Medical Entrepreneurship: A New Movement to Accelerate Cures

There is a new social entrepreneurial movement afoot, which seeks to find cures to some of the world's most challenging diseases. Medical entrepreneurship is, in my view, the very best hope we have for accelerating the pace of finding medical cures. A good example and arguably the pioneer of this movement is Michael Milken's Prostate Cancer Foundation. Milken has taken on a decidedly entrepreneurial approach to providing capital and human resources to accelerate the pace of research into cures for cancer, particularly that of the prostate. From 1999 to 2006 we have seen a 25% drop in the death rate for prostrate cancer. There is little doubt that Milken's leadership has been one of the greatest catalysts in this improvement.

Another leader in the movement is Henry McCance, who co-founded the not-for-profit Cure Alzheimer's Fund, which I first wrote about last year. The Cure Alzheimer's Fund is another example of a cure accelerator, an organization using a venture approach towards medical research. Out of full disclosure, I recently joined the Cure Alzheimer's Fund's advisory board. And while I care deeply about diseases such as Alzheimer's, I am mostly fascinated and hopeful that a more maverick VC-like business model applied to the search for medical cures will be a better approach to solving some of the big medical challenges we have.

The medical research model as we know it today is broken. Why? Three words: insufficient, inefficient, and ineffective. This is both the big problem and the big opportunity for medical entrepreneurship. Today's model is insufficient because typically 1% or less of the amount spent each year on diseases goes towards cure research, with the balance going to caring for people with the disease. Alzheimer's, for example, costs our country hundreds of millions of dollars each year, yet we spend just one cent out of every $4.00 available towards a cure. That is an astonishing 400x delta. The story is similar for diabetes and cystic fibrosis. While care is obviously critical, we need more dollars to go to finding the cure — or the country is at great risk of a healthcare-induced bankruptcy. Henry McCance and Professor Bill Sahlman of Harvard Business School recently gave an excellent overview of this at Venture Summit East and I draw on many elements of their talk in this blog post. 

The current research model is highly inefficient because researchers spend too much time writing grants. By our estimates at the Cure Alzheimer's Fund, the very best researchers in the field spend up to 30% of their time writing grants, and should they win the grant they may have to wait months or even a year to get the funding. As well-intended and needed are organizations such as NIH (National Institute of Health), there is an embedded trade-off between the robustness of review and the approval of grants to new and innovative projects. Imagine any venture capitalist going to Netscape or Yahoo to validate funding to Google or expecting an entrepreneur to spend a third of his time writing a business plan and then waiting a year for funding. This is the frustration that many of the best researchers in our country feel.

Finally, the medical research model is ineffective because it is, by design, risk averse with regard to the projects it pursues. Grant proposals that win funding are usually those that seek out small, incremental discoveries — it is the very nature and policy of the grant making bodies to look for ideas that slowly build on existing knowledge. Breakout ideas are not able to happen under an incrementalist research model. Even worse, as we've heard anecdotally from some researchers, some people write grants for questions whose answers are already known.

Pioneers of the medical entrepreneurship movement are taking bigger risks on researchers, asking them to focus their energies on the initiatives that have the largest potential impact as opposed to those that would get traditional grant funding. They are also doing so faster. Milken's Prostate Cancer Foundation, for example, makes awards based on applications that are limited to five pages and has a 90-day turn-around time. FasterCures has become a think tank and resource-sharing center for this new approach.

Focus on the big ideas that can lead to the big goal of curing a disease, eliminate bureaucracy, and give smart people more capital, faster, and you have a formula for change. What proof exists that the change is positive? Thousands of lives have been saved by the advances in prostate cancer understanding by medical innovators in that field. The Cure Alzheimer's Fund was recognized last year by Time Magazine for one of the top ten medical breakthroughs of the year for work that identified over 100 genes associated with the disease. A number of other dynamic organizations, including the Harvard Stem Cell Initiative and the Myelin Foundation are making significant contributions to cures.

Across multiple diseases, researchers have been conditioned to make progress with bond-like returns. While some of this is necessary, it cannot be sufficient. As in any portfolio, we cannot maximize returns if we hold all our eggs in one big conservative basket. We need to invest more behind higher risk initiatives that can yield equity-like returns, and hopefully real cures.

Anthony Tjan is CEO, Managing Partner and Founder of the venture capital firm Cue Balland vice chairman of the advisory firm Parthenon.

Rumah pertama

      Jarak rumah yang kutempati sewaktu bekerja di Puskesmas dulu dengan Puskesmas tempatku bekerja, kira-kira 25 km. Jarak tersebut ditempuh dengan kendaraan bermotor kira-kira dalam waktu 45 menit. Jadi, setiap hari waktuku habis di jalanan kira-kira 1,5jam. Hhufff..cukup melelahkan juga..Terpikir olehku untuk pindah rumah sekaligus memiliki rumah sendiri. Aku tidak mau mencari kontrakan, karena menurutku, uang bayar kontrakan rumah, lebih baik dipakai untuk menyicil sebuah rumah. Maka jadilah aku berburu perumahan terdekat dari tempat kerja. 

       Setelah berkeliling mencari rumah, kutemukan perumahan yang paling dekat dengan Puskesmas tempatku kerja. Perumahan tersebut kira-kira 15 menit perjalanan.  Tidak besar sih..Type yang ditawarkan adalah type 36, 45, dan 60 m2. Aku tanya ke pengembangnya ternyata semua unit sudah laku terjual. pengembang menyarankan menunggu tahap berikutnya. Ya sudah..akupun pulang aja.Sampai di rumah, aku di telpon dari pengembang kalo ada konsumen yang batal. Wah..kalo sudah rejeki memang nggak kemana. 

        Akhirnya jadi deh punya rumah sendiri walaupun kecil dan bayar pake KPR. Rumah itu type 45/105 harganya tahun 1995 cuma 12 juta. Type 45 terdiri dari 2 kamar tidur, 1 kamar mandi, 1 ruang tamu dan 1 ruang keluarga. Di samping, belakang masih tersisa tanah di belakang buat jemuran, di samping buat parkir motor. Yah..cukuplah untuk hidup bujangan. Rumahku dijual lima tahun kemudian laku 100 juta...wuaahh..aku sendiri sampai kaget juga, rumahku laku 100juta.

Menolong persalinan

          Setelah selesai pendidikan dokter tahun 1995, aku bertugas di Puskesmas Ngemplak 1 Sleman sebagai dokter ke-3. Di situ ada dokter kepala perempuan,1 dokter umum dan 1 dokter gigi. Wah..banyak juga ya dokternya. Maklumlah, di Puskesmas tersebut melayani rawat inap dan persalinan. Jaman saya dulu belum ada yang namanya internship alias magang setahun setelah lulus menjadi dokter. Yang ada waktu itu adalah peraturan PTT atau pegawai tidak tetap selama 3 tahun, dan mendapatkan gaji berdasarkan lokasi PTT. Puskesmas tempat PTT ku termasuk kriteria biasa, dengan honor 500 ribu/bulan. Lumayanlah honor sebesar itu pada tahun 1995, karena untuk bayar cicilan rumah saja masih 140 ribu/bulan.
          Bekerja di puskesmas rawat inap ternyata menyenangkan juga. Kebetulan juga puskesmas tersebut termasuk Puskesmas percontohan sekabupaten Sleman. seringnya maju lomba, entah lomba paramedis, lomba desa teladan, lomba kepala desa teladan, sampai lomba dokter Puskesmas teladan. Meskipun banyak kegiatan, tetapi rasanya santai aja. Pagi hari apel pagi, maksudnya adalah petemuan pagi membahas kegiatan hari itu dan laporan pasien rawat inap atau permasalahan yang ada. Selesai apel pagi, acara bebas hehe...Beabas sesuai jadwal sih..biasanya ke poloklinik meriksa pasien yang datang. Kalo tidak jadwalnya, maka tugasnya jaga di rawat inap, dengan pasien yang selalu full book.
          Melayani pasien pertama kali kayak belajar naik sepeda. Walaupun sudah lulus dokter, namun rasanya grogi juga nih..Beruntung paramedis di situ sudah senior semua. Mereka malah mengajari cara menghadapi pasien dengan penuh keramahtamahan hihi..Ada pasien yang hampir tiap hari periksa ke poliklinik. Seorang perempuan remaja. Entah keluhan pusing, pegel-pegel, wuah..nggak sembuh-sembuh deh pokoknya. Tapi anehnya, pasien tersebut malah seperti enjoy aja periksa. Kata perawatnya sih, mungkin pingin ketemu dokternya yang masih bujang dan ganteng hehe..maklumlah, baru kali itu ada dokter laki-laki (hehe..GR dikit lah..).
          Tantangan lain bekerja di puskesmas Ngemplak adalah menolong pasien melahirkan. Walaupun bidan di situ sudah senior dan mahir, tapi mereka tetap menghormati dokternya (padahal dokternya juga baru lulus). Para bidan jaga akan selalu meminta tolong pada dokter yang jaga bila ada pasien mau melahirkan. saat itu masih jam 9 pagi, aku bertugas di rawat inap. Ada pasien in partu sudah bukaan 9. wah..sebentar lagi mau melahirkan nih..Bener saja, selang 10 menit pasien sudah mengerang kesakitan. Aku periksa (dengan sedikit grogi, karena baru pertama itu aku menolong persalinan setelah bener-bener jadi dokter) pembukaannya sudah lengkap. Segera saja bidan kupanggil untuk mendampingiku menolong persalinan. Dengan semangat dan profesional yang tinggi, akhirnya bayi lahir dengan selamat, dan ibunya bisa tersenyum puas. Dokternya juga tersenyum puas juga karena persalinan perdana. Hehe..begini to rasanya jadi dokter..