A Pharmacist’s Journey Into Startups
Zain is someone I have known and become friends with over the past year. I am a big fan of his progress so far and can't wait to continue following his journey.
It was a pleasure to have the opportunity to speak with him about his journey into healthcare startups.
We talk about:
Humility
Healthcare EMR's
Clinician Entrepreneurship
Clinical Trials in Oncology
Will AI replace clinicians?
The future of clinical notes
Transcript:
Hey
Zane, I'm really excited for this. To start the podcast, I would like to start with talking about humility, and I'll ask a simple question that is more nuanced than it may sound. Why do you possess humility, Zane? Why are you humble? Uh, first of all, thanks for having me, Rishad. Um, yeah, no, that's a really big topic, and I think that we were kind of talking about it a little bit before we started.
I think the reason why I'm humble is because I think that, for me, it drives me forward. If I go to a point where I feel like I'm at the top of the world or I'm the smartest person in the room, then where else can I go, right? What else is... There's nothing else to do, right? So I don't ever want to feel that way.
And for me, I feel like I can learn from anything and everyone. Any situation can teach you something. So I approach every situation, every conversation in that manner. Whether, so, so in society now, I guess that's labeled as humble or humility. Like I don't go in thinking that I know everything or anything like that.
I am, it does lead to me sounding a little unsure of myself. Uh, which does hurt me, but I think that overall, for me, for me, it works out because it feeds into my curiosity. It allows me to learn at a much faster rate than I think others, just because I approach just life in a different way. And that might not sound as humble as it's supposed to.
Do you think that curiosity, which sounds like drives the humility is innate or is it learned through your experiences in life? For me personally, I've always been a curious person. I've always been that person, you know, everyone says, Oh, take that. They wanted to take things apart and learn. I mean, I wasn't to that extent, but like, I wanted to see, I love to create and build with my own hands.
Like I want to, for me, like, you know, if somebody can do it out there, then why can't I do it? Right. And I try to like, learn how to do it. So for me, it was, I think for me, it was innate, but I do think it can be taught. And the way I tell people is like, how do you, because people have asked me, like, how do you become more curious for me?
It's, you know, just pick a project, pick something that you want to do, right. That you've always wanted to do. We all have that in us, but over time through, as we get older and older, like life beats us, beats the creativity and the curiosity out of us. But just think about like what you wanted to do as a kid.
And just work towards that or like you see something cool and you don't have to be a master at something right and it's not about you're not learning to be a master you're just learning to just be happy. I think that's one thing that people like a lot of people just go into learning like oh I need to just getting from point A to point B.
Curiosity is about just starting at point A and you don't know where point B is. So just pick something that you thoroughly enjoy and then just dive deep into that one topic. Pick a project and work towards that project. And I think that that's how you can reinvigorate that curiosity. Because I think as kids, we were all curious, right?
No one, if you ever see a child interact with something that to us is really, you know, just a spoon, right? Just a spoon, like you put something in front of them. They don't know what a spoon is. They don't know how to use it. But they see all of us using it and they're trying to use it. And they'll use it in different ways because...
They're just curious. Maybe there's a different way of doing it or just, so I think it is innate in us, but it's just beat, beat out of us during our school life, during life, you know, every, everyone wants to, life makes us conform into one homologous thing when I don't think humans are meant to live that way.
That's well said. Seth Godin calls education compliance training. And I do agree with him to an extent for someone who possesses this drive for curiosity. One would not think pharmacy is the best vehicle to express it. Why did you go to pharmacy school? Why did you pick pharmacy? Yeah, no, that's a good question.
So, um, So my dad actually used to be a pharmacist back in the Middle East, but when we moved here, his degree didn't transfer over. Um, so he had to go back to pharmacy school, but at the time, you know, it was three of three, he had three kids and our grandparents, and they were, my, my grandfather was not, uh, he was, The reason why I moved to America was because of my grandfather.
He was ill. So my dad went into I. T. So I had like a little bit of pharmacy background with him. My cousin was a pharmacist. All I knew, funny enough, I didn't want to go into healthcare at all because of the Every time I walked into a hospital, it was to watch a loved one die, basically. So I didn't, I always associated healthcare with negativity, but as I got older, I saw the value that healthcare can bring, like, you know, we can really help and heal people.
And that, that's a little bit of a hero complex that I'm sure they. All of us in healthcare have, right? We think that we can solve problems, even the most impossible problems. So, so for me, and also growing up South Asian, you really have two options. You should go into healthcare or engineering. So, um, so yeah, I, when I was in school, I, I wasn't the best student in college.
I was just good enough to see the light hanging over me. I knew I wanted to go into medicine. I didn't really know what. And then during my junior year, somewhere between my sophomore and junior year, my dad sat me down and he's like, Like you need to figure out what you're doing. Like, what are you working towards?
Right. I used to joke with my, my friends that I'd say I'm like pre life. I don't really know what I'm doing, but we'll figure it out. So after talking to my dad, kind of figuring, so then pharmacy kind of, I picked pharmacy because I really liked physiology, pharmacopharmacology. I really love those subjects.
Again, going back to curate, like how things work, like how the body works, how medicines interact with things. Like it just. Clipped with me for some reason. So I was like, okay, pharmacy could be a good route. You know, it's a subject. I enjoy I'll go forward with it. So that's kind of why I picked pharmacy honestly, and then from there, you know They became a pharmacist.
But yeah to answer your question. That's why I became a pharmacist. It was kind of just picked During the summer, I wish I had a really like amazing reason why, but that's a great answer. I love the term pre life when people ask me now, what am I doing? I say, I'm not sure. And I don't want to be sure I'm picking projects.
I love picking projects. I enjoy some of these projects have timelines associated with them and I'm committed to them for that timeline, but I don't know what I'm doing after. And, uh, it's not something I'm interested in knowing because in my experience. Having certainty beyond a few years only brings anxiety until you achieve that goal, and shorter term goals are likely the better path to success.
I'm in a very privileged place to be able to say that, but that's kind of where I'm operating from. Yeah, no, um, goals are weird for me, kind of going back to the curiosity thing and it's, it might sound weird. I try not to have goals because I found that throughout my life, like if I set a goal and reach the goal, then I feel like I've accomplished something when in reality, I really haven't, um, at least in my eyes.
So like, I try not to have any goals, like not, not in the sense of like, you know, like I have like. I shouldn't say I don't have any goals. I have like things I'm reaching for, but there's always something beyond that. Like, I don't have like, okay, once I do this, everything is great. And there's also something to that where like, you know, will I ever be happy if I live that way?
I don't really know. Um, so far it's okay. But for me personally, I try not to have goals because I feel like goals limit me personally. And that's just my own, my own brain thinks that way. As someone who sits on the intersection of a nation. I'm curious to hear your thoughts on Chad GPT, generative AI, and specifically, will Chad GPT change healthcare?
And if so, in what manner? I think it's already changing healthcare. Um, I think that there's a big It's stressing out the system in general. I think it's stressing out society in general. And it's really pushing us to the limit of what is ethical. What is true? What is reality? Like all of it. It's all these questions are happening and it's, and in medicine is not out from it.
I personally love AI. I think AI has the ability. To change everything. I do think that the, and I'm not saying this like just to be verbose or, you know, but I do think that this AI revolution that's coming is going to be akin to the industrial revolution that we, you know, none of us lived through. But, you know, we've read about that just completely changed society as we, you know, we live completely different because of the industrial revolution.
I think that's what AI is going to end up doing. And for me, in terms of medicine. I think that it can help, but I'm, what I'm afraid of is it's going to be, it's going to start being used for things it's not ready for, right? Like, for example, like it's not going to, it's not going to replace us as clinicians.
It's not there yet. It just isn't. And whether whoever is telling you that they have no idea what, what AI is, or I've never used it. They're just kind of talking about science fiction. What it can do is those black and white things, right? Like, does this drug interact with this drug, you know, or it can give you some differential diagnoses based on lab work and.
History and things like that, like help us again. I like to say augment, not replace. It can augment us. And I think that's where AI. It would be amazing at, but to even get to that point, we have to answer the data question. Data is really hard in healthcare. It doesn't, it's not as free as let's say, you know, your search history or this and that, right?
Cause that's not our, our data is protected. Healthcare data is protected rightfully. So, uh, in some cases it's protected based on capitalistic intent, but that's a, that's a, that's another conversation, but. I think for AI to really be good, we need a lot of good data and we just don't have that good data yet either.
So we're still a little bit away from AI really taking over medicine, but I think that it has amazing potential. And what I'm afraid of is it's going to be used in a way it's not supposed to be used, or it's not ready to be used and it's going to cause more harm. And then we're going to lose trust in it, in the, in that specific system or that specific company.
And it's going to bring us back. And medicine will shut itself off from AI, anything, and that's what I'm afraid of. That's why I say, like, it's important for clinicians and anyone in healthcare to use things like chat GPT, understand what AI, you don't have to be an expert at it, but just understand what it is, what it's capable of, just play around with it.
So when you are confronted with it, if you're a decision maker, or if you're a clinician, you can approach it with a more measured approach rather than thinking it's going to solve all your problems, or it's going to just kill, you know, kill your old profession. When I think about data in healthcare. I think there is a very, very big sunken cost fallacy and, uh, harmful tailwind behind these big companies.
As a physician, I know there's good data in EMRs. There's a lot of repetitive data and there's a lot of inaccurate data. Talking specifically about physician notes with templates, um, there are, to be completely blunt, lies in the EMR, most physicians, and this is more because of the malpractice issue because of the payment systems based, you can put pe and a full physical exam is there, um, no one's doing a full physical exam, so based on that premise, should we build it?
An EMR system and I, I realized it has to exist in a different malpractice and a reimbursement environment that truly captures our decision making process, not what we wish our decision making process was. That truly captures an audiovisual NLP based system that does not require any charting because charting happens after we make the decision.
It doesn't happen during. It's not an active representation of how we make the decision. And the physical exam has been a smaller and smaller component of our decision making. But there is, for some reason, I feel, um, A lot of push and a lot of organizations behind protecting the importance of a physical exam is give me your frank thoughts on the EMR.
Should they be scrapped? Should we start from NLP and actually reflect how we make medical decisions instead of how we think we should make medical decisions based on the malpractice? And the reimbursement environment. And I, I realize this is a hypothetical question. It's not based in reality. No, I mean, it's, for me, it's based in reality because I'd love to scrap all EMRs and start from the ground up to answer your initial question.
Um, because of all the things you mentioned, they're not built for clinical workflows. They're built for billing. Um, I even talk about this where I would, in my utopic society, we would have Like a health stack where your EMR is your database, your backend database that just has, just holds the information and can build for you.
And then everything else can work through APIs and you can build a custom solution based on your workflow. Like the, the one I bring up a lot is. you know, a cardiologist and a cardiothoracic surgeon, though they're dealing with the heart, they have completely different patient populations and completely different workflows, but they're forced into the same system, same workflow, same everything.
Um, so that, yeah, so I think EMR should be completely scrapped and we need to restart from the ground up. Um, and I, and I, and you brought up NLP and I think that's how we can do it. And I think I'm more excited about NLP and OCR, um, than I am about like chat GPT right now, because, or like, you know, like generative AI, cause at least in healthcare, we.
I know P and OCR can help us get to the point where we can start implementing generative AI and like the chat TPTs and things like that. We're missing that middle step. And that's for me, like, so that for me is what's more most exciting in healthcare. Like you mentioned, you know, you can, I mean, there are companies doing this where it'll transcribe a full, it'll transcribe the whole conversation that you're having with the patient, you know, doctor and you, it'll create a note for you and you can kind of look at it and just make a couple of changes and boom, it's done.
Like you don't have to. I mean, what people don't realize is a lot of times the notes are done like hours later, hours later, right? And you don't remember sometimes what happened and patients are, and especially if you're in a specialized practice, patients start melding together. You do your best to separate it out.
I mean, when I was in practice, I tried to write my notes right away, but I'm a pharmacist, our notes were way less. The reason I laugh is sometimes discharge summaries are months. If not years later. Yeah. So I think that people don't realize all this stuff is happening. And like to your point, some of the stuff in the EMR is not the source of truth.
Like we don't really have the EMR supposed to be our source of truth, but it's a very flawed source of truth. I'll dig deeper here, Zane. I just want to say one thing. I think we would have a better reflection of how we practice medicine if we didn't have notes. What are your comments on that? So what do you mean by that?
So the encounter existed in a video, and the worry is so when I walk in and there's a, there's a child in the room, my initial instinct is sick, not sick. If not sick, come back in two days if you're not better. That is a whole encounter. And everything I do after that is just to please the parents. Yeah. Um, how would regulators and how would patients react if that was the encounter, and there's a, there's a black box there.
Like, why is sick? Why are you saying not sick? And oftentimes, I don't know, it's based on my intuition, based on seeing thousands of patients. Um, yeah. Yeah. I think that, I think if we got rid of the note, we would need something to replace some sort of document like we need documented somehow. It does, it doesn't have to be, it could be visual, it could be auditory, it could be physical written.
Um, and that's why I think like the NLP solution is really interesting because. You can just have your normal conversation, and in some cases you could record it if the patient is allowing it, um, and it will just summarize it for you and then you just move on. And even if, and then your source of truth is not necessarily the note, your source of truth is the conversation that went on, that actually happened, right?
Yeah. Versus right now, the source of truth is... Our brain, which is fallible, right? Um, there's times where I messed up on a note, um, and accidentally had to like redact something or rechange if I remembered or whatever. So I don't know if that really answers your question, but I do think the way we're doing it now is not.
a good way of doing it because all that's really doing is adding work and not really helping anyone in the really it's not really helping anyone it's not helping us it's not helping the patient it's not helping anyone because again it's just we don't have the right interoperability and it could be wrong it's just like it's just kind of a messed up system right now yeah i think um i'll just add one more thing so usually the way our notes are divided um it's called the SOAP format subjective objective assessment plan the subjective and uh objective I believe should not exist in text because it does not portray the whole picture and at times it portrays a different picture than what's happening.
So the subject and objective should exist in a video format. And for example, if a patient says, I'm having crushing chest pain, and they're saying it like that, you know, they're not having crushing chest pain. Or if a patient is like going like that and is in pain and saying, I'm not having chest pain.
There are visual and audio cues that we just cannot have in text. Um, so I think the EMRs of the future that have a embedded video for subjective audio or for subjective and objective and the assessment and plan can still be, um, uh, text if that's needed, but. As our algorithms improve, um, and we don't rely on text because, you know, text is an invention.
We made because we didn't have a better way of passing on knowledge. If our technology is secure enough. I don't necessarily see the need for text to exist. Yeah, no, I'd agree with you. And I think that, I mean, I would be okay with it. I would be okay with what you said. And I think that there is validity to that.
Um, and I don't think people realize. Like, I mean, what you said, I'm just like thinking about like some patients where they're like saying they're like in writhing pain and they're just like smiling at you. I mean, there's, I mean, you can't, you can't judge somebody just by the way sometimes people are good at hiding it.
But I think it would be a good tool to have. And that's one of the reasons why. I like telehealth, like a lot of people, how are you going to diagnose people via this, this, and this? I mean, you can tell a lot from somebody's body language and the way they're talking to you. And you can do a lot via video.
Um, so that's why I've always been a proponent of telehealth. Uh, for one, for access and B, it just allows both sides to kind of do it when they're, when it's happy for them. But I mean, it's an interesting thought. I've never honestly thought about it. I've always, I guess I've never thought that far outside the box.
I thought I thought outside the box, but that's even more further than me. But I like the idea though. Yeah, I just think it will be more of an objective representation of what actually happens in our actual decision making process, and I think it requires a move away from text based notes, text based charting, and it requires regulators, reimbursement, medical legal environment to support the move away, where if I am sued and I say, well, I don't have any notes, I just have videos, because that is how I make decisions, That should suffice.
Yeah, and then the video can, and videos in general give you much more information than like text would, right? Like things can, things get lost in quote unquote lost in translation. Um, and you know, if a patient is being aggressive, you don't have to like write patient is aggressive, you can just see it in the video, right?
You don't have to like prove to anyone like, you know, and if somebody's, you know, so it'll also, it would also help with like those kind of things. And also if like, like you mentioned, like. And then you can go back to it and see, like, did I miss something, right? Because our brains, you know, like, if we don't think about it, they can go back to it if something happened.
Like, oh, let me go back to that last visit. Or somebody else can go back to the last visit and see it. Like, hey, you know what? They were, this is looking weird. Did you check it? No. Then you can kind of call them up. So there's a lot of benefits to what you say. Yeah, this is, um, speaking as an anarchist and someone who hates charting, I love this solution.
I hate charting too, man. Oh my god, it was the worst. So Zane, we have a good idea and understanding of why you began your journey into pharmacy. Why did you leave pharmacy, Zane? Yeah, man. So, I was just tired of telling people no. I was tired of just dealing with the problems instead of fixing the problems.
Um, I couldn't see a path. to change from within the system. So I had to leave the system to hopefully change it from the outside. And that's just my own personal, um, things. And it, it could be my own shortcomings that I couldn't do it from within, but I just, for me personally, I couldn't see a path and my passion is technology and healthcare and, you know, Everything that's going on that was going on, I, you know, with my own personal, uh, endeavors prior to, um, me leaving, but I just feel like, and then also being able to help at scale.
And that to me is something that's, I don't want to say the word intoxicating because that's kind of, it's just something that I would love to do. I want to do something where I'm like, I helped millions, maybe billions of people. Rather than a couple hundred or a hundred thousand, like, you know, I think people don't realize is when you're in medicine or you're, you're, you're a slave to your schedule, right?
You can only see those people. And if there's an extra person that needs to be added on, then everyone is getting pushed down or up or this and that. It completely ruins everything. Then your home life balance, it's, it's all, it's all screwed, right? Um, and especially even in inpatient, right? Like you have to, I mean, think about this, like you have to make, you have to make a decision of whose life is more important.
Like people don't realize that like us as clinicians, even on the hospital side, we're like constantly triaging patients. And that to me was just not the way I wanted to live. Like for me, like everyone is important and I just wanted to help it scale. So that's kind of why I left. And also the other thing was I was sick and tired of solutions being stuffed down my throat that I knew wouldn't work.
And I knew that. If they just had a clinician in the team, it would have stopped it. Like stop that specific thing from happening. It could have built a better product. Right. And I was like, why can't that be me? Like, why can't I be that person that's guiding change? So that's what that's. And then that's what, that's what pushes me.
Right. Like I want to, I want to get to a point where I'm in a position of power. Not in, not because I want to be, I hate, I hate, I don't ever want to be that, but I want to just be in that position where I'm guiding healthcare rather than other people guiding it for us because I come with the empathy of being a clinician, I come with the empathy of having to sit there, stare at a patient and tell them, hey, your copay is 5, 000, you have cancer, and Uh, you know, like people, I think that people need to like sit down and tell bad news to people if they want to come to healthcare because you really need to empathize with what it is.
And that's kind of what I bring and I think we need more clinicians in tech because of that reason because tech is coming, AI is coming, all this stuff is coming, we can't stop it. But we can help guide it and we can help guide the way medicine is done too. So we can, so maybe I can create a, again, this is kind of the God, like the hero complex coming out.
Maybe, maybe I can create a environment for other clinicians to where they never have to think about. They're doing what they love and they're, you know, what they spent hundreds and thousands of dollars and years of their adult life working towards and they're exactly where they want to be and that's kind of why I did it.
I completely agree with that. The system as it exists now, the volumes of patients we're seeing is not sustainable. Most of us are leaving. I remember reading yesterday in the States, 240, 000 nurses graduate every year, 80, 000 of them leave within two years. I think anyone looking in that statistic can say this system is designed for burnout.
It's designed to overwork clinicians and it's not a sustainable system without just constantly increasing the inflow of workforce, which is where the focus is surprisingly enough. Yeah. And then the thing is like. I feel like the system also takes advantage of our personalities. Most people that go into medicine are very like, give, give, give, they don't really take much.
And for them, like what people don't understand about burnout, and maybe you can correct me. I mean, you may be yours, yours was different. It's not the work. We all knew going in, we weren't going to have the greatest. work life balance, there were going to be late nights, there were going to be early mornings, emergencies, all that stuff.
We all knew going in, things were going to happen. We were going to make hard decisions. We might not be able to, the things are going to affect us mentally. What we didn't see, we weren't taught this, told this, is all the other stuff that, you know, the insurance denials, like, like I can't tell you how many times standard of care was denied.
And that's just infuriating. So imagine you have cancer and, you know, we know that, hey, we can wait a week, but the patient doesn't know that I'm not going to sit there. Oh, you know what? It's okay. You can wait a week. You know, you have cancer. Like that's, that's not a conversation I've ever had and never will have.
And you know, they're, they're freaking out. You're freaking out. Like you don't want to bankrupt somebody. You're just trying to help them. And like, you're brought into this, this other world and the majority and the worst part of it is we live in that world more so than we live in the clinical world.
Which we spent our whole life learning about. And it's just like, that's what I think burnout is. It's not the work. It's not the amount of work it's, it's the type of work we're doing because we were ready, we were prepared for the amount of work we were prepared to for that stuff. We weren't prepared for the other stuff.
I completely agree. If my whole day was just seeing patients, I'm happy. That's what I want to do. I would have never left if that's all I was doing. If I was just doing that and things were working the way it should have been working and I was able to help people, I don't think I would ever. And like people, like people ask me, like, would I do it again?
Probably. Like it's maybe it's something weird. Like it's maybe like Stockholm syndrome or something.
I think I would. I think I got to where I got to because of what I did. So that's why I think I would, but Um, it's just an interesting thing. I think most of us would never, would have never left if it was exactly what we thought, not even exactly, but if it was close to what we thought it was going to be.
And the solution is simple. The clinician's job is to see patients. Period. Automate, outsource everything else. And there will be no shortage. People will stay in medicine. But, you know, for, for lots of reasons. And, you know, people might think we're being vague here, but I can be very specific about this.
Literally, if my day, and I'm happy to see 30, 40 patients in a day, if all I'm doing is talking to the patients, and then when I come out, I have a scribe that's assigned to me that does all the charting, if I get a call from public health to, you know, the patient you saw last week, They have been diagnosed with hepatitis.
Can you call their eight family members? Uh, and if that call, um, you know, why don't you call public health or are you asking me to call? So I, I think, uh, if we just saw patients, like, it's, it's, it's not that complicated. I think we overcomplicate in some ways. I agree. And that, I mean, maybe not the calling of the patients, but that's, I think, where AI is great for, you know, it's not, again, replacing us.
It's doing like the, it's doing the documentation, it's doing all that stuff, like NLP, like it's taking care of the stuff, the administrative tasks that no one wants to do, and it can just take care of it. You're not really paying the AI, I mean, you're paying for the use of it, but it's much cheaper. And I think that's, that's what excites me about AI is because I think that AI has the capacity to bring us, to bring clinical work back into the forefront of what we, what we do 90% of the day.
Yeah, I think, uh, I don't know. It'll be interesting, uh, going back to the video analogy. If you ask someone, would you know what goes on in a basketball game by looking at a text? What happened? Everyone would say no. Why do you think you would know what happens in a clinical encounter by just looking at the text of what happened?
Yeah, no, as somebody who has watched a lot of basketball on ESPN, on like their website, um, because I didn't have cable, you're absolutely right. I mean, you know, like the points, like who's winning, you know, who the foul is, but you don't know how hard the foul is, how impactful that shot was, you know, the emotions behind it, like all that can change a game, right?
Now imagine if you never saw a basketball game and all you knew was the text. How, how different is that from, yeah, that's, that's even worse. I mean, that's a great analogy, actually. Thank you. I think the, the, the next question I wanted to ask you is about cumulative health. How did you get into there and what was the outcome?
Yeah. So Cumulo Health, uh, was my startup. Uh, we never left the pre seed stage. Um, so the grand plan of everyone listening to this is going to think I'm crazy, but, uh, this was, I don't know, 2014, 2015 in that range, um, Epic only had, I think 12 to 13% market share. They weren't like as, I mean, now I think they're in the thirties, uh, like upper thirties now.
Um, So there, there wasn't a lot of comfort. I mean, there was competition, but it wasn't like as it is now. So I was sick and tired of faxes and this and that. Like for me, one big thing is I want patients to own their own health care data, because I think it's ridiculous that your health, the most precious thing to you, you have zero ownership over.
So I was trying to create, I was trying to create a cloud based EHR with telehealth, uh, that patients control their own healthcare data. And my target market was. The rural population, because I wanted to have increased access to healthcare. I wasn't going after, you know, the hospital that I worked at, the Mayo clinics and such.
Um, so that was the goal. Uh, we were, obviously that was the end goal. We were working towards it. Initially we were going to come from the pharmacy angle, like doing med recs and like, you know, labs and scans and things like that, and then kind of move our way up towards it. So, uh, we didn't make it. So this was like three years, three, almost four years of my life.
Uh, working and talking to people and iterating, uh, we were bootstrapped by ourselves, made every single mistake in the book. I didn't know what fundraising is. I had no idea what the hell I was doing. Probably still won't. I mean, there's a lot of mistakes I made that I just. And then when I look back at it, it's almost cringy to think about, but, uh, learned a lot for sure.
Um, and the reason why we didn't make it was not because the idea was bad or people didn't believe in us. We talked to a lot of people. They liked the idea. They thought of, even then they thought we were a little crazy, but they loved the vision of it. But what happened was we were, we had, we picked our developers.
We found the developers, the great developers. They, they were experienced in HL7. Um. Fire HL7 fire. And they had built a previous like rudimentary EHR for another like hospital system in, in Europe. So they showed it to us. It was great. And, uh, so we were kind of working towards that. We were about to get our MVP, like sign the dotted line MVP was going to come out maybe in the next couple of months.
And, um, my co founder just. You know, I don't want to go into his thing, but like something happened, everyone was healthy and okay, but something happened that stopped us. Uh, again, we were all self funded. We just. Cause we were the funding and, um, looking back at it, I wish I would, I had the money in the bank to pay the developers at the time.
I wish I would have just done it, but I was in a different place. Like I was staring at 200, 000 of debt. I was just recently married, not saying that my wife held me back. She would have 100% supported me, but I didn't think it was fair to her, um, at the time. And I just was scared. I mean, that's the easiest way to put it.
I was just scared of. Of just moving forward. Right. So that's kind of why it stopped. I've, I thought, and then like the next year I thought about bringing it back. It just never did. So that's kind of it. I wish there was more of an awesome story behind it, but I used to look at it as a failure. I really didn't talk about it too much, but for me now I look at it as kind of why.
And where I am, why I do what I do. Um, but yeah, at that time it was really gut wrenching to kind of like say no to it when we, when we emailed them saying, Hey, we'll come back to you. I knew after I sent that email that we weren't going to come back to them. But I just needed to like have that little bit of hope, uh, for myself to kind of like, maybe we will, but I knew we weren't, um, in the back of my mind.
So, but yeah, but it was, it was a interesting project. That's why I'm really like, so I was talking about, I wanted that I've been a proponent of telehealth for quite a while and patients owning their data. So like, if I can get to a point where. Patients own their own data, I can die a happy man. That's like my white whale if you want to talk, if you want to say.
Talking about patients owning their own data and making their own decisions to an extent, the, the medications that are over the counter and the medications that are prescribed seem somewhat arbitrary. And you can make a good argument that NSAIDs and for those listening, uh, those are non steroidal anti inflammatory drugs like ibuprofen and then some brand names Motrin, Advil are over the counter but a prescription like birth control or even some of the blood pressure medications like Ramipril are prescription.
I think you can make a fair argument NSAIDs are more dangerous. How is that decided? And why, why, why is that safe? Like, explain to me. Uh, no. I can't explain. I mean, honestly, like, even in pharmacy school, we were told that if NSAIDs came out right now, uh, they would probably be a prescription drug. Um, the fact that I think they came out when they did, I can't remember exactly, uh, what year aspirin was created, but it was a long time ago, and I think at the time it wasn't as stringent, like, you know, FDA and everything wasn't as stringent.
I mean, they really became stringent, uh, I forgot what the name of the drug was, um, but, um, after, after, you know, the BERT defects and that, that drug caused, they became, I can't think of the top of my head, Revlimid is the sister drug of it. Yes, the little man. Yes, that's what it was. Um, after that, they became a lot more stringent about things.
And like you said, there are drugs that I mean, like, there are drugs that, like H2 blockers and things like that, that were prescription for the longest time, right? That are, again, way more, way safer than NSAIDs. So, to answer your question, I think it was just a different time. It was just different regulations now where way, way, way, I mean, U.
S., the U. S. has the strictest, most, most strictest regulations. There are drugs that are in Europe for years before they're even, you know, working and have studies behind them before they even get approved here. Yeah, I'm looking at the list of drugs that were made over the counter from prescription, and it's literally one or two drugs a year.
Yeah, and I think that, I mean, I don't know, like, I think the way, I don't know how they, to be honest with you, I've always wondered how they decided. And I can't really tell you why, and I think maybe they can look at safety data and things like that. But I mean, technically speaking, like PPI's for proton pump inhibitors or for acid reflux for people that don't know, they're finding that they cause a lot of issues now too, right?
And like now they're over the counter. Like, it's just like, there's like, I don't know. I don't think there's ever going to be a perfect system. I just don't think you can, because I think over time you're going to find more and more things that come up. Good or bad, right or wrong. So, I think it's always going to be a system that's just going to be a flawed system and we're just going to have to live within it.
That's not probably the answer you were looking for, but I think that is the answer. No, that makes sense. I am excited about precision medicine epigenetics. And the future of disease treatment, including cancer and outside of cancer. What are you most excited about oncology? So, I love, um, I think it's amazing what's happening.
Like, in my practice, when I worked at the hospital, we were using genetic testing for, I think, like, close to six, like, for the last six, seven years. I don't know, maybe not that much, like, six years, six, five, or six years. Uh, we were seeing drugs that were being used for different disease states. Like, you know, for example, Herceptin, it's a drug that's, uh, used primarily in breast cancer for the HER2 positive.
If they're HER2 positive, they'll get that drug. But they were then like with genetic testing, they found that, Oh, some colon cancers are HER2 positive. Let's add Herceptin there. And, you know, Some lung cancers might be so you know, like it was just it was it was cool to see all these things and I think drug development can also like the newer so there's like the newer chemotherapies coming out are targeting specific genes and you're seeing a lot better um patient outcome like a lot less um Okay, they have much better side effect profiles, right?
Like, I know somebody who's been on, like, Nivolumab. I feel like that drug is going to be for everything. Eventually, it's going to get approved for the flu. But, uh, you know, those kind of drugs, like, patients are on it for years. And, you know, the worst they have is maybe feeling a little nauseous. Maybe their creatinine pops up a little bit for a little bit.
Just get some hydration and then move on with their way. So, for me, genetic testing and, like, the move to creating... Like these drugs based on your genetics or giving you drugs based on your genetics is amazing and I think it's, I think eventually what's going to happen, uh, specifically oncology and maybe also other drugs, other things is you're going to have a specific cocktail made specifically for your, your genes and you might, and you'll be specifically catered to you and to me that's exciting and that to me is going to be the future of medicine.
We're not, you're not going to be like, Oh, I'm getting X, Y, and Z drug. No, you're just getting, um, A cocktail of things that are for you, there is still a somewhat of a black box between genotype and phenotype and from genome to proteome and to pathophysiology, where do you think opportunity lies here for more research and potentially more investment?
I think that I think for me, like gene therapy, gene therapy, that's completely different thing. I think like going after the genetic. Is always going to, in my eyes, reap, reap the best rewards, because, um, I mean, I could be wrong, I mean, this has been a long time since I've taken genetics, but, you know, your genetics are what dictate your phenotype, right?
Like, they're what dictating everything about you. So if you're attacking specific genes, or you're basing treatment based on specific genes, you should be able to Get a decent outcome versus going. I mean, that's how we've been treating patients now, right? Like you're basing them on physical characteristics or things like that, right?
Or I mean It wasn't just until recently where they found that certain drugs don't work well for african americans, right? So that you could have you couldn't find out with gene therapy I mean not gene therapy like looking at people's genes, right? You don't need to know that they're african american or not But just their genes will let you know that hey this drug will work better than this drug Tell me about your time in clinical trials.
What did you do? during your time there and what did you learn? I learned that documentation, documenting, documentation. I spend most of my time documenting, um, and then getting yelled at for not documenting the right thing. No, but I think clinical trials, I got a, I had a much more, I think when you're reading papers about clinical trials, you, you like to poke a lot of holes in it.
Like, oh, why didn't they do this? Why didn't do that? Why didn't do this? But when you're part of a, when you're part of, I didn't run a clinical trial. I was part of the clinical team that was looking after the patient, making sure all the drugs were right, and you know, all that stuff. The pharmacy side of it, um, and also workflow from the pharmacy side of it.
I helped, I mean, I helped with it, but I was part of that. Um, you find out that running a clinical trial is really hard. And it's really, really difficult. And each hospital has its own challenges. So you can't just have a blanket statement for everyone and everything. And I can see why they cost so much money, right?
Because of just the, just the mag just how much you have to do and how many people are involved in just getting a drug to the patient. It's just so much involved. So I, I, I gained a really healthy appreciation for clinical trials while I worked there. But in terms of my actual job, I mean, I made sure that the drug was made properly, made sure the dosing was right based on whatever parameters that were, you know, do we need a new height, height and weight every time do we need, or was, you know, for cycle one, was it okay?
I mean, it's really boring. I can go into it, but it was kind of that kind of stuff, just, um, administrative things, mainly making sure that everything is. buttoned up, making sure the drugs are right and all that stuff. So, uh, that's kind of what I did for the most part when I was working in clinical trials.
Yeah. I'd love for you to get into it. Only. Yeah. So, so yeah. So when a clinical trial is, you know, when they, when they come to your site, they do like this huge audit about what your site is, what they can do, how you can do it. You know, they have multiple people involved. You usually have some sort of, um, you know, P.
I. Primary investigator, which usually is almost always is a physician. Um, that's pushing for this. So then pharmacy gets involved. The way pharmacy gets involved is, um, you know, the whole drug delivery part of it. How is it going to me? How is the drug going to be stored? Where is it going to be stored? Um, how who's who has access to that drug?
How is the drug going to get made? Uh, what kind of safety precautions do we need to make? Does it need to be in like a, you know, a completely negative pressure room? Can it be made in like a standard cabinet? Um, then, you know, then, then from there, we need to come up with the whole workflow because we don't, you know.
You have to like, okay, does it need to be diluted? How long does it need to be diluted for? Like, what are the diluents do we need? You know, what's the dose? How do we calculate the dose? You know, do we need a new weight every time? Do we need a new height every time? Like all that stuff goes in. And then, you know, uh, what are standard doses?
What is, do we need a cap on the dose? You know, all these things are. You know, what labs are necessary, what labs do we need, uh, what are, what are the, you know, what are the extremities of those labs when we should be worried, right, you know, if the ANC is below 0. 5, should we care, um, or should we not, right, depending on what the drug is.
So that's all kind of, I mean, the, the, the trial is kind of dictating us to do that, but we as pharmacy need to be cognizant of it and we have to make sure that that all of that is happening. Um, usually, uh, the doctor is involved, but they're involved in the sense of like, hey, they're trying to find the right patient in for the clinical trials.
That in itself is a hard job in itself. Like that requires a lot of, there's a lot of inclusion, exclusion criteria. But once they get past that, then the doctor is just monitoring labs and making sure everything is okay. Then it kind of falls on pharmacy to kind of take over the rest of it. And then, then the nursing staff has to stay up on labs and all that stuff.
So it's very involved. It's not like a standard. Treatment where you can just be like, okay, this person's getting pertuzumab. All right, cool. Just throw, you know, just dry it up, throw it in. Good to go. Like, you know, I remember when pertuzumab was being studied, it was way more complicated. We don't, we don't actually throw drugs.
Yeah, no, no, you know, we don't do that. Everything is safe. Um, but I remember when that drug was being, uh, being studied at our institution, it was, it took like three times as long to get it to the patient. Now it's just like, they come in pre filled vials. No, sorry, you have to dilute them, but you know, it takes like five minutes to make the drug now versus when it was being studied, it was like a whole huge thing to get it out there.
When people talk about decentralized clinical trials, there's a big movement towards it. It sounds to me this process would be difficult to decentralize. Yeah, and that's kind of I think what's stopping a lot of it is you, you, I think the lab work and all that stuff is relatively easy to do. Not, not relative.
I mean, it can be decentralized a little easier because we have RPM, we have like hospital at home and all that stuff coming up. But it's just like the drug delivery part of it is the most complicated things because there are some drugs that are only stable for X amount of hours or X amount of minutes in some cases.
Uh, so you need to get it to the patient right away. So outside of like having like a mobile lab or something, I mean, mobile, like cabinet where you can draw it up or drug companies have to do a better job of creating stability, because that's one thing that people don't realize is the stability of the drug during the study is a lot different than when the drug comes out to market because they're doing stability studies while they're doing it.
So, um, things can change, but while you, while they're there, it's like. I mean, they're going, they're trying to be as safe as possible and going with the worst case scenario, right? Okay, fine. Like, we know it might be able to go to three hours, but hey, let's just make it an hour cut off because they know they need to make sure that they're not wasting all this money.
So yeah, I think the drug delivery part is what holds it back, but I do think that uh, decentralized clinical trials need to happen for a couple of reasons because I think that it's really hard on the patients too because they there's a lot of
Um, and so that's one thing that people don't realize is when when they're picking patients for studies, they're picking patients that are able bodied, and they can make the appointments, so they're not always looking at the worst patients, right? But like, if we have decentralized clinical trials, we can maybe look at patients that really, really needed, right?
I mean, maybe drug companies might do not do that because it's going to skew their results a little bit. But, uh, those are things that I think a lot of people don't realize is, you know, we're picking people with a You know, uh, low ECOG scores. I mean, good ECOG scores and ECOG scores for those who don't know is, you know, just telling people how well they can do their activities of daily living, you know, can they walk and, you know, change and all that stuff.
So they're looking for people that are pretty mobile, that can make their appointments. Uh, every single time. So that kind of rules out a bunch of people that, you know, they might be homebound, that might have really metastatic disease and they can't, they can't, they're tired all the time, right? So, um, that's why I think, uh, and also the other thing is like just the distance, right?
A lot of these clinical trials are done at academic institutions. So we had, we had patients that were driving an hour and a half one way for these clinical trials. That's three hours of your day gone. You have cancer, you are really tired. And those appointments are not like 15 minute appointments. Right.
Those appointments when you're getting infused or they're hours long, like four or five hours long, right? Your drug might be infused really quickly, but they need labs. Prior to you getting the drug, they need labs. After you get the drug, they need to make, monitor your vital signs, your heart rate, all that stuff, blood pressure, everything.
So, it's like a huge process. So, I think if you had At least they could do that process at home, at the comfort of their home. What's the stability study? So stability study basically looks at, um, how stable the drug is. So in terms of like how quickly does it degrade over time, right. Um, does it have, does when.
When or if it develops particulates, right? So particulates are like little, we don't want those infusing in IT. So like things like that, you know, how long can it stay out in the sunlight? Does it need to be protected from light? Uh, can it be given with, what diluent can it be given with? Like sterile water, normal saline, D5W?
I mean, those things are done. The diluent part is usually and they'll protect from like done stuff is done much before we give it to the patient But like they're looking at that kind of stuff. So but then what happens is like during the study and stuff like they'll do like Almost like they'll like, how do I say this?
So they'll basically create the bag and they'll kind of leave it out in a very sterile environment and kind of check to see, okay, is it, you know, what's it, is it going, is it good? Is it developing particulates, things like that. So eventually like physically seeing it and running tests on it, then they can say like, okay, this drug is stable for six days or this drug is stable for four hours outside of the fridge.
You know, this drug is stable for eight hours, whatever it happens to be after it's been diluted.
Where do you think the biggest opportunity lies in clinical trials?
I think the biggest, I mean, I don't know if it's a money making opportunity. I think decentralized clinical trials are great, but there's a lot of companies doing it. And no one's really caught any footing. I mean, there's some great companies out there, but I think like if we can get to a point where we can
I think getting things to market quicker, I think that's, again, going back to AI, that's where I can help a lot with drug discovery. And so it's like, even before the clinical trial, I think like being able to create a drug much quicker and much. And faster and cheaper is where the money truly is. Because if you can get, it's kind of like, you know, creating a product, right?
The more swings you have at something, the faster you can do it, the better you're going to, the better you're going to do it. Right. And so if you, if it takes you like, I'm making this up, I don't really know, but if it takes like five years to come up with a novel drug. Structure. If AI can give you five in the span of a year, right, so you have five shots at it in a much smaller time, you know, and then you can kind of run your, your things.
And then it's, it's even getting to the point where AI can run, um, simulations for you to see, like, is it working? Is it working properly? How is it working? How is it not working? So I think that's where the, like the money, where like the next boom will come in, in terms of like the pharmaceutical industry and the clinical trial industry.
Is this that we can, we'll be able to have more and just move much quicker.
What is one, I'll stick with cancer research a bit more because I find it fascinating and have a lot to learn here. So, I'll ask you some selfish questions. Why do so many medications fail in the clinical trial phase? What are some things you've seen that get wrong or some assumptions they've made that don't, don't pan out?
I think a lot of them, I shouldn't say a lot of them fail, but I think they fail because of, um, safety profiles primarily like it's not it's just it's just causing too much. One thing about like you know cancer drugs is I mean technically we are putting poison inside of you and it causes issues so if you're not having like if it's causing the patient to like be neutropenic all the time or things like that that's one reason why some of them don't make it through.
Another reason is like It's just not statistically significant, um, and they might make it through the FDA, but they just won't get used, right? So we see quite a bit of that as well. But I think safety profile is one that stops a lot of them, um, because they don't want, it might not even make it to the patient because in like their animal studies or whatever, it just wasn't working out that well.
What is the end goal for you, Zain? I don't know. I don't know what my end goal is. Um, I guess it's kind of like I hope that I can leave this world as a net positive. I hope that I can help, um, like truly help, like at scale. That's that's what I hope I can do. If I ever get to that point, I don't know. But, um, I'll try and see what happens.
But I don't really have like a kind of going back to, I don't set really goals for myself. Like I don't have like, Oh, I want to be CEO of a fortune 500 company or anything like that. Like, I just want to just help people. And I just am still trying to figure out what my way of helping people is. And I think that's one thing that I realized when I leave clinic, when I left, it's, it's hurt a little bit when I left.
Cause I felt like I wasn't, I was leaving. That mission behind, but then I, it kind of, the thing that helped me was, you know, we all can help in our own different ways and my way was just not that at the time, um, maybe it will be one day, maybe I'll go back. I have no idea, but I just hope that I can just find a way to help people and just better people's lives.
That's really all that kind of drives me. I agree with that. A servant leadership model brings me more joy as well. I'll ask you a question. I had David Joe from On Deck on this podcast and he said everyone should have a selfless goal and everyone should have a selfish goal. What is your selfish goal, Zane?
My selfish goal is... Huh, that's a good question, man. Um, I've always wanted to have a car for every day of the week. Okay, interesting. What cars would they be? Um, all right. So, um, I've like a E39 M5 or E36, I can't remember it's, I always get the M3 and M5 mixed up. Which day is that? What? Which day is that for?
Is that for Monday? I don't know. It's, I don't know what that would be. I guess it would be like a weekday car. Uh, 911, Porsche 911 would be in there. And one of the, an A Porsche 911, maybe a 964, uh, their rally version. That would be pretty sweet. They're like millions of dollars. Um, I love Porsche. So Porsche Carrera GT.
Um, a Lamborghini would be in there somewhere. Uh, and then some like older cars, like, you know, a Volvo 240 station wagon, um, manual, that would be pretty awesome. I have a, I have a really long list. It'd be hard for me to kind of pare it down to seven, but, uh, probably an old school Toyota Land Cruiser, uh, from the early, 90s, early 2000s.
Um, I mean, I don't even know how many that is, but, uh, I can probably keep going. I like that. There's some good variety there. This has been a lot of fun, Zane. And I'd love to do this again sometime. Yeah, man, I'd love to come back on. Uh, this was, this was awesome.
