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Re-Examining Prostate Cancer Treatments

Episode 439

Recommended Book:

Colorless Tsukuru Tazaki and His Years of Pilgrimage by Haruki Murakami

Best Way to Contact Shyam:

email: shyam@avendahealth.com

Mentioned Link:

Avenda

Re-Examining Prostate Cancer Treatments with Shyam Natarajan, Co-Founder, Avenda Health transcript powered by Sonix—the best audio to text transcription service

Re-Examining Prostate Cancer Treatments with Shyam Natarajan, Co-Founder, Avenda Health was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

Saul Marquez:
Welcome back to the podcast. Today, I have the privilege of hosting Dr. Shyam Natarajan. He is the co-founder and CEO of Avenda Health. A clinical stage healthcare technology company focused on personalized prostate cancer treatment. He’s also an Assistant Adjunct Professor in the UCLA Departments of Urology and Bioengineering. Prior to Avenda, he led research efforts in developing image guided interventions for prostate cancer at the Center for Advanced Surgical and Interventional Technology and has authored more than 50 peer reviewed publications. His work was instrumental in the clinical translation and commercialization of targeted prostate biopsy. Additionally, Dr. Natarajan has served as program manager of the Business and Science Center, launching Business of Science Center. I love the ring of that. Launching campus initiatives and entrepreneurship such as Innovation Week and Inventathon. Southern California’s first healthcare hackathon. He received his B.S. in Computer Engineering, a B.A. in Japanese, which is super cool. My wife’s Japanese. You guys don’t know. We’ll dive into that. From the UC Santa Barbara and a PhD in Biomedical Engineering from UCLA. So it is an incredible privilege to have Shyam here with us to really take a deep dive into the intersection of science, medicine, and entrepreneurship. With that Shyam, I want to give you a warm welcome. Thanks for being with us.

Shyam Natarajan:
Thank you so much, Saul. It’s a pleasure to be on your show.

Saul Marquez:
It’s a pleasure to have you here now. So are you fluent in Japanese?

Shyam Natarajan:
Once upon a time, I was fluent in Japanese.

Saul Marquez:
Amazing.

Shyam Natarajan:
I would like to think that I’m… I can understand better than I can speak now.

Saul Marquez:
Ahuh.

Shyam Natarajan:
But…

Saul Marquez:
Still though, pretty amazing. You can get by with it. All right.

Shyam Natarajan:
Oh, absolutely. Yeah. I love the language. I love the culture.

Saul Marquez:
And can you read it and write it, too?

Shyam Natarajan:
Yes, I definitely could read those Chinese characters kanji much better in the past. But, you know, I would say it’s serviceable now.

Saul Marquez:
Wow. Good for you, man. That’s amazing. And you know, when we think about healthcare and the sort of the global eco system, I mean, that’s another market, right, where we know you have success here in the US. It’s definitely scalable over there. So huge advantage.

Shyam Natarajan:
Absolutely. Now, I think, you know, my interest, early interest in languages and travel and cultures serves me well in this role.

Saul Marquez:
Man I would totally agree as well. And so, you know, you’ve got a really unique kind of approach. You wear a lot of different hats. And, you know, this kind of perspective across the board is is advantageous. But what is it that got you into healthcare to begin with?

Shyam Natarajan:
Yeah, that’s a great question. So originally, I wanted to be a video game programmer, like every…

Saul Marquez:
Absolutely.

Shyam Natarajan:
But now I think there’s a couple of real instrumental experiences that shape my interest in healthcare. Firstly, being shadowing a rheumatologist of all both physician specialties at Barbara. As part of this healthcare technology class back in 2005, 2006, where they really promoted engineers to go fall around and shadow on physicians. And that was really promoted by this campus effort where, you know, we had in Santa Barbara computer motion come out of Goleta, you know, iRobot, Gallito with Professor Yulin Wang. So I think UC Santa Barbara was instrumental in the beginning of getting engineers and healthcare specialties as specialty providers talked together. And so this experience kind of led me to believe that maybe I should apply for medical school. It was a good idea until it wasn’t. I think twenty three out of twenty four places that I applied, but it ended up being the best thing ever. And you know, that quote unquote, failure really led me into my life. Now, my current passion, which is medical imaging and image guided surgery. And that experience, you know, I built a career on top of… at UCLA, ran a lab, focused on improving technology for the surgeon. So this is using best in class imaging, you know, big data, back then when it was you know, now it’s called machine learning, artificial intelligence, using fundamental engineering skills to be able to improve not just the technology, but focus on that healthcare outcomes. So our lab at UCLA was also pretty unique in that we focused on an unmet clinical need. I know everybody today is talking about the bio design approach focused on your unmet clinical need work backwards. But back in 2007, there weren’t too many people focusing on that unmet need and then building technology to that. I mean, that was just my perspective. I sure there were a lot of others in the industry, but I was just starting out at the time.

Saul Marquez:
Now, that’s a that’s a really great, great story about how you started and how you’ve come to sort of be focused where you are imaging technologies, prostate cancer. And so as you’ve gathered all these years of experience and now doing your work at Avenda, what would you say is the… should be the core focus of health leaders today? And how are you guys approaching it?

Shyam Natarajan:
Yeah, I think the core focus of any healthcare organization today would be to listen to your stakeholders and understanding where you provide value in the whole for all stakeholders in the whole healthcare process. I think that’s something that was drilled into us as a med tech innovator, ex-lawyer company where it’s not just about the physician or not just about the payer. Of course, the patient is at the center of this, and everything that you do as a healthcare organization has to be to the benefit of the patient. But, you know, government, other manufacturing partners. Where do you fit in with all of these stakeholders in a very complicated process? And I think having the clarity of mind to be able to say that this is the one thing that we do that is going to simplify or reduce cost or, you know, improve outcomes for the patient while considering all of these other stakeholders. I think that’s probably one of the most things, most important things that I think about, you know, as we build our company.

Saul Marquez:
Yeah. Some great ideas there. And thinking about the stakeholders in the process, what value units are you transferring to them? How are you doing it while you’re adding value to that patient, improving outcomes and so what about at Avenda? What would you say you guys are focused on solving?

Shyam Natarajan:
So we are focused on the big, big problem of prostate cancer treatment that preserves quality of life. It’s crazy. But you know, in 2019, 50% of men who get treated with radical surgery or radiation therapy and prostate cancer. And this is one out of every now nine men in the US has lifetime risk of getting this disease, 50% lose their sexual or urinary function as a result of treatment.

Saul Marquez:
50% huh.

Shyam Natarajan:
Yeah. That’s I mean that’s a huge…

Saul Marquez:
Kinda nuts. That’s too high.

Shyam Natarajan:
I know. And of course, if you go to a center of excellence, you know, if you go to the academic hospitals and, you know, the marquee private clinics around the country, that number is going to be much lower. But this is a nationwide average. And, you know, as we think about how prostate cancer is currently treated as a whole gland disease, where, you know, if the analogy is if you had a mole on your hand, the treatment would be akin to chopping off your hand, which is also insane.

Saul Marquez:
That is insane.

Shyam Natarajan:
So we at Avenda health decided that there has to be a better way. In our better way is a focal targeted treatment, almost like a male lumpectomy. But this would be interventional using a tiny laser, treating just the cancer and preserving that healthy tissue as well, sparing those critical structures like the nerves that cause all of these important functions. You know, you think about men in their 50’s, in their 60’s. You know, they’re going to die from something else rather than dying from prostate cancer. You know, they’re going to have more than a 20 year lifespan on average. So really, that quality of life component is so important.

Saul Marquez:
I agree with you. And you know, we’ve talked a lot on the podcast about, you know what, it’s less about lifespan, it’s about health span and we’ve got treatments like Avenda is working on to address prostate cancer. Hey, you know, I think we should know about these and and our stakeholders in the health system. If you’re listening to this, you’re in the 1% that, hey, you could actually do something about it. You know what? What are you going to do about this? This discussion that we’re having? That’s my challenge to you. So give us an example about how your team, Shyam, is working to do it differently, maybe an application that you guys have done. My understanding is you’re still working out the data, right?

Shyam Natarajan:
Absolutely. So our approach to this is through a out-patient interventional procedure, almost like a prostate biopsy, except instead of inserting a biopsy needle to sample tissue, we’re inserting a laser fiber and a sensor to be able to oblate or coagulate tissue in real time. And we are using data and we call it artificial intelligence. But really, it’s a vast amount of diagnostic procedures that we’ve amassed over the years as well as with, you know, a decade of experience working on the diagnostic side in the research capacity to be able to say we know exactly where your cancer is and we versus, you know, we’re just going to treat everything.

Saul Marquez:
Chop the hand off.

Shyam Natarajan:
Right. Right. So we’re using data to be able to plan and map our treatments and optimize that surgical margin to prevent a recurrence, to optimize the delivery of the laser energy and also enabling outcomes to be more consistent across the board. Because I think as a healthcare organization, it’s not just, you know, how well can your best physician perform the procedure, but it’s it’s how well can the average physician in your case, the average urologists perform this procedure? Because, you know, high quality therapy is available at you know, again, marquee academic centers. But if it doesn’t diffuse to the average person, you know, out not at a major metropolitan area, maybe there are more rural or, you know, there’s so many areas around this country that have disparate healthcare outcomes. So I think as an organization starting out today, it’s important to think about how do you make those consistent?

Saul Marquez:
I think it’s a great, great idea and some great call outs. So it’ll… when it’s done, Shyam, it’s going to be a medical device that’s treated through laser treatment kind like you treat like a kidney stone or something, targeted.

Shyam Natarajan:
Yep, absolutely. It’s a still a traditional medical device. It’s our first product. We think it’s a 510k and we are in the development or verification path right now. So we hope to be on the market. We’re targeting next year to be on the market. So maybe your listeners can caveat everything I’m saying with, you know, with the fact that we’re not on the market and our challenges will change and shift over time. But I think it’s so important, especially as we’re developing this, that we get it right so that the product that we put forward is the right product.

Saul Marquez:
And, you know, as I think through this, as well Shyam, it’s like, you know, there’s a lot of companies out there in the space today that may become interested in what you’re doing. And if you’re listening to Shyam’s idea and the things that they’re up to, we’ll leave a link to his company and the work that they’re up to. So you could dive in and start a conversation. So as you guys have been working on your project, what’s a setback that you’ve had and what did you learn from it?

Shyam Natarajan:
It’s interesting. You know, when we started this company, you know, I had a lot of experience working in the healthcare industry, working with other medical device companies in various capacities. But when you’re leading a company, an organization like this and you have a lot of young engineers and young contributors that are looking to you as their, you know, this is their first job or their first role. I think one thing that we, you know, we learned how to do over time is to celebrate our wins and and to pace ourselves. I think we’re just so excited getting out of the gate about developing our technology and showcasing it to the world and developing our software platform and developing our manufacturing pipeline. But I think it’s also important to pace yourselves, celebrate the wins, make sure that you communicate to your team that it’s not a sprint, it’s a marathon. And in the pursuit of good outcomes, you know, we this is going to be a multi-year process. So I would say that one setback that we’ve had that we’ve overcome is preventing or avoiding intermittent burnout. So just a quick example on that. You know, we had a conference, I think it was last year or two falls ago. It was the add the med conference actually where we’re actually we’re in the innovation pavilion showcasing our product for the first time just to the industry, not to our customers. But, you know, we spent a long time before the conference, you know, making sure our code was up and running, making sure that demo was so perfect, practicing it over and over and over again and ensuring that, you know, all of the pieces looked just right so that when somebody walked by, they would catch their eye and say, hey, show me what you’re working on. You know, this is our first debut, Right.. And then we did. I mean, we had a great conference. We demo it many, many times. And then after we came back, it’s like, “Okay, let’s go back to work”.

Saul Marquez:
Yup.

Shyam Natarajan:
And then a week later, I started to see signs of the entire team getting fatigued, irritable. You know? Just like vocalizing that. Okay, maybe we need a little bit more time to just slow down.

Saul Marquez:
Yeah.

Shyam Natarajan:
So I think that we learned from that experience and then on our most recent conference, the New York Neurological Association, I think we did it right. We actually planned out, you know, a decompression time, you know, had time to reflect on that huge sprint that we just completed. And I think now we’re coming out of that and we couldn’t be more excited about what we’re building.

Saul Marquez:
That’s great Shyam. And, you know, it’s a good learning. It’s easy to play full out and and then just kind of not leave any breaks for recovery and said some of the guys are finding your ebb and flow. And it’s working out as it worked out last conference.

Shyam Natarajan:
Yes, there are… I think we’re in a really good place right now. We have a fantastic team of dedicated both software engineers. We have a few interns that we’re really proud of the work that they’re doing. We have great manufacturing partners. And of course, I’d be remiss to say I have one of the best co-founding teams. Now, we truly are the perfect I would say the perfect medtech founding team where we have a physician, we have an engineer and we have somebody from the business community all coming together, all have, you know, a core scientific background, but coming together to make this groundbreaking treatment for prostate cancer that preserves quality of life a reality.

Saul Marquez:
So what would you say is one of the proudest experiences you guys have had to date?

Shyam Natarajan:
I think it’s in hiring the right people and seeing our employees especially, you know, I can think of a few in particular out there on the conference floor. Not just in front of a computer terminal, but actually out there talking to potential customers. You know, in this case where we were recruiting for clinical trials and just having them showcase their passion for the company and showcase all the great technology they’ve been building and how they communicate that to the customer. And I think that couldn’t be… there wasn’t a more problem than that. Just seeing them perform on that level as well as just seeing their passion and the passion that I have diffused down through them.

Saul Marquez:
Yeah that’s great. It’s not like hiring the right team to help execute on a mission. And so with a new med device, you definitely need those people, their passion, and their stick intuitiveness to succeed. So definitely exciting times for you guys. What would you say is the most exciting project or focus you guys are working on today?

Shyam Natarajan:
I’m really excited about our software platform for treatment planning. So we have a two part device here. We have a traditional, you know, medical device where it’s a office based ablation system with a set of disposables and needle guide, sensor, and a laser fiber, a laser catheter. Then on the other side, on the treatment planning side, we have a cloud based platform for the urologists to really understand where they’re going, what they’re treating and how to get those good outcomes. Because, you know, our mission is not to make urologist act like a radiologist or act like, you know, another specialty, but really to empower the urologist to be able to do what they need to do. So with this platform, what’s so exciting about it is we’re using diagnostic information from a patient’s own biopsy or own imaging study to feedback into therapy. And that’s sounds somewhat simple and simplistic. And you think, oh, okay, in care, of course, you would use an imaging tests to inform what treatment you’re going to provide.” But in prostate cancer, that’s not the case today. So I think it’s exciting because we’re injecting software into a process that we’re injecting not just software, but we’re injecting, you know, machine learning, artificial intelligence into a process where there is no software really in a process that is done completely ad hoc, you know, very inconsistent, very variable. Just just a small example there. This question of treating, you know, the right margin for a disease is so important. But if you ask 10 urologists, you’re going to get 20 different answers on what is the right dose or what is the right area to go, even if we can visually see something on it, see a tumor on imaging. The outcome is variable, and so software here is a way for us to bring everybody together and have sort of an even playing field and really, you know, to the benefit of the patient so that regardless of what physician comes in and they’re going to bring all their experience and their knowledge. But at the end of the day, we want to make sure at a minimum level we’re gonna be able to hit that cancer and preserve that quality of life.

Saul Marquez:
And it becomes a way of delivering science to somewhat of an art. Right. I mean, prostate from what you’ve kind of explained Shyam, it’s kind of an art too, you know, and I, you know, think about art as you know, we kind of know what we’re doing. We feel our way through there. You add a little software and science. Now we’re talking.

Shyam Natarajan:
Absolutely. Yeah. It’s not just science, but it’s I would say, you know, the core of science, which is data. Show me the data.

Saul Marquez:
Show me the data. And now this is definitely exciting work. I’m rooting for you guys and I know the audiences, too. So, folks, Shyam lives and works in Santa Monica. So if you find yourself nearby listening to this podcast and something resonates, reach out to him. We’ll leave a way to get a hold of them here at the end of the podcast. Have a coffee. Never know. Have a beer. Great things happen on Barn Atkins. And so getting close to the end here Shyam, I’ve got the Lightning Round, followed by a book that you recommend to the listeners and then we’ll conclude. You ready?

Shyam Natarajan:
All right. Let’s do it.

Saul Marquez:
All right. What’s the best way to improve health care outcomes?

Shyam Natarajan:
Listen to the patient.

Saul Marquez:
What’s the biggest mistake or pitfall to avoid?

Shyam Natarajan:
Not listening to the patient and believing your self, believing that you don’t need to listen to anybody.

Saul Marquez:
How do you stay relevant as an organization despite constant change?

Shyam Natarajan:
Measure, measure, measure, monitor and then test.

Saul Marquez:
What’s the one area of focus that drives everything out of Avenda?

Saul Marquez:
Stay true to the mission of improving healthcare outcomes.

Shyam Natarajan:
I think if as long as you have that overarching goal behind your organization, the decisions that you make in pursuit of that decision will be the right ones.

Saul Marquez:
And Shyam these next two are more and a person out for the listeners to get to know you. What’s your number one health habit?

Shyam Natarajan:
I’d say running. You know, we have the beach right next to us.

Saul Marquez:
Now it’s great. I love out there.

Shyam Natarajan:
I mean, you don’t get to do it every day, but running down the beach path and Santa Monica. I mean, it’s the best feeling in the world. You just get so inspired.

Saul Marquez:
I’m right there, man. I’m right there. My mind is there right now. And what’s your number one success habit?

Shyam Natarajan:
I’d say to make sure that you prioritize family as well, because…

Saul Marquez:
It’s good one.

Shyam Natarajan:
This is a career. This is also, you know, we’re changing the world. But never forget who supports you as well.

Saul Marquez:
Amen, what book would you recommend to the listeners Shyam?

Shyam Natarajan:
Can I give to small books?

Saul Marquez:
Absolutely.

Shyam Natarajan:
All right. So so one is Better by Atul Gawande. I’m sure many of your listeners have read it already. It’s just a great perspective on failure and the surgical process and how to improve and build on that failure. But one more interesting to me is a book that I’ve just read called Colorless Tsukuru Tazaki and His Years of Pilgrimage by Haruki Murakami. This is a fantastic novel about really a young person’s not necessarily coming of age, but really realizing and understanding his identity and how it fits into this world. And I would highly recommend to your listeners it’s just a fantastic novel. Just getting a different perspective on, you know, isolation and connectedness and really how do you develop your own, who you are, your own sense of self.

Saul Marquez:
I like that. And, you know, I think, Shyam, the idea of identity, you know, you can apply to yourself. But I think as as business leaders and entrepreneurs, we’re looking at the identity of our companies and and the identity of our mission. What is it? And coming to terms with that and being able to clearly understand. Tell the story. I think there’s a good application there, too. Would you agree?

Shyam Natarajan:
Absolutely. I think it’s you know, we talked about this at the very beginning that, you know, never forget who you are and where you came from. That’s been especially true with me and really been a guiding principle.

Saul Marquez:
That’s key. Now, I love it. And folks, if you want to get the show notes to all the things that we’ve been discussing, you know where to go. But as a reminder, it’s outcomesrocket.health in the search bar, type in avenda, and you’re going to see all the show notes with Shyam Natarajan and all the things that we’ve discussed today. So with that Shyam, I want to just turn over the mike to you for the closing. Give us a closing thought. And the best place for the listeners could get in touch for that cup of coffee are to continue the conversation.

Shyam Natarajan:
Yeah, absolutely. My closing thought is I’m really proud of being part of this industry that prioritizes human health over all others. And I’m really proud of being part of a community that gives back and, you know, push positive forward in terms of advice and in terms of mentorship. You know, I’ve had some fantastic mentors. So my closing thought is, you know, if there’s any listener out there that is looking to either break into this industry or heard something that is interesting to them, you know, I’m more than welcome any, you know, emails, grab me a coffee. What have you? And just send me an e-mail at shyam@avendahealth.com or Linked-In. Sorry, I’m not a social media guy. So you can’t find me on twitter.

Saul Marquez:
Hey LinkedIn is a social media.

Shyam Natarajan:
Yeah, my guess. I’m more than happy to connect and tend to share my knowledge and to learn from others.

Saul Marquez:
Outstanding Shyam. Well, listen, appreciate the the time that you’ve given us here. We’ve certainly learned a lot and we’re rooting for your success. So keep up the great work.

Shyam Natarajan:
Thank you so much, Saul. It’s a pleasure.

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