Give me your innovators yearning to breathe free

by Bernard Munos, FasterCures Senior Fellow

Ingenuity defines America. From sea to shining sea, the country bristles with innovation. Google, eBay, Intel, Tesla, Yahoo, SpaceX, LinkedIn, Flickr, Facebook, exemplify the indomitable American genius… or perhaps the indomitable genius of its immigrants, as all these companies were (co-) founded by foreign-born entrepreneurs.

This is no artifact. Economic geography shows that innovation thrives where cultures blend. It is true of countries built by immigrants, such as the United States, Australia, or Israel. It is also clear from the capitals of former European empires – Berlin, Vienna/Budapest, Paris, London – where the mingling of ethnicities created the ferment that transformed them into cosmopolitan beacons of artistic and technological power. Further back in history, Florence, Venice, Rome, Athens, Constantinople, and Alexandria have all at some point leveraged their positions on trading routes, or their dominion over faraway provinces, to create the cultures that gave us the Renaissance, Hellenism, and the Islamic golden age – when roving scholars from Cordoba to Bukhara made major contributions to medicine, mathematics, and astronomy. 

Today, innovation continues to thrive where cultures overlap: Silicon Valley, Boston, Quebec, Singapore, the Baltic Rim, Switzerland, Flanders, and many other regions.  In the United States, the foreign-born represent 12% of the population, but they account for 25% of its Nobel prizes, 25% of the founders of venture-backed companies,30% of its patents , and 47% of its scientists and engineers with doctorate degrees. Immigrants are over-represented among members of the National Academy of Sciences and the National Academy of Engineering, and among the authors of highly-cited science and engineering journal articles.

It is as if innovation somehow comes more naturally to people who internalize various cultures. Research and casual observation actually support that idea. Polyglots know, for instance, that one does not think alike in various languages. A Frenchman does not think like a German. One is holistic, the other is methodical. These differences carry over to how we solve problems. Some cultures are analytic and reductionist, others are intuitive and associative. No single approach is better, but, depending upon the problem, some may be more appropriate. People steeped in multiple cultures can access a broader set of problem-solving pathways and pick one that best fits the situation at hand.

There are other reasons that put immigrants at an advantage when it comes to innovation. They are apt at challenging norms and authority, and prone to act when unhappy with their lot. With their accents and customs, they never quite fit in, and are used to being different and operating from the margin. They are also at ease with disruption, which is part and parcel of being an immigrant. Like entrepreneurs, they have a tolerance for risk, and a bias for action.  And they top that with a relentless drive to succeed because they can never be completely mainstream.

Research also shows that immigrants have an uncanny ability to function in multiple worlds at the same time. They often grow up speaking one language at home and a different one at school, and they sometimes must learn several languages as their parents change countries to flee war or persecution. Those who become scientists retain the agility to move back and forth between multiple domains. They are boundary crossers, with interest and expertise in multiple disciplines, but operating preferably at their interface. They are not biologists or chemists or physicists, they straddle the boundaries between these sciences, and can see connections that might elude less versatile scientists. This makes them especially effective problem-solvers. They think differently, can approach problems from various angles, and harness multiple problem-solving tools.

With such attributes, one would think that countries blessed with immigrants would see them as assets to be leveraged, not a ball and chain on the economy. Indeed, those that value them, such as Israel, are among the world’s most innovative societies.  But most nations see immigrants unfavorably, like welfare collectors, and relegate them to camps and ghettos. It does not help that many have a precarious immigration status – like temporary visas that get overstayed or no visa at all. But then, people who flee war and misery seldom have their papers in order. This makes much of the current US debate on immigrants – and whether they arrived legally – a bit disingenuous. We should do what best serves the interests of America, and not lose ourselves in legalistic arguments.  Immigration is like free-trade. It benefits a country, even if the other party does not play fair. Just as a nation gains from engaging in free-trade, even if its partners do not reciprocate, it also gains from welcoming immigrants, however they arrived. This is not a plea to lift all restrictions, but one to manage them wisely.

Immigrants build great nations, but as societies mature, they tend to lose their vitality. They become risk-averse while entrenched interests and bureaucracy combine to enshrine the status quo into complex regulations that deter change and innovation. America has aged better than most, due in no small part to the fact that it remains by far the top destination for the migrants of the world, taking in roughly 20% of its “huddled masses yearning to breathe free”. This has been America’s enduring success formula: a multicultural society constantly refreshed by a flux of immigrants that accomplish here what they could have never done elsewhere. Immigration has given us many of our leading scholars and entrepreneurs, and the technological advances that have shaped our society and the world. Let’s make it easier for immigrants to continue to help us remain in the vanguard of innovation. No one else will.

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Cutting-Edge Science, Collaboration, and Sustained Funding Needed to Get New Medicines from Lab to Patient

FasterCures and Friends of Cancer Research Host Capitol Hill Briefing

“While I can tell you there’s never been a more exciting time for science, I can also tell you there’s never been a more stressful time,” said Francis Collins, director of the National Institutes of Health (NIH), addressing the issue at hand – tightening fiscal resources that threaten the research and development ecosystem to fully deliver science’s full potential to improve health and well-being. This was the main topic of a Capitol Hill briefing co-hosted by FasterCures and Friends of Cancer Research.

Moderated by FasterCures Executive Director Margaret Anderson, Collins and other medical research leaders representing distinct sectors provided a glimpse into what it takes to turn a scientific discovery into a safe and effective therapy that will improve, and maybe even save, patients’ lives. More than 300 policy decision makers, advocates, and key legislative staffers participated.

“There is no one in this room who hasn’t been touched by disease, whether it’s yourself or a loved one,” said Ellen Sigal, chair and founder of Friends of Cancer Research, opening the discussion. “We cannot let the FDA or NIH become a victim of political polarization.” The discussion kicked off with video highlights from a viral campaign, Time=Lives, that featured images and stories of patients, families, researchers, and executives, reminding everyone in the room about what’s at stake.

Onyx CEO Anthony Coles explains impact
of public investment on drug development 

Underscoring the role of public investment in basic research by the NIH, N. Anthony Coles, president and CEO of Onyx Pharmaceuticals, noted that pharmaceutical companies depend solely on this research to understand biology and disease origins. “Companies like Onyx then take these findings, advance the research, and move it toward delivery to patients,” he said.

Improving and accelerating research and development requires all stakeholders in the medical research ecosystem to work together – including federal agencies, industry, academia, and patient groups. Collaboration – existing collaborative efforts, and the need for even more partnerships – was a resounding theme throughout the discussion.

Disease research organizations feel the excitement for an improved system. “This is the most robust pipeline we’ve seen. Now is not the time to step back from working together, but to do more,” said Deborah Brooks, co-founder of the Michael J. Fox Foundation for Parkinson’s Research.

“The FDA is the final common pathway to translating science to patients,” said Margaret Hamburg, commissioner of the U.S. Food and Drug Administration (FDA). “If the FDA is not fully funded and supported, the ecosystem will not function optimally. When we engage early with the scientific community, we’re able to cut five years off of the drug development process.”

Roy Jensen, director of the University of Kansas Cancer Center, is already seeing how limited resources are impacting research progress. “We’re not even funding a fraction of the best science. We’re starting to cut to the bone – scientists are having to close labs, they aren’t able to train the next generation… It’s fundamentally altering our infrastructure,” said Jensen.

The importance of supporting the next generation of brilliance and innovation weighs heavily on the minds at the NIH, and researchers are hopeful for the next group of young investigators. “It is very tough right now to be a grad student, or a post-doc. As they look at the landscape of this country, they wonder if there’s room for them,” Collins said.

Coles echoed Collins’ concern with a sobering concept about the future of scientific innovation: “What answers won’t we have in 10 years if we don’t fund this research?”

“The decisions we make today will have implications long into the future. Unlike delaying construction of a bridge that can be resumed in a few years, if we lose a generation of scientists, there’s no way to rebuild that human capital quickly,” said Mike Milken, founder of FasterCures and chairman of the Milken Institute. “We fully understand the need for overall budget restraint in Washington; but short-term cuts in bioscience only assure a less-healthy America down the road. Modest investments in prevention and cures today will help avoid the catastrophic costs of care tomorrow.”

* A video of this briefing is now available.

From L to R: Margaret Anderson, Roy Jensen, Deborah Brooks, Tony Coles, Ellen Sigal, Margaret Hamburg, Mike Milken, Francis Collins

The Human Genome: A User's Guide

Nine years after the successful decoding of the human genome, much of the public are still unsure about what to do with genetic information when those data become available, noted Margaret Anderson, executive director of FasterCures and moderator of a panel at last week's Milken Institute Global Conference. Anderson kicked off the discussion by asking panelists to outline key chapters, as if writing a user's guide to understanding the human genome.

George Fisher, an oncologist and director of cancer clinical trials at Stanford University, outlined the first chapter, calling it: User Beware. He said that the technology before us could be a powerful tool if it's well understood. He said that before patients and consumers get into the data, they need to understand why they bought the genetic screening test and what kind of information they wish to know and acknowledge that genetic information can be quite complicated.

Agreeing about the complexity and ubiquitous nature of genetic information, Caroline Lieber, genetics counselor at Sarah Lawrence College, said that the next chapter should focus on how information is disseminated from consumer to provider. "Consumers need a clear understanding of this information and should seek out genetic counselors to help translate the data, and offer their insights in a meaningful way," she said. She also noted that one of the best tools readily available to help understand genetic information is family history. Sometimes, she said, you can save more lives and prevent more diseases by asking for a detailed family history.

Gwen Darien, a patient advocate and member of the board of the Education Network to Advance Cancer Clinical Trials reminded the audience that it's critical to take a step back and assess the baseline level of a consumer's understanding. She proposed that the third chapter focus on educating consumers about the science of genetics. "Most people's knowledge about science stops the moment they stopped studying it in school," said Darien.

Chris Varma, president and CEO of Blueprint Medicines, said the last chapter of the User's Guide should focus on opportunities and challenges, noting that the cost of sequencing a genome is a "huge paradigm shift." In 2001, it cost $100 million to sequence a human genome, and today the Beijing Genome Institute can apply the same methodology for $1,000. He said that the challenge in front of us is to simplify this information and help clinicians understand the possibilities. And all this information presents us with tremendous opportunity to improve our understanding of disease to better manage it.

Fisher added that with the healthcare system we have, today's physician is neither positioned nor equipped to provide the counsel necessary to make genetic information meaningful. Panelists agreed that there's a lot of ambiguity. But as these tests become more available, providers and genetic counselors must step up to the task of managing this information to improve health outcomes and better predict disease probability.

Will the Supreme Court Affect Investment in Healthcare?

What will the Supreme Court decide about the Patient Protection and Affordable Care Act (PPACA)? A panel of experts at the 2012 Milken Institute Global Conference agreed that no matter what the court’s decision, opportunities for investment in healthcare will continue to abound.

Kneeland Youngblood, founding partner of Pharos Capital Group, predicted with some hesitance that the law will be upheld. But even without the law, he said, many of its provisions for cost cutting and data management will continue to go forward. Bob Kocher, partner at Venrock, agreed, noting that Rep. Paul Ryan’s recently released budget plan included the cost control mechanisms from PPACA.

Nandini Tandon, board member of C21 BioVenture, also predicted that the law will stand but either way the decision would not have a major impact on investment in healthcare. Paul Kusserow, senior vice president and chief strategy and corporate development officer at Humana, Inc., added that with change and tumult come investment opportunities. 

The panel explored a number of promising investment areas, including alternative and holistic medicine, virtual medicine, and capitalizing on the growing understanding of genetics. Panelists agreed that one of the hottest investment areas right now is healthcare information technology. “Data is going to be king,” said Kusserow. Kocher said that he sees investment potential in ideas that make healthcare more affordable for the consumer. He is particularly excited about devices that replace drugs, for example vagal nerve stimulation as a treatment strategy to control certain neurological disorders. Tandon sees a new investment focus on blending the U.S. penchant for innovation with emerging markets like India, which has younger-trending age demographics, a large talent pool, and an interest in considering the cost-effectiveness of new products early in the development process. 

Led by moderator Aaron Task, host of Daily Ticker on Yahoo Finance, the panel wrapped up with a view of personalized medicine research from the venture capitalist (VC) perspective. Panelists agreed that with the VC tendency to look at an investment with an eye toward an exit (e.g., an initial public offering or a merger/acquisition opportunity) within three to five years, most VCs would decline opportunities to invest in personalized medicine projects. “Personalized medicine is showing that things are more complex than we thought,” said Kocher, and the science is not sufficiently developed to attract VC interest. However, panelists noted that VCs can be appealing partners for large pharmaceutical companies looking to introduce a more entrepreneurial character into their activities. Tandon noted that VCs can provide increased “deal flow,” and assume some of the risk for the partnership, and Kusserow added that VCs are more knowledgeable about how to “migrate companies.”

In response to questions from the audience, the panelists provided additional insight into the idea development process from the investor perspective. Kocher said that VC organizations are looking for big ideas. “They will pass on the $30 million ideas in favor of the $300 million ideas – the test is could it be big enough to change the world, create markets,” he said. The panel agreed that early stage companies are most likely to find traction with angel investors like friends and family members. As Kusserow put it, “the process is like an evolution – you have to embrace the journey.”

Harnessing the Market Opportunity of an Aging Population

As baby boomers age, advances in medicine and technology have dramatically increased average life expectancy, resulting in 98 million Americans who are more than 50 years old. While many people tend to focus on the problems that this demographic transition will cause, a Milken Institute Global Conference panel focused on the opportunities. Because of the huge purchasing power of this age group, why aren’t new products, services, and markets emerging more rapidly to address the needs and aspirations of this population?

Ken Dychtwald, president and CEO of Age Wave, started the conversation by pointing out that this demographic shift is unique in human history: “People in the past did not live long enough to worry about the effects of an aging body.” Osteoporosis, arthritis, lost vision, and other maladies that come with age offer a “wonderland of opportunity” for innovators and entrepreneurs who are willing to pour time and capital into helping elevate these problems.

Other sectors that present huge opportunities for growth by targeting this age group are:

• Financial services
• Entertainment (the top six highest-grossing musical tours last year were bands that were popular in the 60s and 70s)
• Premium services (first-class flights, high-end cars, vacation packages, etc.)

Jody Holtzman, senior vice president of thought leadership at AARP, pointed out that advertisers have been particularly slow to pick up on this opportunity. The overall purchasing power for the 50+ age group is much higher than that for Generation Y, but only 10 percent of advertising resources are focused on this age group while a disproportionate amount of resources go to advertising to younger adults. Holtzman pointed out that ultimately “Demographics are destiny,” and advertisers and wealth managers that have not adopted an aging strategy are missing out on a massive and seemingly obvious opportunity. Moderator Paul Irving, senior managing director and chief operating officer of the Milken Institute, asked the panelists why advertisers still focus on the younger demographic. Dychtwald pointed out that this is based on a myth that people make brand decisions early on in life and stick with them permanently.

Doug Busch, senior vice president and chief operating officer of Intel-GE Care Innovations, pointed out that there is a huge “competitive advantage of simplicity.” He discussed the example of the iPad, which is simple to use whether you are 5 years old or 75 years old. Many products cut themselves off from the older demographic by making products that are too complicated. He said that most members of this age group don’t want to “muddle through or fuss with low-quality or unwieldy products and services.”  

All panelists agreed that the 50+ age group is an incredibly underutilized resource. The combination they present of purchasing power and leisure time offer huge opportunities for those businesses and entrepreneurs who thoughtfully target them with products and services that are designed specifically to their unique needs and are marketed in a way that keeps these needs in mind.

Transforming Philanthropy by Connecting the Dots

Five accomplished philanthropists who “see things others don’t and connect the dots” gathered for an informative Milken Institute Global Conference discussion moderated by Richard Ditizio, executive director of program development at the Milken Institute.

The panelists’ experiences ranged widely across the globe and across issues. Laura Arnold, co-chair of the Laura and John Arnold Foundation, described the very deliberative process she and her husband went through to arrive at the policy objectives for their U.S.-focused foundation, including government accountability (specifically pension reform), criminal justice, and education.

Phyllis Washington, chairwoman of the Dennis & Phyllis Washington Foundation, reflected on her 25 years of philanthropy primarily in Montana, and highlighted the importance of involving the employees of the company in a meaningful way, a theme which recurred several times.

Denis O’Brien, chairman of Digicel, the biggest cellular provider in the Caribbean, became involved in Haiti after the 2010 earthquake, particularly building schools. He emphasized the importance of good project management and working with people with local knowledge and professional standards. “If you break all Haiti’s problems down, they’re all solvable, but you need capital and capable people,” both inside Haiti and at the nongovernmental organizations you work with.

Seth Merrin, founder and CEO of Liquidnet, told the powerful story of how he and his firm got engaged with building a Youth Village for orphans in Rwanda. He is also engaging his employees in a significant way in this work, and in fact sees it as a meaningful tool for attracting and retaining great people to the company. “Our generation wants hands-on,” he said.

Julie Sunderland, senior program investment officer with the Bill & Melinda Gates Foundation, is responsible for applying investment instruments to the work that the foundation does, a trend which she views as powerful because of “the ability it creates for partnering between philanthropy and the private sector, to tap into innovation within and outside the philanthropic sector. It brings into the foundation the tools and outlook of the investor.”

Several panelists echoed the theme of injecting more private-sector culture and accountability into nonprofits. Merrin noted that of the more than 1 million nonprofit organizations in the U.S., the vast majority are extremely small and probably having very little impact. “There’s no real measure of the efficacy of many of these smaller nonprofits; they’re incredibly duplicative, and have done very little research.” Liquidnet is engaged in a project with the Gates Foundation called Markets for Good, which aims to create standards and metrics for nonprofit performance.

Sunderland agreed that “capital allocation within philanthropy is not particularly effective,” but noted that while metrics are important, making sure the incentives of partners are aligned is also essential. She closed the session by saying, “The opportunity to bring the private sector and philanthropy together and break down the barriers is exciting. Creative conflict between world views allows us to solve these problems.”

View FasterCures’ philanthropy toolkit that helps philanthropists make better decisions and make an impact.

What Will It Take to Prevent Cancer?

“The best cancers are the ones that never happen,” said Wendy Selig, president and CEO of the Melanoma Research Alliance, when introducing the Cancer Prevention panel at the Milken Institute Global Conference. As many as two-thirds of the 1.5 million new cancer diagnoses each year are linked to environment, behavior, or lifestyle factors that can be prevented or managed. So what will it take, she asked panelists, to reach this potential?

Their answers ranged from eliminating tobacco consumption, to making sure people get screened, to providing healthy lifestyle education, to ensuring that every American has access to primary care.

“I’m a lucky one,” said Sherry Lansing, CEO, The Sherry Lansing Foundation and founder, EnCorps Teachers Program. After losing her mother to ovarian cancer more than 20 years ago and receiving treatment for an early cancer of her own, Lansing committed herself to raising money for cancer research and awareness about prevention. “We dreamed big,” she said of her co-founders of Stand Up To Cancer (SU2C). Calling it a Manhattan project for cancer, Lansing noted that SU2C has raised and distributed nearly $200 million for scientific “dream teams.”

Sancy Leachman, director of melanoma and cutaneous oncology at the Huntsman Cancer Institute, noted that “Nothing would have more of an impact on prevention than education on healthy lifestyles.” If you think of successful prevention methods, “it takes research, money, and market forces to push the ball forward.” Behavior science is an important tool to design behavioral approaches to lifestyle change.

“We hear a lot about data, data, data,” said J. Leonard Lichtenfeld of the American Cancer Society, “but we have to remember that at the end of that data is a human being.” He argued that America is stuck in a culture of illness and pointed out that “we could reduce cancer deaths in this country by 50 percent with what we know today about science, exercise, and nutrition . . . if we could convince our country that this is a good thing.”

Stephen Gruber, director, USC Norris Comprehensive Cancer Center, spoke about the benefits of genetic screening in predicting, preventing, and treating cancer. “Screening, medicines, and risk-reducing surgery can have huge impacts on cancer incidence,” he said. For example, oral contraceptives are known to reduce the risk of ovarian cancer by 50 percent, and screening reduces colon cancer risk by more than 50 percent and saves millions of dollars.

“Knowledge is power,” agreed Lansing, “but it can also be destructive.” It’s important, she and Lichtenfeld argued, that sensitivity and specificity be exercised when presenting genetic test results to patients. “We will find out that all of us have a genetic propensity to something; the question is about the penetration of that gene characteristic and how to act upon what we know.”