Hello and welcome to Shortbree Things on Long-term Thinking. Thanks for joining us. I'm Mark and Bortwick, Managing Editor at Bayley Gifford. These are exciting times for cardiac medicine. Technology is transforming the treatment, diagnosis and prevention of heart attacks, strokes and other blood circulation problems. It's just as well because the challenge is huge. These are the leading colours of our age, but the time you finish listening to this podcast about eight people in the UK will have died of these ailments. That's a rate of one person every three minutes.
To discuss why the figure is set to fall and some of the firms making that possible, I'm joined by Rose Rien, an investment manager in the Health Innovation Fund. Before we start the conversation, some important information. Please remember that as with all investments, your capsules at risk and your income is not guaranteed.
Rose, great to have you with us on Shortbree Things on Long-term Thinking. Thanks for joining us. Thank you, Mark, and for having me and thank you everyone who is tuning into this podcast.
Let's start with why cardiovascular diseases are so hard to cure. Heart disease is a very common disease, as you mentioned, is the number one killer globally, but it's also a very complex disease. Heart disease is an umbrella term that includes many different conditions that affect the heart and the blood vessels.
The most common condition is a build-up of plarks and fatty deposits inside of the arteries and the blood vessels, and this will restrict blood flow and can lead to heart attack, strokes, organ failures and so on. Unlike many other diseases, like rare diseases that are caused by single gene mutations, heart diseases have been very difficult to cure and eradicate because of the complexity of its biology. It is the result of the interaction of many genes in our body and on so many other environmental factors like lifestyle, diet, smoking, habits and so on.
How the disease manifests itself and how it progresses differs vastly from one person to another. That's why it has been very difficult to treat with the types of medicines that we have today, which are mostly generic medicines that are one size fits all and they don't take into a cow the differences between the individuals. If medicines don't work, then the other option that we have is surgeries, but surgeries have been typically very invasive and risky up until recent years. So that is the scale of the challenge that we face, but I believe that with the pace of innovation that we are seeing in the field, there are reasons to be optimistic about the future.
And tell me why you're optimistic about the future. So the reasons why I'm optimistic about the future is because there is this great convergence happening among many different fields of sciences and technologies and they are all coming together to transform life sciences and potentially transform how we diagnose, treat and prevent heart diseases in the future.
Over the past five to ten years, we have seen massive advances in some areas of technologies like gene sequencing, material sciences, biomedical engineering, imaging and so on. Maybe just take gene sequencing as an example. The first human genome cost three billion dollars and thirteen years to complete back in 2000. But now we can routinely sequence the whole human genome for under 700 dollars and under an hour.
And that massive decline in cost and time over the years have been made possible due to advances in chemistry, optics, software, data analytics and so on. And I think gene sequencing is probably the one technology that has really revolutionized life sciences. Thanks to gene sequencing now, we understand much more about the biology of heart diseases, the genes that are involved in contributing to higher likelihood of getting heart attacks in humans. And such insight can help us develop much more precise medicines to cater for the individuals.
To give you an example of some of the insight that we have derived from genetics. So scientists have performed many population genome studies over the years and they have discovered many risk genes that contribute to higher risk of getting heart diseases. One of them is called PCSK9. This is a gene that regulates the amount of cholesterol in the bloodstream.
But some individuals who are unlucky to inherit two copies of mutated PCSK9 gene can develop heart attacks in their childhood. And if you inherit one copy of this mutated gene, you can develop heart attacks in your 40s or 50s. So these are incredible insight, really important knowledge that has just been unraveled recently. Thanks to new tools like gene sequencing.
So let's explore the three broad areas of progress in more detail, treatment, diagnosis and prevention. Where would you like to start? Let's start with diagnosis, because I actually think this is one of the biggest challenges that we face in our battle against heart diseases.
The challenge here is that heart disease is very difficult to diagnose. It is often mistaken as size of old age, you know, with symptoms like shot a breath, fatigue, chest pain and so on. And so it's often even ignored by the patients themselves. And then the second part is even when you go to get your health checkup, the current methods for diagnosing heart diseases is not very accurate at all.
One of the most common tasks at the moment to diagnose heart disease is stress tests. So you basically put a patient on a treadmill to make them do some exercises. And then you can see how their heart performs under stress and see if there is any area of the heart that is deprived of blood. But stress test is highly inaccurate. About 20 to 30 percent of patients who are sent home actually have undetected heart disease heart problems.
So there's a very innovative US company aiming to transform this paradigm of diagnosis by using a combination of advanced imaging and AI algorithms. It uses CT scans which capture the image of a patient's heart. And then it uses AI to reconstruct a 3D computer model of the heart and calculate exactly the blood volume that flows through each artery. So this helps the doctors diagnose patients much more accurately. And they can also pinpoint exactly which artery has some blockage within the heart. And this technology has already been approved in many countries including the UK and the US. It has been studied in more than 10,000 people. So very hopeful that technologies like this can potentially transform the way we diagnose heart diseases and live no one behind.
It's fascinating and it's a common theme in short briefings actually about how companies are using AI to crunch data and make progress. Another company that we're very excited about at Billy Gifford is Shockwave Medical. And we spoke to the company's CEO to ask him what problem his company is trying to solve.
这是一个很有趣的话题,常常在简短的介绍中涉及到,就是企业使用人工智能来分析数据并取得进展。 Billy Gifford非常兴奋的另一家公司是Shockwave Medical。我们与该公司的首席执行官交谈,询问他的公司试图解决什么问题。
Hi, this is Doug Gouchel, CEO of Shockwave Medical. At Shockwave we're in the business of improving outcomes in patients suffering from severe cardiovascular calcification. And at Shockwave we introduced this revolutionary new technology that delivers shock waves, little sound waves in a catheter just next to the arteries inside the artery actually. Those sound waves crack the calcium and once the calcium is cracked the vessel opens up very benignly, that trauma and blood flows restored to the heart muscle or to the legs or the feet or wherever the blood is flowing to.
And Shockwave has a fascinating backstory, doesn't it Rose? Yes, it has a very unique, but also a very humble beginning actually. So the story was that the company was founded in 2009 by three co-founders, one engineer, one business man and one physician. And they had this crazy idea which was disregarded by many people at the time which was to use little tripsy which is the technology that is used to break kidney stones.
And the idea was to use little tripsy but somehow modify it so that it can break calcium inside the blood arteries and the blood vessels. Now if you have ever seen the machine that breaks kidney stones you will probably understand why many people laughed at this idea in the past because the machine is huge, it's very bulky. And so their challenge was to figure out a way to make this machine somehow fit into a catheter that can go inside our artery and then break the calcium inside the artery wall. But they managed to achieve just that.
But without any funding in the beginning they had to produce their prototype machines inside the garage and do you know how they prove the technology with the proof of concept? They collected egg shells from their own chicken farms and they used the technology and they could show that it broke the outer shell of the egg without damaging the membranes inside the heart shell. That is their proof of concept and the rest is history. Yeah I'd love to tell you stories about them buying ultrasound equipment on eBay and various other things as well.
Fascinating. And you've been seeing them as well in California.
有趣啊。你也在加利福尼亚看到了它们。
Yes I went to visit their headquarters in 2019 in San Francisco and I had a great meeting with the CEO of Duc Gosho. He also demonstrated the technology to me and I was very impressed by how simple it is to use and yet how effective it is. I also talked to many physicians and cardiologists in the field as part of our due diligence work and their feedback was overwhelmingly positive. They have never seen a technology like this.
It's very rare in medical technology to have this combination of novelty, safety, effectiveness and ease of use. Usually it takes a long time to train doctors on a new medical technology but with shockwaves approach it takes less than one patient for them to get very familiar and up to date with the technology. So yeah we invested in the company in 2019 after visiting them and after my route of work. So let's go back to Doug for the last word on shockwave.
We also asked him what would the world look like if his company was successful. We would envision that all the patients who have the calcification which is a growing problem would have access to our therapy. They would not have to go to surgery. Patients who have calcified valves in the heart could be treated with our lithotrypsy system and they wouldn't have to have their valve replaced or wouldn't have to have their valve replaced as quickly. So better outcomes, lower costs, fewer implants required for the patients suffering from these diseases and that should all accrue to the benefit of both patient but also the healthcare system by reducing complications, reducing complexity. It conjures up images of what the Nobel Prize winning physicist Richard Feynman talked about in the late 50s in terms of swallowing the surgeon.
So companies like shockwave, they still require some degrees of invasiveness to put external catheters into the body. But the future could be surgeries that are totally non-invasive. The idea may sound science fiction but there are actually research teams already working on that concept of developing nano robots that can march through our bloodstream and break up calcium inside our blood arteries guided by MRI imaging. So you could imagine, you know, one day in the future you could actually swallow these nano particles, these nano robots that can basically do the surgeries inside of our body for us.
So we talked about treatment and diagnosis. Let's move on to the third part which is prevention. Tell me about a company that you're excited about in this area, Rose.
So with prevention, we all know that lifestyles and diet are one of the most effective way to reduce your risk of getting heart disease and heart attacks. So leading a healthy lifestyle is the number one defense against heart diseases. And there are companies like Beyond Meat and Peloton and so on that are encouraging people to do that in a more effective way. However, for the individuals who are unlucky to inherit some serious risk genes, lifestyles alone may not be enough. So we might need some medical intervention to prevent heart attacks in those individuals.
And there is a really interesting company called WERF Therapeutics. In the US, it is developing gene editing treatments to edit out the very serious risk genes like PCSK9 that I mentioned earlier to lower the chance of heart attacks in humans. This approach is revolutionary and this is the first time that gene editing treatment is being tested in humans. And the data that the company has shown in non-human primates is very impressive. They are able to show that after taking out the PCSK9 gene, the non-human primates are perfectly healthy and the level of bad cholesterol in their bloodstream has been reduced by more than 70%. And the impact of that is persistent for up to two years now. So I am very impressed by such results and hopefully those results will translate into humans as well.
Another any ethical considerations with gene editing? This is a question that is asked by a lot of people and specifically in this case where you permanently turn off a gene in the human body, it's fair that some people may feel uncomfortable about that. However, again through human genome studies, we actually have discovered that there are many people around the world who are born without the PCSK9 gene and they are perfectly healthy and they actually have much lower chance of heart attacks compared to the average population. There are already drugs approved on the market that also targets the same gene. So as far as we know with all of the data that we have, editing out this gene seems to be perfectly safe for humans.
Now you may ask why does nature give us a gene that does not serve any purpose? And I asked this question to the management team of Verve Therapeutics actually and they said that one hypothesis that the scientists have is that this gene might have played some roles in the past in the very early days of human evolution when food resource was scarce so it might have played a role during periods of starvation. But now we have the exact opposite problem of excess food and not enough energy bone. So it could be that this gene, even if we allow nature to take its cause, this gene might be edited out by nature after many years. So what Verve is doing is basically speed up the natural cause of evolution in a way.
And what companies are you researching right now? So I just finished a report on a company called Star Searcher Co. It's also really cool. So instead of laser eye surgery for people with short sightedness problems, it develops these lens that you can insert on top of your natural lens in the eye and it will correct for, you know, short sightedness, fast sightedness and so on. And compared to laser eye surgery, this has much better outcomes especially for people who have very serious short sightedness problems like above minus six. It also has fewer sight effects and no dry eye syndrome and things like that. I didn't know about this company until very recently.
But when I was chatting with my parents, my family back in Vietnam and they were saying, oh, your brother is considering an eye treatment because he has quite bad eyesight, like minus nine. And so I was asking them, oh, is he doing laser surgery? And my parents were like, no, no, no, no. Like nowadays there's a much more innovative, much better treatment and it turns out to be the one offered by Star. And so I thought, okay, if my parents know about this, before me, it's probably quite a strong signal that this is reaching some sort of critical tipping point in terms of his adoption curve. So yeah, I did the research and I got quite excited about about it.
Is your brother in Vietnam? Yeah, he's in Vietnam. And he knows about it because his colleague got the treatment. So he sort of now he's got to a point where what the mouth sort of becomes them, you know, a way to educate people.
Yeah. So tell me a little about your own journey, Rose, because you're clearly enthusiastic about the topic. How did you become interested in health innovation? So I joined Billi Gafford as part of the training program for graduates. And so I've been rotating through several teams before coming to health innovation. But even when I was in my previous teams, I have always been drawn to healthcare companies. And I think part of the reasons might be because I was brought up in a family with two parents who are a pharmacist. So our dinner conversations always touch on health topics and medicines and so on. So it is something that is very close to my heart. But I would say that sort of the critical moment that makes me decide to join health innovation was when I did a research project in my previous team looking into the history and the future of medicines. And through this research project, I realized the pace of innovation in healthcare and life sciences is accelerating at a very rapid rate. And things that seemed like science fiction ideas a couple of years ago are now turning into reality.
So as an investor, I think there is no better hunting ground for great investment ideas than healthcare. So that's why I decided to join health innovation. And that's a great way to end the podcast Rose. Thanks so much for joining us on short briefings on long term thinking. Thank you Malcolm. And thanks to you the listeners for investing your time in short briefings on long term thinking. You can find our podcast at BayleyGifford.com forward slash podcasts or subscribe at Apple Podcasts Spotify or on Juneon. And if you enjoyed the conversation, you can check out previous discussions we've had on the podcast, such as why private companies matter more to exploring the innovative Scandinavian country that does an earth global giants such as Ericsson Spotify and Ikea. What's its secret? Find out by listening to the podcast and there are 27 other episodes so planted to choose from. And if you're listening at home, you're listening in the car wherever you're listening, stay well. We're going to bring you more insights in our next podcast.