Less Is More. Unless We’re Talking About Physicians in Clinical Trials - Gary Hughes

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HANNAH: Hello, and welcome

to the Totally Clinical podcast, brought to you by Teckro.

Totally Clinical is a deep dive into the freshest trends, big-time challenges, and most excellent triumphs of clinical trials.

I'm Hannah, your host. Join me as I chat with industry experts, trailblazers, thought leaders, and most importantly, the people benefiting from clinical research.

So tune in, settle back, and don't touch that dial. It's time to get Totally Clinical.

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Now

this week, we have a very special guest. Six years ago, our CEO, Gary Hughes, founded Teckro along with two fellow co-founders to modernize the clinical trial process by making them safer, more efficient, and convenient. During this podcast, we discuss Gary's big vision for Teckro, why decentralized trials are not the panacea they're made out to be, and how a German industrial designer inspires Gary's philosophy when it comes to Teckro.

Welcome, Gary. In the introduction, I touched on the story behind how you founded Teckro. But it's always fascinating to know what drives people at a more visceral level. Could you explain more about this?

GARY HUGHES: Sure. I guess personally, I've always been attracted to solving big problems. And my journey or experience of working in clinical research, both in a previous company that I helped co-found and during my time working at global CRO, it became very obvious that there were very big problems to solve in clinical research.

I guess as we looked more and more into it, it really felt there was a need to almost start with a blank page. And that, in itself, was a very exciting prospect for me and the team. I guess also, just looking at the complexity of clinical research, one of the things that really struck us was not only just to start with that sort of blank page, and if you could design the perfect clinical trial, where would you start, and that type of idea and that type of thinking we brought to it, but also a need for real modernization and simplification in clinical research.

Really started to dig more and more into this. So much so that we really wanted to start with something that didn't even feel like another technology, or another system, or interface, or application that people had to learn to use.

Could we create something that had immediate and obvious value for every stakeholder? Something that people could intuitively start to use, didn't require training, but could it deliver real impact in day-to-day conduct of clinical research, but also overall in sort of the outcome of a trial?

HANNAH: And you wanted to create something really innovative with Teckro, didn't you?

GARY HUGHES: That was really key to us starting Teckro. I don't think any of us who founded the company were particularly interested in creating something that was 10% better, or 10% faster, or 10% cheaper than the status quo. We really wanted to come at this with a novel approach, really try and get deep understanding of the core problems in clinical trials, and, as I said, really bring that sense of modernization and simplification, but also real empathy with the end user--

create a platform and products that people wanted to use, and, as I said, deliver a real impact on the outcomes of clinical trials.

HANNAH: We've

seen a lot of discussion in the media, including in the mainstream publications like the New York Times about how decentralized trials are the way of the future. But there's another viewpoint, that maybe decentralized trials aren't the panacea they're being positioned as. What are your thoughts?

GARY HUGHES: It's a great question. And I think I might start off by saying while I'm not opposed to the idea of decentralized trials, in fact, anything that makes clinical research more patient centric is to be welcomed, I do think about it a little bit differently. Maybe to offer a contrarian view, while a lot of people get excited about the idea of direct-to-patient and these kinds of concepts, or remote-data-capture at the patient's home, or these type of ideas, I think the most important thing for us, or to offer that contrarian view, would be, what we need really in clinical research are more sites and more physicians who are participating in clinical research, not less.

We've always thought about it from that perspective. For many of us, the physician is a trusted advisor. And I think the big challenge we've seen in clinical trials has been not just a lack of patient participation in clinical research, but the lack of physician participation in clinical research. And in fact, it's worse in some cases because the statistics show that there are a large number of physicians, somewhere in the region of 50%, who participate in clinical trials, will never do a second clinical trial. And I think that gets to the core of some of the bigger problems that are out there and need to be solved.

I guess people forget about the time with a patient. It's quite short. Really, I think, a lot of the problems that have been generated in clinical trials, I think kind of come from that lack of real understanding or empathy with that limited time frame that physicians have to interact with a patient. And to try and work clinical research into that time frame as well is quite difficult.

HANNAH: And so what do you think the answer to the time issue is?

GARY HUGHES: When people talk about the need to go direct-to-patient, or it's too expensive to run trials in a particular way, or how do we reach more patients, as I said, our view has always been, the bigger challenge is there just aren't enough physicians globally who participate in clinical trials. And if we can make clinical trials work more at the site level--

enable physicians, and coordinators, and research staff at each of the hospitals to be more successful in the conduct of clinical trials--

you will encourage more people into research. You will encourage those doing trials to do more trials. By extension you will bring clinical trials and increase access to more patients around the world.

There is no reason why we can't have more physicians involved in clinical trials today. And I guess that's just something and we're very conscious of, that the need to go and do things that are more patient centric is great, but doing it for the right reason and not doing it because we just weren't able to overcome some of the challenges at the site level, seems to be not tackling the core problem. And that's very much where we're focused. It's just how do you increase that investigator pool globally, who participate in trials. How do you, as I said, enable them to be more successful in the day-to-day conduct of their trials. And in doing so, you're helping advance the pace of clinical research and increasing access to patients everywhere.

HANNAH: And the

urgent need for more physicians ties into your big vision for Teckro, doesn't it?

GARY HUGHES: I guess our vision has always been, very simply, how do you engage more physicians in clinical research? We think about it a couple of different ways. One, obviously, is how do you encourage more physicians to participate either as investigators or sub-investigators in clinical trials?

But also, and maybe this ties in a little bit with more patient-centric approaches to clinical research, I'm sure there are lots of physicians globally who could play some role in clinical research, whether it's supporting a major center by doing some of the procedures more locally to a patient, but also, I guess in another way, just the ability for every physician to easily be able to refer a patient into a clinical trial. And that seems to be a big challenge, as well, today.

Lots of physicians, I think the vast majority of physicians who have been surveyed on this would willingly refer patients into clinical trials. But it's just difficult and hard to get access to either protocol information or to know where these trials are being conducted to easily do it. So I think that's really been our guiding light. It's how do you engage every physician in clinical research?

The way I think of it is, it's a big challenge. But it's definitely a problem that can be solved, and something we're very conscious of in terms of how we approach our product, and our platform development, but also about how we think about where this could go next and some of the other things we need to start thinking about in terms of the wider health care ecosystem, as well.

HANNAH: You mentioned

before that you're very much about Teckro being about first principles, what matters on a fundamental level. You're inspired by German industrial designer Dieter Rams and his Ten Principles of Good Design. Could you explain more about this?

GARY HUGHES: It's an interesting challenge to bring things back to first principles. And when you do that, you really have to focus on what's really, really important, and to cut out any noise whatsoever. If you think about it in very simple terms about clinical trials, you've obviously got the drug company who are developing this drug, you've got the clinical trial protocol, you've got the physician at the site, the site staff, and you've got the patient.

And the challenge is how do you just keep it that simple. And it's very easy to throw lots of things, and processes, and solutions, and applications, and technologies at the problem, the way a clinical trial is conducted. It's very, very hard to take things away. And I think there's something in what Dieter Rams has said. He's been a huge influence on lots of designers around the world. And I think Jony Ive at Apple took a lot of those principles on board as well. And you can see that idea coming true in their products over the last 20 years or so.

But it really comes down to good design is really as little design as possible.

And it's not so much what we can add, but what can we really take away?

And I'm going to bring it back to the, maybe where we started--

just that idea of modernisation and simplification. I think if you go to any physician or nurse in the world, or even to anybody in pharma, I'm pretty sure the last thing they want is another technology.

You also see, every now and again, different sort of industry analysts will produce these kind of maps of the ecosystem, with all the different technologies and where they fit into in terms of the different stages of clinical trials. And it's quite overwhelming, really, when you look at the number of companies and the number of products that are competing for everybody's attention in the course of a clinical trial. And we definitely didn't want to do that.

We were very deliberate in terms of trying to adhere to those principles of what is good design. And not so much what could we add or what can we build on as another technology, but what could we really take away. And that process started with that sort of blank-page approach to designing the perfect clinical trial.

HANNAH: Really, with all of these companies, and Teckro as well, it's about putting the end users first, isn't it?

GARY HUGHES: We really only wanted to do things that were really important to the customer, to the sponsor company, obviously, but really to the site and to the patient, and really show empathy with those physicians and nurses who are challenged in those settings where they've got very, very little time to interact with patients and really need to be able to do things quickly without the burden of additional technology.

So it's been hugely important in how we think about each of the products we developed. It's never been a case of, here's another thing you add to the stack of technologies you're already using. I also think about it a little bit with the word "decentralized trials," and traditional or in-clinic-setting kind of trials. We shouldn't really be talking about technology that way. It shouldn't really matter where or how the data is captured in the clinical trial.

Really, we should have platforms that engage all stakeholders, enable all stakeholders, that it shouldn't really matter whether it's a phase 1 clinical trial being run in various hospitals around the world, or whether it's a decentralized trial, or it's got aspects of a decentralized trial where certain activities or processes or procedures are being conducted remotely. We shouldn't think of technology that way. And that kind of troubles me a little bit, that we have these differences in terms of the language that's emerging. It should just be a common platform, regardless of the clinical trial.

And I think what will be more exciting for the industry is if we were talking more about ways we could design better studies--

how we could enable things like adaptive trial design to become more mainstream and more the norm in clinical research--

really these ideas that can really accelerate the pace of clinical trials. So yeah. I think a lot of what we do really comes back to that type of design thinking. And we're very conscious about what we do, and just the danger of adding more steps to a process or burdening the end user in ways that might make sense to one stakeholder but could cause problems for somebody else.

HANNAH: And the industry

has been really slow to catch up with the modernization mindset when it comes to trials.

GARY HUGHES: When we think about modernization or simplification, it's kind of crazy when you think that to this day, people are still relying on paper protocols, or that the industry still is largely heavily reliant on services. And you see that in terms of what most of the CROs offer today, it's still largely a services business. There's something quite refreshing when people see Teckro for the first time and when they comment on it--

it's a no-brainer, and of course, why aren't all clinical trials like this.

That really encourages and validates the approach we've taken from day one. Keep it simple. Make it relevant to the end user. Show real empathy, but get out of the way. You don't want to be an obstacle or a hurdle to somebody doing an important task. You really want to enable and help them.

HANNAH: The pandemic

has really shifted sponsors' attitudes to technology. You've written about this before, that the genie is now well and truly out of the bottle, so to speak. This has had a huge impact on Teckro, in terms of sponsors adopting technology at speed. We've seen a lot of changes over the last year and a half.

Looking to the future, where do you see Teckro being in two years time?

GARY HUGHES: I wish I had a crystal ball.

I can tell you where I'd like us to be. I guess it's opened people's eyes up to the potential of technology. I don't think technology in itself is the solution. It's really how it's applied, how people use it in their everyday lives is more important than the technology itself. I think we would have got there anyway. I'm not sure we were overly reliant on the pandemic for that to happen.

I think we were making a lot of good progress with all our customers prior to that. But if anything, I think it's opened up the view over the next couple of years about what's possible and really looking to build on top of that digital platform. If I was thinking about where we're going to be in a couple of years, I think it would bring it back to our vision for the future. It's really, how do we engage more physicians in clinical research?

And for us as Teckro, we're already on hundreds of clinical trials.

And I really want us to get to a point where we're really supporting and enabling thousands of clinical trials.

And I really don't think we're that far away from getting to that. We've got some really great partners.

We're working with great customers. We're working with great sites around the world. And everybody's very engaged with what we're doing.

So I think it's definitely an opportunity for us. It's definitely where I think we can be. And it really comes back to us executing as a team. But also, I think, staying true to some of the things we talked about on this call--

modernization and simplification, engaging more and more physicians in clinical trials, getting technology to play a role, but not getting in the way of research sites. And I think all these things are important.

But that's really where we want to get to. And, I think, hard to know without having a crystal ball, but very confident in the team, the product, the platform, that we can definitely get there.

HANNAH: And that's your dose

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Thanks for listening. Goodbye.

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