in. And so like one year we were like a technology zone. Next year we were like site-based model. And then we went through a therapeutic based model. And all that really meant was like every year they're going to lay people off. And every year I had to reapply for my job. And that's stressful. Very stressful. One of the things that came about it was all of these different technologies started coming together. So we had like genetics, proteomics, metabolomics. We had wearables. Like before the Apple watch, we had like these big wearables for sleep studies, blister pack technology with electronics, all the clinical technologies, all of these different groups. And they all had like these neuroscience leads. And as we were starting to file all these technologies into this one big group called molecular medicine, there was multiple neuroscience. I had to apply for my job. And luckily I kept getting the position and I just got more and more and more tools in my toolbox to apply to the drug development pipeline. And it kind of taught me again, strategy about like, just because you have, a whole bunch of cool technology, doesn't mean it should be used everywhere. And the job is, is to say this cool little hammer, not everything's a nail. Like over here, we need nails over here. We need screws over here. We need staplers. Like it's okay. Like we just need to pick and choose the right technology at the right place at the right time. And that was what I loved about the job at Pfizer was that strategic decision-making.

Jon - 00:15:26: Very cool. The constant rearranging of the organization, a little bit less cool.

Bryan - 00:15:31: Yeah.

Jon - 00:15:31: But I love the ability to just like, again, it's like finding the right tool for the right situation versus just like, again, it's kind of, if you only have a hammer, everything looks like a nail.

Bryan - 00:15:41: That's right.

Jon - 00:15:41: Versus in this situation, Pfizer having all these cool tools, you have this opportunity to kind of a bird's eye view and have a more macro strategic outlook on it. And you manage a large team at Pfizer and you've managed a large team at Oxygen. Are there any differences between managing a large team in a big pharma company versus a startup?

Bryan - 00:16:00: So what was interesting about Pfizer was I was in charge of no one directly. So it was a matrix-based organization. So all of the technology experts lived in core functions. So like genetics, proteomics, metabolomics, clinical technologies, like that's all the imaging, like scans, MRI scans, wearable devices. These were all different core. Technology groups. And then my job was to have a team put together from all of those groups for the various drug development programs that was in research, commercial, even commercial stage or development stage and say, this drug program needs this tool. I need people who are experts on that to be part of that clinical team. And I would sell to the organization about why that technology was needed in that specific spot. And so I then was in charge of all those teams that were supporting the neuroscience portfolio, but none of them reported to me. They were just reporting to me for what their work was. They had to go out and get work. I had to bring them work. And then they were on my teams, but I wasn't their line manager.

Jon - 00:17:03: Whoa, that's really interesting. And I'll be honest, that's the first time I've ever heard about the Matrix organization. I know at Berkeley now, there's the Li Ka-shing building that they recently built. And they're trying to have a similar situation where it's like chem department, MCB, kind of like this satellite of each department. And they're trying to have a similar situation where it's like chem department, MCB, department. They pull people together. It's not a direct report type of situation. But how was that? How was that experience going from something where it sounds like you had 15 direct reports? Now you have, it's almost like you're pulling from an all-star roster to work on hard problems. How was that?

Bryan - 00:17:36: It was great because you get to know a lot of different people. You get to know where they're good, where they're not. And it is like picking a team. You go there and like, you know what? I would really like this person over here to be on this team. They get it. They understand this problem. They're like a champion for it. But the other nice thing too, was it was also like a sell-in process both ways because the core people representing them, they would tell me like why they want to solve the problem. Here's why I think I can solve the problem. Here's why I think I can solve the problem. Right. And then I would be like, I think maybe the two of you can solve it together or no, I'm going to pick you and not that one. So you're picking the teams and then you're executing on it. It just, it was great. It was like having all the pieces at your table to like combine in any way to like do things in a unique structure. For example, now you're talking about early detection of cancer all the time. We were doing early detection of Alzheimer's disease. And it was a combination of could you have a genetic risk factor for it? And then could I follow you on a electronic cognitive battery where you do cognitive testing on a frequency basis that I just like send you over the internet? And then if you're having a certain decline in your cognition, can I go get you to a spinal tap where I look at some proteins in your CSF? And then if you're positive there, can I move you into a very expensive PET scan imaging to like look at a certain early detection of Alzheimer's disease and get you into these early detection studies? And so it was like the ability to like take a piece of each different idea and combine it in a unique way to empower like novel treatments and things. So it was super fun.

Jon - 00:19:05: That's badass. That's like super badass. I'm curious. You mentioned that one, you have to assemble the team, the right team, but you also have to find the problem to solve. And I'm going to assume you'd also have to like pitch it.

Bryan - 00:19:17: So this is something that I learned at Pfizer that I do here at Sherlock all the time, which is start with the problem statement. You know, instead of saying, like, I have a solution, I'm looking for a problem. Like, you know, other way around. And Pfizer was phenomenal. Like, Jeff Kindler, the CEO, came out of, like, McDonald's and, like, Boston Market, food pub. Like, it doesn't matter. You have to look at the big problems. And so they would go to the customer and say, what's the problem we're solving? We need a drug that's going to do this, this, this, and this. It has to fit into this profile. And it has to be once a day. It has to be, like, and they'd create this minimally acceptable commercial profile. And then they would go back to the teams and say, if you build something that can address this commercial need, we will move it forward. But if it doesn't address that, we're not going to take it forward. And so it always start with the end in mind. It has to fit into that parameter. If it doesn't, don't do it. That was another big lesson there. And that was fun because now it was all, okay, I have to do this. I have all these toys and all of these technologies and all of these possible drugs. And now I have this profile. How do I pull pieces together to kind of fit into that space? And then we'll win.

Jon - 00:20:25: Very cool. Very cool. It's a straightforward concept to just find the problem first versus having a solution and then just like looking for the problem.

Bryan - 00:20:33: Startup companies don't do that, right? This is why I love at Sherlock. When I joined Sherlock and I brought in my chief commercial officer, Julie and team, the whole point was, let's bring in commercial now. We're a research stage company. Let's bring in commercial to go figure out what is the killer app that is needed and then see if we can build it with our technology. And that's what we've done here.

Jon - 00:20:54: Yeah. And it's interesting that you bring that up because I feel like there are plenty of startups that don't do that for a really long time. And then there's a rude awakening. Like a very rude awakening at a later stage where everyone has already invested time, money, blood, sweat, and tears. That there wasn't a problem to begin with. And it's just, what were we doing? And that's what I kind of love about this. The straightforwardness of it is just like, invert it. Just like quickly invert it before you plow like 10 years of your life into something.

Bryan - 00:21:24: Well, and also know, are you really differentiated or if there's something different? Like, I mean, if it's good, like all those different tools at Pfizer, it was like, well, we could do imaging. It works. We could do proteins in the CSF. It works. We can do some genetics. They work., but like, which one's going to be the best solution? But if you were an independent person, you'd all be arguing that yours is the winner. And like when I came in to Sherlock, we were trying to use CRISPR diagnostics, but in the central lab. And I kept saying, why are we using CRISPR in the central lab? PCR, which I've done for 30 years, is in the labs. It's great. It's the gold standard. And this is not going to be any better. So like, this is a great tool, but not where we're trying to position it. It will not work. It's great for decentralizing and democratizing healthcare. It is not good for keeping healthcare in central labs because PCR is already great there. We don't need to do it.

Jon - 00:22:12: Yeah, exactly. It's kind of like evaluating like the improvements. Like what multiple of improvement are we going to have here and achieve here? It's novel. It's for sure novel. It reminds me of like reading on the FDA, you know, taking the approach of like, you're going to have to prove that whatever you're putting through the clinic is going to be significantly better than what is already out there. And please don't waste your time on being just like incrementally better. Let's try to actually raise the bar in terms of patient outcomes versus just like pure incrementalism.

Bryan - 00:22:43: Pfizer was a great learning ground for me because they had two, like, even like if you were going to compete in the same class of therapeutics, they had a concept, which is either you're a first in class or you're best in class. Meaning you're the first to market and you build the brand. And because you're first, everybody uses you first. And so therefore you're going to be the winner or you're the best. Meaning like you can come out and take over from the best because you have some advantage, you can do it. And, you know, like we have Prozac and then we launch Zoloft, right? Right. You know what I mean? So, but then Lexapro came over, but that was a concept first to market or first in class or best in class. And what I've learned in diagnostics along the way is that oftentimes being best, which is what you'll see when I was at later on, when I went to myriad of things, sometimes you can't dislodge the thing that's first to market. And so first to market, even if you get better, everybody's so used to using what is there and it's integrated and it's like in plans and in hospitals. And it's so integrated that you have to be way, way, way better. For anybody to change, like incremental better, as you just said, is not enough. It has to be significantly better to dislodge something that's fully integrated already. And the longer somebody has a headstart, the better you're going to have to be to dislodge it. It becomes like routine.

Jon - 00:23:58: What an insight, because it's inertia. It really is just inertia. People like convenience. So you're going to have to really, really convince me like this works. This is great. Like you're going to have to really convince me to get off this. So that's a great observation. So you've been at Pfizer now, when did you know it was time to move on from Pfizer?

Bryan - 00:24:16: So it was a really interesting day. So I've told you a little bit about these diagnostics. I care about them, but like diagnostics can do so much. Like you have risk, then you have like early detection, then you have diagnosis, then you can make a prognostic, like how bad your outcome gonna be. Then you can do it for like treatment selection, monitoring whether those treatments are working. Like there's so many things that diagnostics can do and you don't even need like therapeutics. Like sometimes if you're early enough, you can just like have a surgery, like in cancer and cut it out. And then you're not bleeding yet or whatever. And so I realized that diagnostics have all this great value, even more value as I've always said than therapeutics. And therapeutics get paid billions of dollars and diagnostics are paid pennies in the lab, right? And I was like, something's wrong. And so all of a sudden one day, Medco came to Pfizer and I didn't realize, I didn't know anything about pharmacy benefit managers. Well, pharmacy benefit managers were the biggest payers in the United States. They're the biggest purchaser of drugs in the US. They insure all the costs of drugs in the United States. And they also deliver them to the pharmacies, right? And so this company I never heard of, Medco comes in. They're a Fortune 35 company. They make 65 billion in revenue a year. They're the biggest purchaser of drugs in the entire United States. And they started talking about like personalized medicine and how it's the diagnostic that should drive the medication utilization. If you don't have the right diagnosis, you shouldn't get medications off label or all these places. Like you should get the right medication for the right diagnosis. And I realized, wow, a pharmacy benefit manager could become a diagnostic benefit manager. And the chief medical officer, Rob Epstein at Medco, wanted Medco to not just be a pharmacy benefit manager, but a diagnostics. And diagnostics were paid out of the medical insurance because the doctors ordered them and not out of the pharmacy insurance. But if we could pull them into the pharmacy insurance, you'd pair out the right diagnostic with the right medication, right? And so I met them. And like two weeks later, a headhunter came to me and said, we're looking for the head of diagnostic R&D for Medco. Would you like to apply? And I was like, absolutely, I'd love to apply. And so I got the job and moved down to Bethesda, Maryland, and was starting to create this whole diagnostic arm of a pharmacy benefit manager.

Jon - 00:26:34: Oh, that's crazy. The timing is crazy. And it's also serendipitously that there's that overlap. And for a pharmacy, benefit manager sounds abundantly different than Pfizer, like structurally everything, the product. Can you talk a little bit about making the shift to almost like a, not a different industry, but a different part of the industry, like the broader scientific industry?

Bryan - 00:26:56: It really opened my mind, right? Like to actually understand like operations. Just two minutes to understand like pharmacy benefit managers, how they came about was drugs was a very small amount of spend compared to all healthcare. And so the UnitedHealthcare is all the big insurance companies were not focused on this. And so the PBM said, you know what? I can actually save the individual employer's money on the pharmacy side if I manage that with a pharmacist. What's the right medications? Are you doing it? And so these pharmacy benefit managers came out. And so they initially were just managing who pays for what and how it's going to like CVS or Walgreens or your pharmacies like Rite Aid. And then all of a sudden they realized, well, we're paying for the drugs and we're moving them. Why don't we just order mail order pharmacy? And so they started like delivering your drugs in the mail. And so then they had their own, like they paid for the drugs. They actually bought the drugs. They actually put them in the bottles, actually ship them to your house for repeat. And they would still cover the drugs at the drugstore too. But now they're starting shift the delivery to make it easy for people to stay consistent on the medications, to make it right to your house instead of having to leave your house or leave work to pick up medications. And so I realized like this efficiency of delivery systems, doing things in a different way. It was amazing. And I thought, why we can do diagnostics that way. We could get a sample, like a saliva sample at home and we could ship it to the lab and the lab could get the results. So we could give the results to the patient on the portal. And that's what we started doing at Medco. We started working with these diagnostic companies. In order to have like mail delivery of DNA collections and pairing them up with the right medication choices and covering the diagnostic tests and working with the diagnostic companies. It was great.

Jon - 00:28:36: That sounds like a lot of infrastructure, a lot of infrastructure build out.

Bryan - 00:28:39: Well, the good news there was the PBMs already created all the infrastructure. So they already had the mail systems. They already had the delivery systems. They already had the payers. They already had the insurers, right? So it was just about putting the diagnostics into the infrastructure that had already been built out for pharmacy delivery.

Jon - 00:28:54: And so you're spearheading this new effort. How did the diagnostics companies feel about it?

Bryan - 00:28:59: They loved it. So the reason they loved it was we were all about value-based reimbursement. So right now, diagnostics don't get reimbursed and they're always fighting it for the medical policy coverage or whatever. And so what we had at Medco was this concept of closing gaps in care. Can your diagnostic help us get the right patients on the right medications so that they have better outcomes? And if we have better outcomes, we'll actually save money for the payers as well. And if they could use generic medications, which are cheaper than branded drugs, they could also save a lot of money as well. So we had this concept like genetics for generics, right? It was great. I was like, and that's where I learned about this triple win where it's like, can the payer win and save money? Can the clinical system, like whether it's the pharmacy or whether it's the doctor or whatever, like the healthcare system, can they have a win, better outcomes, easier delivery? And then does the patient have a better outcome as well? Like if all three are winning, then you're gonna have a good equation. And so those diagnostic companies were like, finally, if I do something with Medco, they'll reimburse me directly. They'll pay me for it. I don't have to worry about coverage or who's gonna pay me. And it's all about like the value proposition. How much money can I save by getting people on the right treatments for the healthcare system?

Jon - 00:30:11: Yeah, that's amazing. Talking about when you're at Pfizer, having the right problem, right team. And it's kind of like this thing when you have this sort of like alignment, it's like stakeholder alignment. And when everyone is aligned, magic happens. Again, I'm sure the diagnostic companies are all like, about time.

Bryan - 00:30:29: There's articles about it. And it's because diagnostics never have a pathway to get reimbursed. You know, in the United States, when a drug gets approved, it automatically gets utilized and automatically goes to the medical companies and the insurance companies, and they figure out how we're going to pay for it. It becomes automatic. When a diagnostic gets implemented, there's nothing like that. So there's no guarantee for payment, you have to knock on every door and say, please, please, will you pay me something for this great tool that I want?

Jon - 00:30:55: It's a weird bifurcation. I've never truly understood it. I can't pretend to know the deep intricacies of it, but I've always found it weird. It's very weird because it's like, again, exactly what you said, to know what therapeutic to use, you have to have a proper diagnosis. Prescribing the wrong medicine is better to do nothing. There's side effects. There's toxicology effects of you can get serious harm for having the wrong medicine.

Bryan - 00:31:18: No, seriously. One of the companies that we were working with at Medco was a company called ShoreTel Health that was using pharmacogenomics to help pick medications that would help identify medications that would cause patients problems so that they could avoid the wrong medication. And therefore, at least you have a smaller list of medications to choose from that you might find one that works for you, but avoid the problems that the medications could cause, right? And so it wasn't trying to find out what would work. It was trying to find out what wouldn't work, you know? It's like trying to find the needle in the haystack. It was, we're not going to find the needle, but we're going to remove a ton of the hay. If we remove a ton of the hay, you're going to find the needle a lot easier if there's a needle in there for you, right? And that was one of the companies that we were working with was doing, it's a company I eventually became the chief medical and science officer of, but it was great. And so like at Medco, it was like logistics. It was like decentralizing, putting diagnostics into homes, collection, making people not leave their houses, getting people paid, reimbursement. It was like solving the big problems. Like who's going to pay for it? Is it affordable? Is it accurate? Is it accessible? So what we do at Sherlock now, we're always focused on these three A's like accessibility, accuracy, and affordability and getting them decentralized into people's houses or where they're at. And it started from my Medco days that I really had that idea. Like that's what we need to do to diagnostics.

Jon - 00:32:39: That's amazing.

Outro - 00:32:42: That's all for this episode of the Biotech Startups Podcast. We hope you enjoyed our discussion with Bryan Dechairo. 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 Bryan journey. 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 dot E-X-C-E-D-R dot 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.