technology

Giovanni Traverso of Brigham and Women’s Hospital and MIT, Joins Denver Frederick

The following is a conversation between Dr. Giovanni Traverso of Brigham and Women’s Hospital and MIT, and Denver Frederick, Host of The Business of Giving on AM 970 The Answer in New York City.

prof497Denver: Only about 50% of people take medication as prescribed. Some folks on long-term medication, well, they eventually just give up and stop taking it. This non-adherence could cost up to $100 billion a year in the US alone, so this is quite a problem. But with us right now is someone working on the solution. He is Dr. Giovanni Traverso from Brigham and Women’s Hospital and MIT in Boston. Good evening, Doctor!

Giovanni: Good evening! Thank you so much for having me on the show.

One of the things that we recognize, and others have recognized this, is that making it easier for a patient to take their medication really increases the likelihood that someone is going to take their medicine.

Denver: So, tell us about your research to address this problem.

Giovanni: Absolutely. As you highlighted, non-adherence is an incredible problem affecting over 50% of the population and translating into significant cost to the health care system and access actually about $100 billion per year here in the US alone. Aside from the cost are the significant morbidity and mortality that are associated by the simple fact that folks just don’t take their medication. One of the things that we recognize, and others have recognized this, is that making it easier for a patient to take their medication really increases the likelihood that someone is going to take their medicine. So let me give you an example. If a doc prescribes a medication that you have to take four times a day versus taking that same medication once a day, people are more likely to take it once a day than four times a day just because it’s hard to remember to take it four times a day.

Denver: It makes a lot of sense.

Giovanni: Exactly. And actually there are some data out there also supporting that if you extend that a little further, that the likelihood of taking the medication also continues to increase. And so what I’m referring to is going from, for example, a medication that is dosed once a day to once a week and even once a month. There are some medications where you can do that, there’s only a limited number that exists in those formulations. And so, what we set out to do is to try and develop a system that allowed patients to take their medication more infrequently.

Let me just take a step back and tell you sort of a little bit about where we started this work. Several years ago, a team from the Gates Foundation came to visit us in the lab and then subsequently circled back to us with a challenge. They said, “You know, it would be great if we had systems that allowed us to give our patients, for example, in Sub-Saharan Africa, really resource-constrained settings, their full course of treatment in a single-administration event.”

Denver: Like for things like malaria, I would imagine.

Giovanni: Exactly. And you have to sort of put yourself in that situation. And really what you want to make sure is that folks on the ground in these really sort of limited setting have the ability to get the full treatment and the docs and other health care professionals there on the ground will ensure that the patients are dosing themselves correctly just to avoid any complications or antibiotic resistance, et cetera. And so that, working with the Gates Foundation, we actually set out to address this. And so what we did was develop a capsule that can stay in your stomach for a prolonged period of time, and by “prolonged,” I mean a week, two weeks, and perhaps even longer. When you consider a regular capsule, you take a regular capsule, you take it, and just as food, when you eat your food, that would go through your body in about a day.

Denver: Right through the pillories and out it goes.

Giovanni: Exactly. And so similarly, a capsule, typically when you go the pharmacy and you get an extended-release capsule. An extended-release capsule is for 24 hours and that’s really limited by a couple of factors, but one of those is just that our GI tract — our stomach, small intestines and large intestines – they’re actually thoroughly effective at transiting materials through them. And so what we set out to do is really to explore different ways of sort of slowing that down and then allowing essentially a system to really deliver a drug over prolonged period of time.

And so, the way that we did that was by developing a capsule that looks much like a star. The capsule itself looks like any other capsule, but when the shell dissolves in the stomach, out pops out a star that is able to stay in the stomach without causing any obstruction or any symptoms but that little star, the arms of the star, so the spokes of the star, are made of a polymer which is impregnated or loaded with a drug. What happens is then that drug can slowly come out over whatever time frame it is that one needs to receive that medication over.

Denver: So if I get this right, you are warehousing the medicine in the stomach?

Giovanni: That’s exactly right. In order to prevent that star system to essentially be expelled out of the stomach, there’s a couple of things that we had to work out in the lab. One of them was “what’s the best size?” What we know is that the exit of the stomach is about 2 centimeters, so we knew that a star had to be over 2 centimeters when in the stomach. And then the other thing that really is really important is that the stomach is actually a really strong organ and that it helps digest food and it really compresses material in the stomach, so we had to develop some materials to withstand those compressive forces. And then what we built into this system are segment that are capable of dissolving either in the intestine in case it passes inadvertently out of the stomach so that it breaks up and doesn’t cause an obstruction or that can break up over time. And so you have a star that you can control how long it will live or reside in the stomach.

We really want to bring this technology to the patients, and as part of that effort, we actually started a company in 2015 called Lyndra that is really focusing on bringing these technologies to patients and really building out all of the safety parameters and all of the data that’s required by the FDA in order to safely dose human.

Denver: Now, I know that you have so far managed a two-week diffusion but were working on increasing it to a month. How is that going?

Giovanni: It’s going really well. We’ve actually managed to actually keep these stars without any side effects in our pre-clinical models for over a month. And so, I think we’re well on our way. I think it will require more development. We really want to bring this technology to the patients, and as part of that effort, we actually started a company in 2015 called Lyndra that is really focusing on bringing these technologies to patients and really building out all of the safety parameters and all of the data that’s required by the FDA in order to safely dose human.

Denver: That’s fantastic. And I would imagine actually the dosage that people are going to get is going to be even more even than the spikes we get when we take that daily pill or that multi-day pill. Would that be correct?

Giovanni: That’s absolutely right. Now, that’s a great point. Because you have the system in your stomach slowly releasing, it’s exactly as you pointed out. It gives you a much more even dose, constant dose, and so therefore, actually, in some situations, for example, you may need less drugs because you’re able to provide this continuous, steady dose as opposed to the peaks and valleys that you might face when you’re dosing a regular medication. And then I think the other piece to that is that because it’s there for prolonged period of time, any effect that sometimes are seen with food are really significantly removed because it’s there all the time. It’s delivering slowly irrespective of the food and that really, as you highlighted, really provides a much smoother level of drug in the body.

Denver: We mentioned malaria before. Give us a few other things that this might be useful for.

Giovanni: Absolutely. So we’ve been working on HIV and some other neglected tropical diseases. There are some parasitic infections that affect a lot of people, for example in Sub-Saharan Africa. And so a lot of our focus in the lab has been with the Gates Foundation on working on diseases affecting Sub-Saharan Africa and Southeast Asia, for example. But HIV is another big area that we’ve been focusing on and parasitic diseases also. Lyndra is looking at a whole host of different things including psychiatric illness, problems with addiction. So really, I think, there’s a very broad of conditions that can benefit from this system.

Denver: It’s truly a brilliant platform and I know you don’t have a crystal ball predicting what the FDA is going to do, but how soon do you think this might get to market and people on our listening audience might be able to take a pill like this?

Giovanni: That’s a great question. So we’re starting the first in human trials this year and 2017, so as far as being on the market, likely in about three to five years.

Denver: That’s fantastic. Well, this is very exciting and important research with some real practical benefits to just countless people out there. Thanks so much, Doctor, for taking the time to share it with us tonight.

Giovanni: No, thank you so much, Denver, for your interest in really sharing it with your audience.

Denver: I’ll be back with more of The Business of Giving right after this.


The Business of Giving can be heard every Sunday evening between 6:00 p.m. and 7:00 p.m. Eastern on AM 970 The Answer in New York and on iHeartRadio. You can follow us @bizofgive on Twitter and at facebook.com/business of giving.

Doug Powell, Designer at IBM, Joins Denver Frederick

The following is a conversation between Doug Powell, Distinguished Designer at IBM, and Denver Frederick, Host of The Business of Giving on AM 970 The Answer in New York City.

dap_headshot02_cropDenver: I am at the Measured Summit and I’m now speaking with Doug Powell, Distinguished Designer at IBM Design. Good evening, Doug.

Doug: It’s great to be with you. Thanks, Denver.

Denver: IBM embarked on a complete redesign of its company back in 2013, which is an incredibly ambitious program. You’re one of those lead designers. So, tell us, what inspired it and what are you doing?

Doug: Well, it’s really about connecting with the people who use IBM technology and really understanding who they are, what their needs are, and finding ways to design and develop tools and technology that really meet those needs in a very human way.

The users of our technology traditionally and historically have been deeply technical people – engineers and developers. And what we found in the last decade or so is that more and more of our users are less and less technical, so think about nurses and teachers and data scientists and small business owners. That requires us to think about the tools we’re building in a different way. Designers happen to have the skills to really address problems with a user and human focus, so that’s really what inspired the design-driven reinvention of IBM, as you said. It was about four or five years ago that the program was launched.

Denver: And I guess users today, they want something delightful and intuitive and fun and mobile.

Doug: Yes. And it has to be available to them anytime, anywhere, in their pocket, in their purse, in their backpack. The tolerance for a bad user experience has evaporated, whether it’s in personal technology or in the technology we use for our work, which is IBM’s focus, of course. That line between work and life has completely blurred at this point. The bar for a great user experience is incredibly high right now and we need to be reaching that bar and even setting that bar in the experiences we’re building.

Denver: And at IBM, Doug, you had about 100 or 200 designers or about 350,000 or 400,000-person organization. That has expanded dramatically.

Doug: Right. We’ve hired now more than 1,200 formally trained designers into IBM. We now have more than 1,500 in the company making IBM the largest employer of designers in the world, which is kind of a surprising little piece of trivia for many people. But it’s exciting. It’s really cool.

Denver: Tell us a little bit about the impact the design has had in the business world. Can you please give us an example or two of that?

Doug: Well, you go back now almost exactly 10 years to the release or the introduction of iPhone in early 2007. And that was a pivot point. That was really the moment that everything as we look back on this era is going to be before iPhone and after iPhone. And it really demonstrated that design and user experience is a business driver and it is increasingly the single way that businesses can distinguish themselves. Everything else has been commoditized. You can’t find an edge anymore in supply chain or manufacturing or materials or even advertising and media. It really comes down to the kind of experience, the quality of the experience that you can deliver.

Denver: What has the impact of design been in the social sector and particularly in health care and in education?

Doug: I think healthcare is a place where, quite frankly as we all know, os a pretty lousy user experience. We all are required at different points in our life to engage with the healthcare system, and I don’t know anybody who really looks forward to that experience. So that means that there is an opportunity. That’s an opportunity space for designers to make a difference and we’re just seeing so much cool stuff.

We’re going to see at the Measured Summit just some great examples of designers making a difference in health care, from the patient experience level of doctors and caregivers interacting with patients in different way up to the systems level, and at IBM that’s where we play, at the systems level. Our Watson Health business is just doing incredible work in making sense of just unthinkable amounts of medical data that is out there and packaging that data in a way that is consumable for clinicians who are making diagnosis so that they can have access to far more relevant data than they ever have before.

Denver: I think it was Thomas Watson who said, “Good design is good business.”

Doug: Indeed. In fact, that’s interesting that you point that out because we just discovered a memo that Watson Jr. had written to his executive leadership and it was dated December 20, 1966, which means that a few weeks back, we celebrated the 50th anniversary of “Good design is good business.” And so that’s pretty cool. It’s cool, as a designer, in the year 2017 to be able to reach back a half century into a great heritage of design and really be inspired by that.

Denver: Well, what you’re doing is pretty cool as well. Thanks very much, Doug Powell, Distinguished Designer at IBM, for being on The Business of Giving this evening.

Doug: It’s my pleasure. Thank you.


The Business of Giving can be heard every Sunday evening between 6:00 p.m. and 7:00 p.m. Eastern on AM 970 The Answer in New York and on iHeartRadio. You can follow us @bizofgive on Twitter and at facebook.com/business of giving.