Episode Transcript
[00:00:00] Speaker A: Hello, and welcome back to Veg to boardroom, your podcast about transitioning from academics to industry. I'm your host, Cynthia Steele, and we have another fantastic episode for you today. So I think you might know what I mean when you hear me say that there are some people that you meet and you click with them instantly, and you just have a feel, feeling that this person's going to end up being really big and important in your life. And that is exactly how I felt when I met today's guest, Dr. Barbara Orosco, who wears a multitude of hats. As you'll hear, she is.
Oh, gosh. She's a professor at the University of Moran Department of Ophthalmology. She is the chief medical officer at Cularis Bio, a drug development company for patients with glaucoma. She's also the chief medical officer for a company called my eyes that sends out at home tonometers, which is a way to measure eye pressure in your eye.
She and her husband started a foundation that you'll hear about to honor their son Joseph, who had dyslexia and very tragically passed away as a young adult. And so they took a lot of that energy and people's willingness to reach out and help and turn it into a foundation that truly benefits young people with dyslexia. So we'll put a lot of links in the show notes so you can find out where you can learn more about Barb's many different hats. One thing I will say, and I apologize for this, Barb and I do both have deep ophthalmology backgrounds. We do get a little technical at times.
We talk about tonometers again, which is a way to measure pressure in your eye. I think, as many of you know, eye pressure needs to be within a certain range in order for you to be able to see when that pressure gets really high. That can be a sign of glaucoma, and that's why you get the dreaded puff of air test when you go see your eye doctor. So I apologize in advance if some of the rhetoric gets a little bit technical, but the overall concepts are the same. Barbara is an absolutely wonderful mentor. She is an incredibly supportive person. And I really think that you'll enjoy today's episode if you are a medical doctor or a medical student who is interested in pursuing research, if you're a PhD who's interested in pursuing clinical research, or if you are a would be entrepreneur possibly sitting on some intellectual property that you might be interested in working on. This episode, my episode with Julie Tetslaf and my episode with Karen Torhan would be very good for people who are interested in starting their own companies. So I could talk to Barb all day. I could probably talk about Barb all day, but I won't. Here's my episode with Dr. Barbara Roscoe.
Dr. Barbara Morosco. It is an honor to have you on the bench to Border and podcast.
[00:03:28] Speaker B: Thank you, Cynthia.
Thank you. I'm so glad you did this. I'm so glad I was asked to participate, so it's really an honor.
[00:03:38] Speaker A: Oh, my gosh. So I have known you. Oh, my gosh. Has it not quite been ten years?
[00:03:45] Speaker B: Maybe at least ten years.
[00:03:48] Speaker A: At least ten years, yes.
[00:03:51] Speaker B: Because how long have you been living in Florida?
[00:03:54] Speaker A: Now we're going on six years.
[00:03:57] Speaker B: Okay. Yeah. So back when you were calling on me as an MSL, at.
[00:04:07] Speaker A: Was obviously, for those who don't know you, we'll have you introduce yourself in a second. But how I met Barb was actually, as she just said, as my first MSL job at Baushan Lam, and I had this key opinion leader, this Kol named Barbara Roscoe, that I had to go visit. And thankfully, I had a very wonderful colleague who said, oh, I know Barbara Orosco, and no problem, I'll get you a meeting. And we just had the most wonderful little coffee session, didn't we? Talking about research and glaucoma and everything. And we've been friends ever since that moment. And it's just been wonderful to have you and have you as a mentor and a sponsor and now a member of a guest on my podcast.
[00:04:53] Speaker B: Yes. And business colleagues. Right.
[00:04:55] Speaker A: And business talks. Yes, absolutely.
So why don't you introduce yourself to our audience?
[00:05:01] Speaker B: So thank you. So I always say, which hat am I wearing? Right?
So, Barbara Orosco, I'm a glaucoma specialty trained ophthalmologist. I am a clinician, researcher, entrepreneur, a parent, a wife, chief medical officer, and a creative person. I think what I've learned about myself through the years is that I like creativity and I like to build.
So my current role is I still see patients, as you know. So I have an academic appointment as an adjunct professor at the University of Utah, both in ophthalmology and biomedical engineering. And I think that it really enables me to do the best possible job I can from the drug development.
You know, it's funny. People used to ask me, do I like taking risks? Because we'll probably get into it. My career path has not been a straight trajectory at all, but I think I get bored. I really think I need a lot of different aspects to fulfill me. And right now, happy to say that I've got a really good mix of things in my life that excite me every morning when I get up.
[00:06:22] Speaker A: That's wonderful. That's wonderful. Yes. We will definitely go into all of your hats. So, first of all, you are actually the first MD guest that I have had on this podcast, because, again, I want to focus on the transition from academics to industry. But I also don't want to negate any of the clinicians or clinicians in training who are industry curious and beyond just being a speaker or being a member of an advisory board to actually get their feet wet in research and become part of a pharmaceutical or surgical or whatever it is infrastructure. But secondly, I think it's definitely another career path that perhaps people in medical school and in residency don't necessarily think about. So I guess, yeah, let's start there with you. So you grew up as the child of an eye doctor, right? So did you always know you wanted to be in ophthalmology?
[00:07:25] Speaker B: I always knew I wanted to be a physician ever since I was little. And I knew ophthalmology the best out of all the subspecialties and or the medical field just because of being involved with my dad. And it was funny because my brother is also an ophthalmologist, so he's a retina specialist. And I was in high school and I was like 16 or 17, and I wanted to make some money, and I was hooked. And even my brother tried to get away from ophthalmology. He tried to do orthopedics, but he ended ophthalmology. So somehow my dad had this very strong influence. And in fact, my kids, when they were little, they used to ask my mom if she was an ophthalmologist as well, because it seemed like we were all ophthalmologists.
[00:09:41] Speaker A: Yeah, I think I can assume. But secondly, I tell her all the time, one of your grandkids is going to become an artist or they're going to want to go into theater. There's going to be at least one rebel amongst your grandkids. She was like, oh, I don't care. It doesn't matter. But the two of her kids that I've met, I asked them, like, didn't you want to rebel? And they said, we all thought that teeth were really cool. It wasn't like their parents pushed them in that direction. It's just they think that teeth are cool, which good for them, because I think teeth are disgusting.
[00:10:44] Speaker B: I do, too. And there's funny, because what a lot.
[00:10:48] Speaker A: Of people think eyeballs are disgusting.
[00:10:50] Speaker B: I was just going to say that when I was a resident. I mean, the general surgeons, they didn't have an issue in the trauma room with open bellies, but they could not look at an open globe like that was just grossing. Very funny. But it's interesting, because sometimes I wonder, why did I go into ophthalmology? Besides finding the eye so cool? I love the fact that it was a marriage between medicine and surgery. And even though it's defined to a specific organ, it encompasses so many other aspects of systemic pathology. Right? So I would think about it from the perspective of the cardiovascular system, oncology, infectious disease, diabetes, endocrine, almost everything. Neurology, even your prior podcast, talking about the synergy. Like you, between neuroscience and ophthalmology, there's so much overlap that it was really cool. Even though you're focused on one organ, it really does open up creativity and exploration into other systemic illnesses. And I think that's how I address my patients, too. I look at the whole patient, which sometimes we get so micro focused in one aspect that we forget that this is a patient sitting in front of us.
We're not just looking at an eyeball, so to speak.
[00:12:22] Speaker A: Yeah, I know. Absolutely.
Out of curiosity, if there's anybody listening who's considering where they want to rotate or what subspecialty they might want to go into. Do you ever meet residents? Not residents, but do you ever meet any students who ask you, how does one even go about picking that? Because, for example, I know my sister works with a lot of medical students, and she's given them Myers Briggs tests to look at what their personality type is. And maybe the joke is, of course, if you hate patients, then maybe go into radiology or pathology or something like that. But do you have any advice?
[00:13:00] Speaker B: Know, that's a great question, Cynthia.
[00:13:02] Speaker A: In fact.
[00:14:56] Speaker B: And I was like, wow. And I think a lot of times, I look at glaucoma that way. If I see somebody who's losing vision, I look at their age, I look at their rate of progression, and I say, okay, can I save their site and keep them functioning before something happens to them?
And can you save that? I think medicine, too, I have found it really rewarding. I love my patients. I think that's why I still wear so many hats. I'm not ready yet to give it up, because I learned so much from my patients, and I've gotten to the point in my career where I can spend the time and really understand the patient and really talk to them. And we forget. We forget how much other things play a role in their ocular complaints. It may not always be ocular. It could be something else that's underpinning it.
[00:15:58] Speaker A: That's so true. So obviously you have this passion for medicine. So where did the interest in business come from?
[00:16:06] Speaker B: I know you had asked me that. Did I ever have a business degree? No. I wish I did. I wish I had an epidemiology degree and would have loved public health.
Business and MBA would have been really nice. It's funny the way I got into industry, so I don't have a PhD.
And I think something that you and I were talking about prior is if I had applied for the position, I never would have applied because I would not have thought I was qualified. I would have judged my capabilities. I would have said, I have no education in drug development. I've never been in corporate America. Who am I to sit in and sit on review committee? And this is a funny story. This is a true story. So of course I go in, I say, what do I have to lose?
And in the back on the wall of the office, it says, doctor of gastroenterology.
And I'm like, that's not accurate.
Great catch. I'm like, I could do this job.
[00:19:28] Speaker A: That's a good litmus test.
What is wrong with this photo?
[00:19:35] Speaker B: Is it medically accurate? And I'm like, not medically accurate. And then it was fun. It was just really fun. And six months into it, I was consulting one day a week. Six months into it, they said, look, we really want to hire somebody full time. We need a full time medical director. And at that point, I said, ok, I really enjoy what I'm doing. I was pregnant with Christina, so we had to go back and get the babysitter, get the nanny. And I walked away from my practice and went into Pfizer full time as the US medical director and just loved it. I think it was such a trajectory. It was such a learning curve, like, you know, going from an academic lab into industry.
But how else are you going to learn? There is no course that you can take that teaches you to do that role. And I never would have applied, never would have left my practice. It was just a crazy phone call from a headhunter.
[00:20:36] Speaker A: Wow. It's interesting listening to this story from the perspective that I have of you now when you say, I'm going to go back, and you said, I don't have an MBA, I don't have a PhD, I didn't have any business acumen. And I'm thinking to myself, that does not matter. And you are the embodiment of that not mattering. And that, I think, boils back down to what you said. You're a creative person, you're an incredibly energetic person. Because the joke when we used to work together is that somehow you were eventually going to master cloning technology so that you could manage to handle all of your kids and their things and handle your practice and handle the business and the other side hustles that you have, of which there are many. But I love this idea that you know yourself, you know what you're going to want, and so you pursue that and that must give you that energy and that drive to keep moving forward. Right.
[00:21:34] Speaker B: And you know what's funny is I.
[00:21:36] Speaker A: Didn'T.
[00:23:24] Speaker B: You wouldn't be doing this podcast if you were probably still in a lab working on cell cultures.
[00:23:31] Speaker A: Absolutely not.
[00:23:33] Speaker B: Right?
[00:23:33] Speaker A: Absolutely not.
That's such a good point because as someone who recently, very recently changed jobs and I was only in my position for a little over a year, and I do get the eye rolls. I saw some old friends last weekend and they got, where are you working now? It's all very funny, but you're right. This is a conversation that I had with my husband. I've spent four years here, two years there, one year there. And it's every time you learn something, and I think even if it's a failure, so to speak, first of all, there are some successes built in. Obviously, there has to be. But even if it doesn't pan out and you don't have the 30 year career that you hear that your parents have had, at the same time, you do take away knowledge, and in this case, I took away a lot of knowledge about myself.
[00:24:24] Speaker B: Yes.
[00:24:25] Speaker A: And I think you learn, at least in this case, you learn.
I don't want to stand for feeling disrespected.
And I think that's because of the previous jobs that I've had before and working with people like you and others that we both know who are very good at empowering women to have the confidence. And so one day I'm same as you. When I was younger, I had no confidence whatsoever. And I think in a lot of ways that's bred into us, but that's a totally different conversation.
But you realize you look at yourself in the mirror and you say, I got two advanced degrees. I can do better than this. Yep. And then, you know. So I agree that these good and bad experiences shape you into this person that you end up being.
[00:25:18] Speaker B: And, you know, it's funny when you talk about failures. My first position, so when Pfizer was getting out of ophthalmology, I knew I wanted to stay in ophthalmology. So I left Pfizer. As you know, we moved out to Park City. I joined the University of Utah, and two very interesting takeaways. I maintained my MD and my credentials while I was at Pfizer, but I stopped operating. But I wanted to go back into academia. And so many people told me I could not go back into academia because I was in industry. And I said, this does not make sense. I'm a clinician. I'm an ethical, well trained ophthalmologist that should still have value. And when I left Pfizer, I really had a very hard time identifying who I was. So I was an ophthalmologist, but I stopped operating. And so know we think of ophthalmologists as surgeons. So I said, am I less of an ophthalmologist? But then I said, I have all this background in now. Training in drug development, device development, regulatory, understanding the landscape, the commercial place. I should be able to offer a skill set to people. And it was amazing how many people then came to me as a consultant. And then the third piece was, what was great was the University of Utah allowed me to be an adjunct professor so that I could be on staff, see patients, work with residents, work with fellows, but then yet continue to run companies, start companies. And the first company I went to was Altheos, and we were a single asset company. Swear I will never be a single asset. And here I am, a single asset company again.
But so much rides on that single asset. And the drug was not potent enough. It was a rokinase inhibitor. We were developing it at the same time Ari was developing their rokinase. We were very close in timing, in terms of clinical development, and we just didn't have the efficacy. And we ended up stopping. We did a quick no go study to basically determine if the drug had efficacy. It didn't, and the decision was made to bring the asset, give the asset back to the japanese company, Asai Kasai, and close down the company. And it was so. And I think, you know, this feeling, too, I felt personally responsible. I felt I had failed because I could not develop this drug. And what was so eye opening is that I actually got kudos, because we found that the drug was not effective and did not have enough of efficacy to make it commercially viable. And we closed the company and then saved the investors money.
[00:28:21] Speaker A: Okay.
[00:28:22] Speaker B: Rather, they probably appreciated that. They appreciated it. So again, like you said about successes and failures and everything that you learn, it was a great learning experience. Unfortunately, it was a bummer for the company, but it was very insightful.
You get to that point and you're valued because of your efficiency and your honesty and really sometimes making the tough decisions.
[00:28:54] Speaker A: Sure. I think that's an important point to stick with for a second, because I think the perception of industry, big bad industry by academics, is it's the dark side. And this is where people lose their sense of right and wrong. And this is where you're just in it for the money. You're not in it for the love of the science or whatever. But what I'm hearing from you is that actually, well, we could both say, absolutely not. I think we're both still pretty ethical people. But on top of that, sometimes having that attitude of, no, I'm going to do what's right. I'm going to follow the science where it's directing us to, and I'm going to be the one to have the tough conversation and say, this investment is not going to pan out.
Let's back out now before you put in more money for a clinical trial. That's not going to go anywhere and.
[00:29:49] Speaker B: It'S not going to have know. And it still, I remember it was George Spithe, and I've just a tremendous mentor and just a legendary physician in the whole field of glaucoma. So ethical. And I remember we were having a conversation about, and I think a lot of researchers don't get that education from the bench. And then so often they've got these great ideas that just can't materialize because it's not, unfortunately, going to make somebody money.
[00:32:20] Speaker A: That's true.
[00:32:21] Speaker B: It's a tough balance.
[00:32:24] Speaker A: Yeah. And in fact, when I was involved in a product launch, I think we probably had conversations like this, either sitting in a coffee shop or even just on your couch in your beautiful home. Oh, we could do this. Oh, we could do this. We could do this.
And those moments are just absolutely lovely. And I love all those conversations that I get to have with you because you just feel so energized afterwards. But then, yeah, you have to put everything on ice a little bit and think, okay, now what is that going to a. It's a different, you know, Diane Bovenkamp mentioned thinking about your lab as your company and you are the CEO. And I feel like these thoughts are not that different from how the PI of a lab has to think, because sure, he or she has plenty of ideas as well. And our listeners probably have a ton of ideas as well. But then you have to do a cost benefit analysis. You have to think, is this going to move me closer to my first ro one, for example, or move me closer to graduating this student or whatever stage that you're in?
And so I guess one point I'd like to make with that is that the thought process and industry is not that different from academics. It's just in a very different setting. But secondly, one of the things that Diane brought, the context that Diane brought that up in was we were talking about the skills that students in labs and students that are training right now, the skills that they acquired that actually could prepare them for a career in industry. If you think about it, not just I'm a worker b, in a lab, but you've trained people, you've worked with teams, maybe you've negotiated prices, you've run budgets, you've managed projects. And all those things put together actually could make you a very valuable asset in a company if you can train your mind to think of it that way, versus I'm just a little work in a lab.
[00:34:34] Speaker B: Exactly. And I think it's really interesting, too, because in any organization, academia, a lab industry, you have people that think outside the box. Right.
And then there's individuals that are very much focused on one specific area.
And I think understanding where you gravitate to enables you to find that path.
But you're right. I mean, it is very much the same. It's like, okay, what is that work going to get me?
And another thing that we've spoken about all the time, too, for the young researcher, MDPHD, clinician, is if you have an idea, don't publish it right away. Don't say it right away.
[00:35:29] Speaker A: Let's talk about that in detail. So this is in the context of intellectual property, right?
[00:35:34] Speaker B: Yes. Correct.
[00:35:35] Speaker A: Okay, so for anyone out there who's listening, this is very important. If you have an idea that you think is patentable or something that you want to use to spin off into a new venture, this section is for you.
Wow.
Yeah.
So that was one thing that I took away from working together with people who are doing drug development, is if there is something that you are working with, be it a new molecule or a mouse model or anything new, even.
[00:37:40] Speaker B: Mechanism, even a mechanism of action, if you find, I love the story and I don't know all the specifics of Murray Johnstone, love him. And it turns out he holds the patent for lash growth on prostaglandins. And again, there's a perfect example. It was found as a safety concern right on the prostaglandins when they were being developed. And I remember hearing that Pfizer did not have any interest in lash growth at the time, but Allergan obviously was interested. And I don't know the whole arrangements with the patent, but it was Murray who actually filed the know on an observation on a safety finding on a drug that was being developed for glaucoma that had a lot of value. So it could be a new molecule, it could be a target, it just could be a concept, it could be a finding with a current drug, but it has to be patented. You have to file that provisional patent first.
[00:38:47] Speaker A: And I think that's so important because in a lot of ways, I think, especially students, again, they want to be good little worker bees.
They want to help their PI get the next ro one. They want to publish aspects of their dissertation to move things along.
In some ways, you're trained with this mindset.
It's here. And together we're all going to work together, the royal we, to advance glaucoma or advance this type of cancer and improve our understanding of it together. But I guess what I'm trying to say is there's nothing wrong with going to your tech transfer office at your university and saying, hey, I've got this thing, and I'm just wondering if I should protect. And hopefully, hopefully again, your mentors, like Karen Torhans, who practically pushed her into that office and saying, yes, you should protect this and you should start a business with, you know, hopefully you can find people who will support you in that. And each university should have at least somebody there to help them with that process.
[00:39:55] Speaker B: Exactly.
[00:39:56] Speaker A: Good. Perfect. So besides that, how else could either a clinician scientist or a clinician in training, what do you think they can do while they're in school still to maybe either, I don't even know if I want to say, improve their chances of getting a job in industry, but maybe prepare themselves if that's the type of career path that they want to go into.
[00:40:17] Speaker B: And I think definitely getting involved in clinical research, for sure.
If your academic center is doing clinical research, drop by their office, understand what type of clinical research is ongoing, understand what an IRB. What is an IRB? Why does it need ethics approval? How is it set up? There's some great courses online. Citi actually has a lot of great courses around drug development. In fact, any medical student or undergrad that wants to work with me on any of my current clinical programs at the University of Utah has to do a city course on clinical development, and it goes know good clinical practice, ethics committees, what does an informed consent look like? What are vulnerable populations, what's needed?
What are IHC guidance, different harmonizations, regulatory paths. So that's a good place to start. The other thing, too, is a lot of our, again, this is ophthalmology focused, but this would be for any organization or any specialty arvo. Again, go to your research meetings.
More of the research meetings probably are better positioned. We try to do educational courses. We do a bench to bedside on Saturdays before, again, you know, I'm sure some of the oncology research meetings probably have very similar setups with programs and then even just Google the know. The FDA is know giving courses, and it's really just trying to get those courses under your belt and just perusing information.
[00:42:08] Speaker A: Definitely.
Is that something that phds could do as well? Could a PhD or a graduate student go and find out what types of clinical trials are being done? And maybe they're not handling the patients, but maybe they're doing something with patient records or coordination or something, and that's something that they could do as well.
[00:42:26] Speaker B: Yes, absolutely. And even public health epidemiology, when you think about. Let's just take a.
I think there is a lot of opportunity. If people are drawn to device or drug development from any field, there's a lot of opportunity.
[00:45:20] Speaker A: One of the things. And just spinning off of this, but one of the things that you and I have talked about in the past.
[00:46:13] Speaker B: Yes.
[00:46:13] Speaker A: Right. And how many times have we gone to seminars where you watch a student get asked a tough question, and rather than just saying, oh, that's a tough question. I don't know. I have to get back to you. They dig back in their memory and they try to come up with something. So how do you eat a nice big slice of humble pie and say, I don't know this, and I need someone to teach me?
[00:46:35] Speaker B: And, you know, I think it.
I don't know if I. If. I'm not sure if I answered your question, but I think you have to be okay with not knowing all the answers if you want to be that bigger picture person.
[00:48:08] Speaker A: Sure, that makes sense. But also, I think it just comes down to understanding that you can't possibly know everything. And I will say the conversations that I've had with some of the smartest people that I have ever met, they will know, oh, I don't know, or someone that we both know very well, one Dr. Peter Farina would say, who ran R D for decades at BI, and he said people would come into the room and I would say, teach me. Yeah, he was a chemist. And he said, what the heck do I know about designs for asthma inhalers? Nothing. So someone needs to give me a crash course in designs and prototypes and why this small change would make a big difference and why this is something that, again, going back, how is this going to make things more lucrative for the company? By making it easier for patients, delivering more accurate dosing, anything like that. And I always think about him saying that because again, you look at people and you say, gosh, they know everything, they're so smart.
But I think in large part it's because they're willing to say, I have no idea. You tell me. Teach me about it. I think that's amazing.
[00:49:36] Speaker B: And I think that's something too. You know, my interest in IOP fluctuation and these spikes that we're now finding in the mornings with home monitoring. And so often my patients will ask me, well, why is it spiking at this point and not then? And I'm like, I don't know. I said, right now we're sort of at the cutting edge of trying to understand this, and you're actually teaching me. I said, you are the one that's teaching me because we don't know all the answers. And again, when I first came out of medical school, I felt like I had to have all the answers because if I didn't know the answer, then I was not a well trained ophthalmologist and the patient would not trust me. And now I realize that I don't have all the answers and I have a very low threshold to tell a patient, look, this is what I'm thinking. I'm not sure. Let's get a second opinion. Let me ask my colleagues. I'll get back to you on this.
And I think they really appreciate it because you're open to ideas, but, yeah, you don't have all the answers.
And there was something else I was going to say and now I forgot. Oh, that was the other thing you started to talk about, too, which I think is so important when you were talking about Peter, is why is this important? So we may have a great idea, we may have a novel new drug, a new device, but at the end of the day, what unmet need is it fulfilling? And I think from a development researcher industry, you always have to ask, what's the commercial value? Is it something that somebody would pay for?
And it needs to be both pieces. It needs to fulfill an unmet need and you need to test that. I think that's the other thing too, is if you have an idea, you need to get like minded people behind you and you need to test that idea and see, is it you just drinking your own koolaid, or is it really an unmet need? And there's a great book that I wanted to mention. It's called nail scale it. And it's by Nathan fur and Paul Astrom, I think is how you spell it. But nail scale it. And it's a great entrepreneurial book because it teaches you, if you have an idea, nail it. Like figure out what is the thing that's really going to matter. And it talks about the analogy of the iPhone. Why was the iPhone so innovative? And you can imagine it being much more complex with a lot more things. And it really just came down to it made a need. And even like the iPod, when it first came out, it was just simple.
Yeah, right. And we were able to scale it. But it's a great book for anybody who wants to be an entrepreneur.
[00:52:37] Speaker A: For you youngsters, an iPod was a device that we used to use to listen to our music with headphones that connected to the iPod.
[00:52:51] Speaker B: Ipod shuffle, remember?
[00:52:53] Speaker A: Yes, very easy. Mine was hot pink. I loved my hot pink ipod. I think I had the nano. And that changed bench research for me forever because now you had this little thing you could put in your pocket.
I think we all stopped talking to each other because we all had headphones in. After that one Christmas.
We're lost in our own little worlds.
[00:53:18] Speaker B: It was simple.
[00:53:20] Speaker A: You're right. Absolutely right.
[00:53:22] Speaker B: Sometimes the best inventions don't need to be so complex. And if you can figure out what that need is.
[00:53:30] Speaker A: Yeah, absolutely.
[00:53:32] Speaker B: But somebody has to be willing to pay for it. That's the other piece.
[00:53:36] Speaker A: So let's talk about some of the other entrepreneurial pursuits that you have had, which most of them are in the eye care space.
[00:53:46] Speaker B: Yes.
[00:53:47] Speaker A: Right?
[00:53:47] Speaker B: Yes.
[00:53:49] Speaker A: Which ones would you like to talk about? Before we get into your nonprofit space, let's talk about, are there any of the other ventures you'd like to talk about and what maybe lessons learned from some of these? You know what?
[00:55:41] Speaker B: Again, just a huge learning. At the end of the day, no one had any doubts that the product would not work. And it actually was just shown to heal persistent corneal epithelial defects. But it's being on the shelf fulfills a huge unmet need but will never get developed. And the patents are going to expire. So that was a very interesting learning, my most recent. So obviously qilaris so developing, which you know well, where you were working with me as a colleague, and we're developing a small molecule, a topical small molecule for IOP lowering, working on episode venous pressure. And again, it's an interesting time because the rage these days is around sustained release and retinal therapies. So again, in thinking about the commercial landscape, there's a lot of generic drops available. So it always comes down to, yes, we need more IOP lowering. We need something that works on EVP. That's very well tolerated, but we're back to that commercial. How is it going to get reimbursed? And what's interesting, too, is reimbursement is different in different parts of the world.
So that's another thing, just to let people know as they're thinking about an idea that they're trying to move off the bench, it may be reimbursed very differently somewhere else in the world versus the US.
And then the most recent actually, is my eyes, which is completely different, still in ophthalmology, but there we found an unmet need for getting the eye care home into patients hands, even on a mental basis. So the eye care home is a device that measures IoP that you can use at any point. It's based on rebound tonometry, and currently patients can't buy it, so they would have to get it through their doctor's office. But we realized that patients, even for a week, could get so much information from using this device that it was so impactful, because as it turns out, looking at the literature, and we're publishing a paper on this, I put together a whole consensus panel, talk about trying to move the needle, that fluctuation is an independent risk factor for progression. But we never talked about fluctuation. We only talked about peak IOP in the office because we never had a good way to measure the fluctuation. And what we've been learning from the device in terms of IOP spikes that occur outside the office, and that's why I now call it normal. What is normal is just incredible information. And I've been able to pick up huge spikes in patients into the 30s when may be 18 and 19 in the office on no treatment. And you really have the discussion. Do you want to go on eyedrops? Do you want to do an SLT?
Should we act now? Because otherwise we're just waiting for damage.
[00:58:56] Speaker A: Right?
[00:58:58] Speaker B: Yeah. We're working with eye care to get it reimbursed to get insurance coverage for it, a hickspix code.
But really, I just stumbled upon an unmet need patient.
[00:59:13] Speaker A: And I want to back up a little bit to talk about cularis, since that's one of the big ways that we know each other from. But the first presentation that I ever saw your CEO, Lorraine do.
Oh, gosh, almost 30 years ago now, isn't it? Yes.
[01:00:00] Speaker B: Almost 30. Yeah. Isn't that crazy?
[01:00:01] Speaker A: 30 years ago. And when those came out, as Barb mentioned earlier, it was revolutionary. It was this huge, huge thing. And then there was nothing. There was not much in the way of pharmaceutical intervention, plenty of surgical innovation happening, but not so. You know, the CEO of this new company gets up in front of a lot of really smart investor types and clinician scientists and everything at this meeting that we're at in San Francisco, and he says, we created a new drop. Why should you care?
Why do we even need a new eyedrop? And he spent five minutes saying, this is why this drop will make a difference. And he won the best pitch award, as I recall, that year.
[01:00:50] Speaker B: Yeah, he did.
[01:00:51] Speaker A: Because you have to, as Barbara saying, you have to identify what your unmet need is. And the other thing that I like about your, my eye story, know, it's you making an observation and others making an observation. And then when you get everybody together in a room to discuss and you realize this is probably more pervasive than we think. This is much more of an unmet need than we think. It's something that I want to emphasize to the listeners to say both of these stories reflect what happens when you get key stakeholders together in a room.
[01:01:25] Speaker B: Yes.
[01:01:26] Speaker A: And you start talking, and it just goes back to the benefits of collaboration. And when you meet new people and you talk to people and you say, this is why I think this is important for this podcast, I basically just asked my nieces and their friends, would you listen to this? And they said, sure.
I really hope they are.
But I think when it comes to a new venture, when it comes to anything new, it's important to go to meetings, talk to people at your posters, meet other people at posters and say, you're seeing this, too. I'm seeing this. And then you can start collaborations like that. So the one thing that I could say about you, Barb, is you're phenomenal at helping people make connections. And so let's talk about some of these connections that people can make and where they can meet other like minded people.
[01:02:17] Speaker B: And, you know, it's so funny because even for ophthalmology or for glaucoma. I learn so much from the cardiovascular space, and I don't go to cardiovascular meetings, but I just Google and I think about how is something? And even when I was at Pfizer, we were scratching our heads around a compound that we were trying to develop. And again, it was for glaucoma, and it was having some pro inflammatory findings and epithelial irritation, but it was really pro inflammatory. And all I did was just google the class of compounds and saw what it was doing as a drug or a molecule elsewhere in the body, this class. And I was like, it's causing inflammation elsewhere when it was given for some other thing. And I'm like, of course, this makes sense, but I think we can learn so much by exactly that. Keeping an open mind, looking at other therapeutic areas, looking how things carry over, and then just being open to conversations because you'll never know. And again, getting back to my eyes, it was really funny because the way we started, and I think.
[01:05:20] Speaker A: Heart rate monitor.
So the two things I take from this is one, it is nothing wrong with finding ways to get patients access to more of their own data. I mean, my apple Watch can apparently do an EKG.
[01:05:36] Speaker B: Yes.
[01:05:37] Speaker A: It can tell me if I'm in rem sleep. And so I think patients are very open to that. But the other thing, I want to go back to this concept of the IOP fluctuations, because it was, I believe, like cell and molecular biologists, who actually took that observation in patients and said, okay, let's take some of these cells that grow, that live in the back of the eye. Let's put them in cell culture and expose them to different atmospheric pressures. And they did this beautiful experiment where they elevated the pressure for several minutes at a time, and then they measured gene expression. And then they did it again and raised the pressure, lowered it, raised it, and lowered it, raised it, lowered it, and measured the genes. And those cells that weren't exposed to a steady state, high pressure, reacted so differently when they were exposed to intermittent high and low pressure.
And it's just like, I'm sure we all know people who have just a steady state, baseline low blood pressure, and you can survive like that. Your body can adapt to that or whatever steady state you're in. But if conditions constantly change and you're never going to really feel well, or someone like you who lives in a mountain town, you go down to low elevation and back up into the mountains, and then low elevation, back up into the mountains, I think you always feel like you're going to die. But if you stay up there for a few days, you do start to adapt.
[01:07:12] Speaker B: And just talking about something else you said in terms of getting information from other people, and ophthalmology is really cool because we have so many biomedical engineers that come from biomedical engineering into ophthalmology. And I started asking the biomedical engineers exactly that question. If you take a tissue, let's just say, the optic nerve, and you keep it at pressures between you're exposing the optic nerve or any laminocrobosa or any tissue to pressures between 22 and 24, like, let's just say, or 24 to 26, or 22 to 26.
What's worse? Is it worse to go from ten to 1810, 18, or is it worse to go 24 to 26? And they said, oh, absolutely.
The ten to 18 puts a lot more stress on the tissue.
When we treat glaucoma and we see a patient with 24 and the knee jerk is, oh, you've got glaucoma, you're an ocular hypertensive.
Maybe they're not the ones that are at risk. Maybe it's the ones that are lower pressures with big fluctuations. So I think this data right now, we've got over a thousand patients that have used our service over two years, and it's so cool. And we've got a collaboration between Moran and Wilmer, looking to identify the phenotypic parameters and just characteristics of different people with different glaucoma and who fluctuates and what therapies work. So it's pretty cool, it's fun. That's the creativity side of me learning.
[01:08:59] Speaker A: I will say, whenever I speak to biomedical engineers or whenever I look at their posters, it looks like the matrix to me. It's just a bunch of characters and it makes absolutely no sense to me. And so I have no problem saying to any of those folks, okay, I need you to explain this to me like I'm an 8th grader.
[01:09:16] Speaker B: Yes.
[01:09:18] Speaker A: What do these equations mean? And why should I be interested in this? Because I do not understand. And I will say, I have never met a person who has rolled their eyes and said, I don't have time for this. I think if people show a genuine interest, not just an interest in your work, but an interest in actually understanding your work, that I think anyone's open to it. So that's a little nugget I would like to leave. Everybody is, don't be afraid to ask.
And it's probably not a dumb question, so don't do that thing where you say, this is probably a dumb question.
Just admit I don't know this. Please explain it to me. Can you please teach me or explain it to me like you would to your elderly parents.
People are always willing to do that.
[01:10:11] Speaker B: And I think it goes back to what you said before about how do you create that team? And it is saying, I don't know this topic. I don't know this. Come help me. Explain to me how does this fit together? But, yeah, I think it's all about networking. So often we get so micro focused, and you need to be out there discussing. That's why team meetings is so effective. Why do you put a group of people together? Why do you put an advisory board together with a lot of different insights? Why do you have diverse boards?
[01:10:44] Speaker A: Yes, absolutely. So let's switch gears a little bit, because as we talked about, you wear a multitude of hats, from raising a future Olympian and being an ophthalmologist and running companies and starting your own ventures. Do you want to talk to us about the foundation?
[01:11:05] Speaker B: Sure. So, in the last few minutes, you know, it's funny, I have not. Of all my kind of endeavors, this one has been probably the one that I don't talk about the most.
And I recently just made it more visible on my LinkedIn because we got an external validation from charity navigators.
It's very.
[01:13:53] Speaker A: Of course. And you give scholarship money to children with dyslexia.
[01:13:58] Speaker B: Right now we're doing so. We were giving the financial support, and we thought that was sufficient. But what we realized in nine years is that our kids were still failing and dropping out of college. So upwards of one third. And as you can imagine, if they don't realize what accommodations they need, if they don't realize that they should go to smaller colleges, if they don't realize that they could start at a community college and then go to a regular college to increase their likelihood of success.
So now we do mentoring. So we do mentoring, which has kept our kids in the program and kept them in school. So we decreased our dropout rate to near zero.
And the kids stay in the program, and now they go on to be mentors. So we've got the mentees becoming mentors and giving back to the freshmen coming into the program. And then we do a lot of resources, education, webinars, as we've heard it, the kids tell us they feel like they're part of a community. They're part of a community of people that get them and understand them and perfect strangers who believe in them.
[01:15:07] Speaker A: That's amazing.
You have a really beautiful and admittedly very emotional TEd talk that's out there to talk about the origins of the foundation. And obviously we won't go into that. But one of the things that you pointed out that I remember, my husband and I watched this TEd talk, and he looked at me and I think I told you this at the time. He looked at me and said, I think I might be dyslexic. Because all he knew is that he hated to read. Yes. And his handwriting is abysmal. I mean, I'm not telling any secrets. His handwriting is abysmal. Spelling and spelling is abysmal. Yeah.
I have to proofread everything that he puts out into the world because, no offense, but if anyone sees any of my posts on Instagram and you see od misspelled words. I did not post that. You will see later.
The spell checker has come through and corrected. But anyway, he's a brilliant guy. But the way he takes in information is he listens to podcasts and YouTube, and that's how he learns rather than reading.
[01:16:19] Speaker B: And that's exactly what we're trying to teach our kids.
If you're going to go into college, don't take a lot of classes that have you reading all these books. Ask for podcasts. Ask for books on tape. There's so many accommodations. Get half time on.
Know, it's interesting.
Then, you know from my TED talk that I'm also dyslexic. But I wasn't as severe as Joseph. But the same thing. My spelling is terrible. My handwriting is terrible.
The joke is that Lorraine has asked me to be the secretary at our board meetings.
It's so painful, and you learn to compensate.
But, yeah, I always had support. Joseph had support. So we really wanted to help so many kids who don't have the support. And we get over 250 applicants a year. And it's just heart wrenching because still to this day, there are kids that are so smart, so gifted. All they want to do is have an education, and they're constantly being told you're not trying hard enough.
Just basically they're being brought down rather than built up.
[01:17:41] Speaker A: Yeah. And I actually feel like that was a great place to close because that almost embodies your entire career. It seems like you have made this life of building people up and helping see their potential, myself included. And I'm sure anyone who's listening to this, who knows you would agree that that's what you do, that's what you do best. And I guess I want to point out that, at least for my listeners, that's how people should be. That's how mentors should be. And you should look for people who elevate you and challenge you, but always will lend a hand when you need to.
Yeah, I think that's a really good place to close it. Are there any closing thoughts that you want to give for our listeners?
[01:18:33] Speaker B: No, but thank you. I always say I'm sort of the Pollyanna. I definitely see the glass half full and the potential. And you're right. I think you're going to make me cry. I think I do.
[01:18:43] Speaker A: Sorry. That's okay.
[01:18:44] Speaker B: But, yeah, I look at someone and I see their potential. Even as a manager.
[01:18:49] Speaker A: Yeah, you very much do.
[01:18:50] Speaker B: Right?
[01:18:51] Speaker A: You very much do. And you were the one who reached out to me and said, I think you could do this role that is in this new company that I'm starting. And then when I found my next role, and then ultimately my next role, I mean, you were one of the first persons I thought of to say, I want to talk to Barb, and I want to see what she thinks about this, because, yes, you could be, as you say, pollyanna ish, but at the same time, you're very realistic, and I think that there's a very good balance of, and it's important to find people who will look you in the eye and say, yes, I love you, yes, I respect you, but that's not your strongest place, or that's not where your talents belong. And I think that's so important to find in mentors.
[01:19:38] Speaker B: You're absolutely right. It's asking, yes. And that's what I do for my students and my kids. And it's funny, I never thought about how it translates to the scholarship, but you're right. It's like, look at your strengths. Don't focus on the negative, but be realistic what you're capable of. And again, I joke. Don't ask me. I would love to write a book. I will never be able to write a book.
It's just not my strength.
But knowing what you're capable of and finding that mentor who does believe in you but also is realistic, because, again, you don't want somebody to sugarcoat it, but you want somebody that can really help you and be there for you.
[01:20:24] Speaker A: And I think the other thing I will add to that is be willing to accept that advice, because I can definitely think of when people have told me, I'm not sure about that. I'm not sure about that. And I've said, no, it'll be fine. And if enough people tell you something then you probably should listen.
[01:20:45] Speaker B: Yes. And you know what? That gets back to nail it. Scale it. Because if you go out with an idea and you talk to 20 people and 19 say, I don't think that's such a great idea, then kill it. Or if they say, change it this way, take their advice.
[01:21:05] Speaker A: And if the one person who says, no, it's brilliant is your mother, then you probably should ask somebody.
Absolutely. Yes, it's brilliant. When all my husband's aunts and his mother all come back to me, the podcast is brilliant. Thank you.
But I think you're biased, which of course, I appreciate.
[01:21:25] Speaker B: You know, it's funny, Sadia, just to kind of get back to Mike, and I think you're so right. So many people don't know. And he hated to read.
But look how gifted and brilliant he is with it. And.
[01:21:43] Speaker A: He'S built into cars. He's built two cars in our garage.
[01:21:49] Speaker B: Yeah. And that was Joseph. He would take apart and put together different types of fax machines and printers, but yeah, he couldn't write or read or spell.
[01:22:02] Speaker A: Yeah.
I feel like now we're getting better at recognizing strengths in the less traditional way. But certainly when he was growing up and when I was growing up, it was what? Reading, writing and arithmetic. The big three.
[01:22:20] Speaker B: Yes. And if you couldn't read, you were held behind, and then you only failed further down the road because the reading only got harder.
But thank you. Thanks for asking about everything. That's been great.
[01:22:33] Speaker A: Thank you. This has been wonderful. Thank you so much for your time today. As you know, I could talk to you for days, and I'm sure at one point we're going to have you back because there's so much more to discuss. And I would love to get you on a panel with some other like minded people to give some advice and just talk about some best think. I think that would be absolutely wonderful. But for now, thank you so much for your time. It's been a pleasure having you.
[01:23:00] Speaker B: Thank you, sweetie. Thank you so much.
Happy holidays.
[01:23:04] Speaker A: Thanks. Happy holidays to you.
I'd like to thank Dr. Barbara Roscoe again for joining me today.
And happy holidays to everyone. I think this is going to be our last episode of 2023, but we have some outstanding guests lined up for next year. So everyone, please be safe. Celebrate however you want with whoever you want, and we'll see you next year. Thanks for listening.
