Maneesh Jain - Mirvie - Part 3

Intro - 00:00:00: Welcome to The Biotech Startups Podcast by Excedr. Join us as we speak with first-time founders, experienced scientists, serial entrepreneurs, and Biotech investors about the challenges and triumphs of running a Biotech startup. Gain actionable insight into navigating the life sciences industry in each episode as we explore the business of science from pre-seed to IPO with your host, Jon Chee. 

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Recap - 00:01:10: In our last episode, we spoke with Maneesh Jain about his experiences founding multiple start-ups, executing Ion Torrent's go-to-market strategy and how simple blood draws paved the way for his current endeavours. If you missed it, be sure to go back and give Part 2 a listen. In Part 3, we chat with Maneesh about what led to the founding of Mirvie, the importance of empathy in company culture, his thoughts on the maternal health crisis and fundraising strategies in difficult times.

Jon - 00:01:44: And so we're now kind of getting to the current day. And after the acquisition by GRAIL, what was the driving force behind founding Mirvie?

Maneesh - 00:01:51: So I spent some time at GRAIL and I think that was good, but I think they were starting to have their own discussions with Illumina and kind of expanding. And it was a pretty big company. So I think it's again, all this thinking about what bears the biggest unmet need. And so what happened is I kept in touch with Steve Quake over the years. He'd done some exciting stuff, of course, with the non-basic prenatal test in the US and commercialized that. His older daughter, Zoe, I think he's been quite public about this, was born several weeks preterm. And so this kind of very personal experience with a pregnancy that was perfectly normal. And then suddenly several weeks before their due, they're rushing to the ER because now the premature birth is happening. And this we realized just happens all too frequently. I remember with my older, we were expecting a kind of routine induction. And then it was just like 36 hours later, and then it's emergency C-section, all kinds of stuff is happening. And I think what we took away from these journeys, which most parents have and moms have is that. It's kind of a black box and we know so little about something that matters so much. I think that's just been a shared experience. And I think people don't always talk about it maybe as much as some other areas of healthcare, but it's pretty clear that the impact is huge. You know, one in five pregnancies and families are impacted by complications. We know very little. And yet if you could detect these conditions really early, then you can take preventive action. And everybody's highly incentivized to take that preventive action because everybody is looking, whether it's the physician or the mom or the family, everybody wants a healthy, healthy mom and baby. So I think the opportunity to have a window into what's going to happen in the future and try to take preventive action is pretty compelling. So I think when we looked at it, we kind of said, “okay, we can do another cancer company, right? We'll certainly get well funded and there's a lot of technologies, but there's at least a hundred other companies, maybe several hundred other companies that are doing that”. So why not work in an area which we know has a really large and met need? People really care about it. And very few are actually doing something on that. Also the lessons we had from early cancer detection. So one thing we learned at Cirina was we could detect these tumors that were a few millimeters. And in fact, they were so small that by imaging it looked clean. You couldn't see them sometimes. And so they were actually false positives for your test. But when you did follow up two years later, the person ended up developing cancer. And so you actually had a true positive is just that imaging could not confirm it. So I think that gave us some confidence that, “Hey, if you can detect tumors that are so small and you can see that in circulation in the blood, then certainly big organs like the placenta, the uterus, the cervix, which are involved in the whole process in pregnancy, you should see signal from those”. And that was kind of the hypothesis. So Steve Quake published a paper in science, which showed that, Hey, in fact we can under some conditions detect preterm birth, like a couple of weeks, actually a couple of months, I think in advance in that paper, but it had longitudinal sampling. And so we took a leap of faith and said, Hey, if this works, we might be able to develop this RNA platform to look at the underlying biology of pregnancy and kind of really show, is it in the course for normal development or abnormal development? That was really the genesis for getting the company going is the idea that while cell free DNA has been so productive in cancer, cell free RNA, which is much more tied to development, right? The baby and mom's development is mediated by RNA that would be provided as insights into how things are developing and give us the signals on, is it a normal course or abnormal course of development?

Jon - 00:05:11: This is deeply personal. It's like very deeply personal. And that leads me to ask, as you mentioned, there's tons of vendors out there that are cancer diagnostics focused companies with pregnancy being so important to humanity. Why isn't there more pregnancy complication diagnostic companies out there? And why is it such an unmet medical need? And frankly, what is the state of the market?

Maneesh - 00:05:32: It's a great question. And we've thought about this a lot. So I think it has to do with some systemic reasons. It has to do with awareness and probably also technology. So let me just touch on those three areas. I think systemically, there's just been fewer women in leadership roles, whether it's Congress. I think it's, you know, 20% of Congress, 25% venture funded female check writers. And that's probably in the single digits and other areas. So I think there's been less investment in this area historically, because it's been perceived as it's a women's health thing and there haven't been as many people pushing it. But I think that's one area we're trying to change, where we actually think, like you say, it's one of the most important things for families. So we think it's actually a family health question, not just a women's health question. And everybody should pay attention because it's so important. We think about it as foundational to everything.

Jon - 00:06:18: Yeah. Another understanding, I think that having children is important for humanity to exist. Yeah, slightly, just a little bit.

Maneesh - 00:06:27: And then I think what's understood now, then let's talk about awareness. I think the second leg here, right? I think often it's been thought of as something that just happens during pregnancy. So there's two areas where that's incorrect. One is that you realize that in the last 10 years of research, that what happens is pregnancy at lifetime impact. So moms who have hypertensive disorders in pregnancy have a two to four higher risk of heart disease throughout their lifetime, and even in the early years after pregnancy. And so there's actually now cardiologists are starting to, as part of their assessment of heart disease, they ask you, have you had preeclampsia in a previous pregnancy or hypertensive disorder? So that's starting to emerge. It wasn't really clear. And then the second thing is it's just for many societal reasons, I think not as much talked about. And so when you ask somebody, you get all these conversations. But otherwise, people don't talk about if they went through a complication, it's kind of under the radar and maybe they talk about those as friends. But it's not been something that has had high awareness. I don't know if there's stigma associated or what, but I think those are the things we need to change. And I think that's increasingly changing. So I think women in leadership roles is changing awareness. I think we now start to see the media actually talking about the maternal health crisis. You know, just simple things. Today, pregnancy is more dangerous for moms than it was for their mothers. I think just think of that. How can that be in the most advanced country on Earth where we are doing worse than the previous generation when it comes to this issue? It's just staggering. Right. And then the last area is, I think, also technology. If you are only able to recognize symptoms, then it's pretty tough. But if you can do something safe, and that's, of course, really important. In pregnancy, nobody wants to take risks. But if you can do something as safe as taking a blood sample and tap into the biology through that and understand where you are on the course of development, is it normal or is it on course for disease? That's a game changer. And that really we haven't been able to do that till the last few years because we really needed to be able to look at a whole genome very scalably. In our case, the whole transcriptome. And you also needed these machine learning tools and data science to evolve where we can find patterns reliably in these very large data sets. Because if you're looking at thousands of patients and for each of them, you're looking at tens of thousands of genomic data points pretty quickly approaching 100 million plus data points. And so to make sense of all that, you need advancements in data science. So I think those two technologies have also come to a place. So I think we understand the historic reasons why this field has been left behind. But I think now the awareness is increasing. The technology is certainly there. And I think fundamentally, it's really not something we can ignore any longer. So it’s come

Jon - 00:08:54: It sounds like a no brainer. Like hearing this, I don't think it takes a rocket scientist to understand how important this is, to be quite honest. And I'm glad you guys are doing the work that you guys do. And on the Mirvie front, the technology that you're developing and the team that you're building, can you tell me a little bit about your approach to company building? And obviously, you've built up a wealth of experience, you know, as we've kind of covered thus far. But, you know, what is your approach as the leader of Mirvie?

Maneesh - 00:09:21: Definitely a few lessons learned, I think, from past companies, which I'm bringing to bear here, and actually several of the leadership team, too. I have a lot of combined startup experience. One is, I think it's really important to build a collaborative and supportive environment. So people should feel that they can come in and do their best work here and that if mistakes happen because they're taking risks, then we acknowledge it, figure out how to not do it next time and move on, not blaming people. So I think that's part and parcel of taking risks and moving past. So I think that sort of fundamental collaborative and supportive environment is pretty key. Now, alongside that, we need to have pretty aggressive goals. Otherwise, you end up getting really not a cutting edge environment. You end up getting a softer environment. So sort of balancing the collaborative and supportive pieces as a base, but then putting some pretty ambitious goals on top of that and be really kind of stick to hitting those goals and milestones and do everything possible to hit those. The other thing is just empathy. That's one of our core values at the company. Our core values are also innovation and rigor and speed. And you'll see those more often. But empathy is really central to what we do. Obviously, it's empathy for the families and moms who are going through this process, most important process in their lives and a very important outcome, but also empathy for each other in terms of knowing what each function needs to do for it to all come together and successfully. And when you're doing large clinical studies, right, you know, the early companies I talked about, “oh, life science is complex because it has aspects of devices and computation and molecular biology and chemistry and all that disciplines, data science has to come together”. Now you're layering on the whole large clinical trials, clinical operations, PIs, clinicians. And so there's all of this complexity, regulatory. There's so much complexity that goes into this. So I think just empathy really means for us, make sure we understand the challenges that other groups are up against and how they're solving those. So that, again, we have perspective, right? Each of us is doing amazing stuff in our area, but perspective that it all needs to come together and it'll only come together as well as each individual piece.

Jon - 00:11:15: Absolutely. And I was thinking about empathy is also a core part of Excedrs philosophy and ethos as well. Exactly what you said. It goes to having empathy for us. It was like, you know, our vendors, our team, our shareholders, everyone in the ecosystem. It takes a village, really. And it may sound cliche, but it really does take a village. And sometimes on the Internet can distill business to just it's just business. And it's not personal. And it's a number in a spreadsheet. But business for me is very, very personal. And it really requires empathy for whoever you're working with. And nothing important gets done by yourself. It all gets done as a team and in the broader team as well. I know you're kind of like in this motion where you've set these aggressive goals. And by the way, we do the same thing here at Excedr. We set an aggressive goal. And I think it just sharpens everybody like everybody comes together and rallies towards that North Star. And I know when you have big, ambitious goals and we're talking about big clinical trials, which are, you know, intense. In addition to operating the company, how is your fundraising experience been? I know 2022 and 2023 have been difficult for the broader life sciences. You've worked miracles in 2000. You've worked miracles in 2008. Is there any advice for those who may not have lived through those experiences when it comes to fundraising and capitalizing a company that requires a ton of capital, especially when you were planning to go to clinic?

Maneesh - 00:12:38: Couple of answers to that. I think one is just to build on something I think that you have shared about is focused right. Like for you guys, you're doing liquid handling and not doing, I think you said building planes or something like that.

Jon - 00:12:47: Yeah, yeah, yeah, exactly. That's exactly it.

Maneesh - 00:12:49: I think that comes into even sharper focus in this kind of environment. Right. You really have to distill it to the essentials that you need to be successful. Really a hyper focus and kind of saying, “what are the essential things we need to do right now to get to the next milestone?” Generally, I've carried that philosophy through most of the company building over the years, but I think in environments like today and 2008 and 2001, it's just much more of a sharper focus in terms of what allows you to get to the next milestone. So if you think of it, control of an uncontrollable, what we can control is hitting our milestones. Can you control how well the market's going to do and how big checks investors are going to write when? Not really. You can try to persuade them, but you can't really control those macro forces. But what you can control is hitting those milestones. And I think the more value you create by hitting those milestones will eventually get recognized. Now, if somebody is, you know, trying to raise money in the next six months, it's tough. There's no going to be no easy base. If that's the position you're in, then I think you just have to make sure you partner with investors who they'll get a pound of flesh, but hopefully they're very good partners for the longer term, right, and can take you through and share your longer term vision. So the very short term advice would be is if you're having to raise money. It's not going to be in great terms. That's a given right now, but I think still there's the opportunity to find investors who share a longer-term vision. So that meant things do turn around and get better than they're even more solidly behind you, right? But the other side of it is if you can wait a little bit, if you have at least a year of runway, think about how you can extend that a little bit. And what are the really key milestones that are valued by investors? Because there are many things that are very nice to do, but you really have to get to the must do list. It's very easy to say and actually very hard to do because everything feels like it's a must do. But if you keep asking, is it really a must do and why is it a must do? Keep asking the why question till eventually you say, no, this is absolutely essential or you know what? I could actually push that out. That's not absolutely essential. So that's another piece of the discipline. I think just try to hit the milestones and extend your own way wherever possible by just prioritizing super highly. And it's not a fun process, I think, but that's sort of, like you say, it's along with the collaborative aspects and the empathy, which are really foundational to building great teams. You have to have a sharpness too with startups right now. And so this process is about sharpness. Where are you going to cut the line for projects? And there will be a line and it has to be really crystal clear. In fact, articulating what you're not doing may be more important than what you are doing even in times like this, because you have to not do some things and focus on other things. So yeah, I think those are kind of the two pieces of advice, very short-term try to find the right type of partner in investors. And then hopefully, I think by sometime next year, mid next year, things should be better. Eventually they'll get to, I think, a more normal place. There is a lot of capital in the market. There's a lot of innovation. And I think those things are still happening. I think the deploying of capital and the valuations are in a tough place right now and probably not recovering in the next six months, at least. So I think just being as judicious as possible.

Jon - 00:15:48: Yeah. And when I kind of zoom out exactly what you're saying, it's so critical. And the science is incredibly compelling. Exactly what you said. The innovation is happening. It's not like the volatility of the market. It's not the science that's problematic. If the science was problematic, we are in trouble. But when the market goes up and down, I try to remind the team that it's like, “look, it's going to be what it is. It's a roller coaster. But on the grand scheme of things, the innovation is taking place and we want to be where the innovation is”. So I completely agree with you there. And exactly what you said about focus is so important because if you just work backwards that like Charlie Munger's like inverted that his saying, it's okay. Well, how many hours are there in a work week? And then from there back into, okay , what can I actually do during this work week that is of import and then just try to actually be so critical, like do a self audit of what you as an individual is doing and as a team are doing. And is this pushing the ball forward to hit this goal, to reach the North Star? And it's painful. We did this exercise like last year and we get so invested in the project, it almost feels personal. But as we reflect on the decisions we made to kind of pare things back, no regrets, no regrets at all. Everyone has like come together is like this was the right move instead of rowing like this way, we're now rowing together in the same direction, which is critically important to and not even as a startup, but I think also big companies as well. But instead of rowing in two directions, there's like 10 directions where you are running different directions. And so looking forward over the next one, two years, what's in store for Mirvie?

Maneesh - 00:17:21: A lot of exciting things. We are a very mission driven company. So I think that's really one of the things that binds us together. And I think generally if companies can find that mission that really unites everybody, that's awesome, because I think that's like you say, a North Star or a longer term direction that everybody is very unified. And so if you have to make sacrifices in the short-term, it's understood that it's not personal and it's not because the project is not worthy. It's just not above the cutoff rate. So that's, I think, one of the focus areas. But for the next one or two years, we want to complete our trial. That's a big area to make sure that we are really thoroughly validating our test. I think that's one thing that has hurt the industry. We all know the famous examples, but I think it also happens more broadly where it's not fraud, but I think that data are weak. Companies getting to market very quickly, but maybe with the more limited data set. But then the price you pay when you commercialize is quite heavy. It might feel like you get to market pass, but the scaling is very slow because there are just these questions about the data and that just come up at every conversation when you're trying to sell your product. And so I think even though it's not easy, we've tried to take the approach and say, “Okay, we're going to do very rigorous studies, but the data is then so clear and compelling that it makes your life much easier when you commercialize”. So that's one of the things that we are very focused on. I think obviously then getting women access to this test so they can finally have a way to really have a window into what's to come in the pregnancy and then use that to, I think, take some actions. We have a kind of paradigm. We call it no act prevent. And it really flows in that order. If you don't know what is to come, then you can't act and then you can't possibly prevent something more challenging from happening. So it really does have that flow. But I think what we really hope in the next two years is to start to change this mindset, which has been much more of a wait and see. Everything will be good. Wait and see. And if symptoms develop or something bad happens, then we deal with it. And often it's a crisis management type of situation. So that current mindset, we hope to start shifting that to a more proactive and preventive mindset. It's like, “hey, let me not assume it'll be perfect because even though four out of five times things look good, one out of five times it can end up in a crisis”. And do you want to take those odds with something so important in their life? I wouldn't. Right. So I think that's really the idea is hopefully we can start to shift to say, “hey, if you do want to know how this is going to evolve and then try to take some preventive action and eventually”, I think, to hopefully have many more healthier moms and babies and I think just make the whole experience pregnancy and pregnancy health just more dignified and more kind of transparent and more knowledge-driven versus a hope for the best type of experience that often is the case.

Jon - 00:19:53: Absolutely. And honestly, that's a world that I would like to live in where it's not just a wait and see, because honestly, that's terrifying, like absolutely terrifying. And they are very close friends of mine who are embarking on this journey, learning everything through this conversation, learning about everything that a mother might have to consider. That is not something that I want to wait and see on. I would very much want to get ahead of it. I'm on Team Mirvie here when it comes to changing that mindset. And I'd like to close things out with two closing questions. And the first would be if you were to give any shout out to anyone who supported you or would you like to give any shout out to anyone that supported you throughout your career?

Maneesh - 00:20:28: I think what I'd say is there are few key transitions in my career, which I think others experience as well. One was really just in college having a mentor who gave me a chance to do research and kind of maybe you'll screw up stuff in the lab, but you learn a lot and this will open up things for you. So that was amazing to have that opportunity, I think, in college. Then I think when we talk about at the Genome Center, switching fields from physical sciences to life sciences, Ron Davis was amazing. Right. He was like, yeah, I know you know nothing about this, but I think you're fundamentally curious and capable and can make a difference. So come in and give it your best shot. And that was amazing, I think, example of trust that will always carry with me. And then I think finally at Affymetrix was an amazing experience. I worked closely with the commercial leader there, Gregg Fergus. And I think just learned so much about how you think about commercializing, which is often a different mindset than innovation. It's not opposed to it, but I think there's different set of considerations. And I think just, again, having that opportunity with Ion Torrent to go from scratch to a really high growth in the space of a few years was just an amazing experience. So I think these moments in your career where you take a risk on doing something new is not necessarily an area of expertise, but it's a great area of interest and you have great willingness to learn from others. And then somebody gives you a chance to do that. Those are really amazing moments. And I think you grow so much as a result of that, taking that risk and then having some support on the other end to kind of, you know, guide you a little bit along the way.

Jon - 00:21:51: I look back on my big inflection points. It's like exactly what you said, too, about like wanting to live in an era. Where the wind is behind your back and the Cambrian explosion of innovation is taking place. But that's like one part of it is like catching that wave, if I'm using a surfing analogy of catching that wave, but also having a team or a mentor or someone who's there to take that early bet and bet on you. When you have the wind behind your back, there's a big wave like a Mavericks level wave that you're about to catch on your surfboard and someone there who's about to kind of shepherd you through it and give you a shot. I think that's truly a recipe for success. My last closing question, if you can give advice to your 21 year old self, what would it be?

Maneesh - 00:22:33: You know, I think what I realize now is my success and my team's success is identical, right? There's no daylight that separates it. We're one and the same. People say a lot about that, but I think really just feeling that in your heart is so important. And that's one advice I'd give to my 21 year old very, you know, I was hard charging doing all the of a team that that really makes sense and is so much more meaningful. That's one, I think, really important learning. And the other piece, I think, which I sometimes tell my kids, but you know, my Angela famously said, people won't remember what you told them, but they'll remember how you made them feel. I'd definitely give myself that advice at 21 because it's something that goes a long way along with, you know, we live in the world, which is so content and intellectually-driven and knowledge-driven that sometimes we forget that softer side or don't emphasize that enough. And I think there's a way to balance the two. And then together it comes to the same place. I think if people love working together, then you kind of do great things together, right? I think talent is assumed. But then if you bring in this empathy and love and teamwork and kind of feeling great about what you're doing together, it's going to go good places. That's just key learning 

Jon - 00:23:39: I couldn't agree more, honestly, at the end of the day, we're all human. We're not robots with the AI overlords coming in. They're the robots. We're still humans here. And I think it's always good to remember that is that at the end of the day, like if you work with a good team that you know, you're working towards a mission and a team that you enjoy working with and you guys are all aligned, good things are to come. Well, Maneesh, thank you again for taking the time to jump on the podcast. I really appreciate it. And if I had my own way, I'd keep going down rabbit holes with you. But I realized you're a busy person and you got other things to do. But thank you again. I'd love to have you come back in the future to double click on any concepts. I know the listeners here are going to find incredible value from your journey and your story. But yeah, Maneesh, thanks again.

Maneesh - 00:24:22: Thank you. I really appreciate the opportunity. And I also thank you for doing this podcast because I think there are so many who are wanting to go down this journey. And I think podcasts like this can give some inspiration, some measure of inspiration, and that's sometimes all you need. So I appreciate it.

Jon - 00:24:35: Absolutely. Thanks.

Outro - 00:24:38: That's all for today's episode of The Biotech Startups Podcast. We hope you enjoyed our three-part series with Maneesh Jain. Be sure to tune into our next series where we chat with Sandy Paige, Co-managing Director of the Seabright Ventures Fund, which invests in the US middle market with a focus on life sciences and clean tech. Sandy is an expert CEO, having acquired and scaled Explorer Biolabs before their acquisition by Charles River. His extensive experience as a director at the Jackson Laboratory also offers a unique perspective that is invaluable for founders growing their business. The Biotech Startups podcast is brought to you by Excedr. Don't want to miss an episode? Make sure to search for Biotech Startups podcast in Apple podcasts, Spotify and Google podcasts, or wherever you get your podcasts and click subscribe. To learn more about our leasing program, visit our website www.excedr.com We provide research labs with equipment leases on founder-friendly terms to support a path to exceptional outcomes. On behalf of the team here at Excedr, thanks for listening.