End of Medicine Excerpt: Breakfast at Bucks

This excerpt of The End of Medicine originally ran on GigaOm.

I never turn down a chance for breakfast at Bucks in Woodside. Any place with a motto of ‘Flapjacks and Tomfoolery’ gets my devotion. It’s a daily ritual for venture capitalists - the khaki patrol is out early, snagging the tables and booths with the best views of the room so they can spy who is talking to whom and have something to talk about with their venture partners over lunch.

I come here every so often, but it seems that the same folks – hey, there’s Steve Jurvetson doing another nanotech deal – are here every time I come, almost no exceptions. Over the years, I’ve gotten to know Jamis, the owner, proprietor, and self described Pancake Guy, and he made sure I had a table with a view of the viewers.

“Hey, sorry to be late. Don Listwin,” he said as we shook hands and he slipped into the booth. I could almost hear the gears sputtering and subtle whispers, ‘Hmm, hedge fund guy and networking exec - avert gaze - wireless, maybe, how ‘90’s, nothing of note here. Better to check out that other table with blog index guy and venture stud dripping yolk on each other.’

“No problem.” I said coming out of my Bucks hallucination/paranoia. “You’re a tech guy?” Don asked. “Yeah, double E, worked on Wall Street for a bit too long.” “I’m an electrical engineer too,” he told me. “I figured that. How’d you get into funding medical research?” “I’ve had a lot of cancer in my life,” he sighed. “My dad survived colon cancer. My mom died from ovarian cancer.” “I’m sorry.” “I don’t know how much you know.”

“Not that much,” I admitted. “Ovarian cancer is known as the silent killer. It’s asymptomatic. Most doctors diagnose a bladder infection and prescribe antibiotics. It spreads fast. You can’t even see it on scanners - it’s soft tissue on soft tissue, kind of blends in. I figured there had to be some way to detect it early.

“Anyway, I left Cisco in 2000, had to sell the options at, well, you remember what it was like then. But I set up a foundation and figured I could take an active role.”

“But how? Isn’t most research segmented into silos, islands, funnels, whatever?”

“Look, you’ve been in Silicon Valley for a while, right? Stuff happens, technology spreads, people share information, you motivate people and they break down old ways of doing things.”

“Sure.” And how. “Not much of that in medicine. The FDA is like the FCC, big pharma like the Regional Bells.” “I get it.” I said. His Cisco was showing.

Our food came. I had ordered the breakfast burrito, which is a grueling way to start the day. Don passed the food order test, eggs and bacon, excellent, a true believer!

“We’re just missing entrepreneurs and open standards to get things going. I started Canary Fund to see if I could create an open platform for early detection. I work with Stanford and USF and the Hutch. It’s just not there yet.”

“Tell me about this Canary Fund. It’s a venture fund? And what is the Hutch?”

“No, no. Let’s see if I can explain. In the fall of 2003, I gave $10 million through a family trust to the Fred Hutchinson Cancer Research Center up in Seattle, to focus on early detection. I also joined the board to make sure it happened. They’re the largest U.S. funded cancer center, something like $300 million.” “Fred?” I asked.

“Fred Hutchinson was a baseball player who died young and his brother was a doctor that helped set the place up in his name.”

“I had no idea.” I said. “They’re not as famous as M.D. Anderson or Sloan Kettering, but they do some important stuff. It’s just that none of these places spend much on early detection.”

“Why not?” “Lot’s of reason – politics, too hard, not glamorous, who knows.” “OK.” I said. “The key are these biomarkers. You know what they are?” I shook my head no.

“Something that you can identify in your blood or urine that points to some type of cancer being present. Over simplifying, each tumor will express a unique protein, and if you can test for that protein, you may have a biomarker.”

“Sounds straightforward.”

“Not even close. There even is a biomarker for ovarian cancer called CA-125. It’s 80% effective meaning 20% false negatives. Let me say that again – it means that 20% of women who actually have ovarian cancer are told they don’t with CA-125.”

“Isn’t that the same as PSA for prostate?” I remembered the 80% number.

“Yeah, pretty much. None of them are all that good. That’s why I am funding this work – to not only find biomarkers but to create a platform so that others can more easily identify new biomarkers. Then medicine gets turned completely around.”

“Look, to get biomarkers to be real, you have to have both specificity and sensitivity. Picking up just on one protein and not missing it. But there are millions of proteins - we probably know about 5000 of them. I’m funding a bioinformatics platform to hold all this protein info. It’s amazing no one has done this yet. I’ve got a bunch of ex-Microsofters writing code.”

“So it’s an engineering problem?” I asked.

“You are probably used to thinking of eight inch wafers and billion fabs cranking out microprocessors. Forget all that. Think mass spectrometers, one protein at a time, often a protein whose quantity is eight orders of magnitude lower then other stuff in your blood. It’s not easy at all. It’s a couple of gigabytes of data out of the mass spec for each one.”

“There is talk of getting it down to a chip – that’s when it gets interesting.”

Don Listwin paused and quietly looked around the room at the venture capitalists who were still stealing glances at our table, trying to read lips, perhaps.

A chip? What did he mean? Was there some chip that could do this stuff? Or just a piece of glass like the DNA stuff? I was about to ask when Don got sat up and collected his cell phone and got ready to go. “If I do this right, it then becomes investable. These venture guys can’t see a return right now. I have to create something so that a huge return will be obvious, then the capital will come. They’ll do it - you know how it works. But I figure someone like me has to create the platform. Once you show it works, early detection will be a huge business. After that, money won’t be a problem. These guys will come out of the woodwork.”

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