Ankur Gupta: The Higher Cause of Medical Research

Alan Can you give us background of, you know, education, history, things that you've been doing in your life? Ankur So I was born raised in Texas, but made my way over to the farm maybe 2004 when I started undergrad at Stanford, I think up until that point I was pretty dead sure I was going to be a physician, and actually still am but in doing so did a lot of research projects and other exploratory things that let me dabble in a lot of different ways to make an impact really, and I think that's the one thing I drank the kool aid on and Stanford was to figure out like, what is the biggest way I can make an impact in my lifetime. So among those activities included, sort of going into biotech, so I've had some stints at Genentech, which is here in the in the bay, thought about getting a PhD, decided against it ended up with just a Master's unfortunately at Stanford, to my parents dismay, but that was in a field called stem cells and regenerative medicine. And so that was basically trying to figure out how to regrow various body parts using stem cells. And to me that coincided, or for me that coincided with this burgeoning interest in the eye. Going from industry where even flirted with the idea of venture capital briefly, but instead pivoting into medical school and the medical profession, got really excited about the eyes and eye surgery. Part of that was just due to personal and family health issues specifically isolated and part of that was Looking at the eye as a platform to make a really, really big impact for people who are in tremendous need. So when when you feel like you're about to lose your eyesight, it's, at that point, very apparent and visible to what you're about to lose. And so I figured that that'd be a great way for me to make my mark. Alan So you said you went to Stanford, but there's there's been other schools of education- Stanford probably stands out is the probably some of the most prestigious. Did you go to another school for medicine? Ankur Yes, I actually went home to Dallas, Texas, called UT Southwestern for medical school. And while I was there, I even took a further sort of fellowship gap here where I went to the National Eye Institute in Washington, DC, following that had spent time in my residency training at the University of Chicago and Washington University in St. Louis. So I did zigzag across the country a bit before coming back here to the Bay Area, where I am now. Alan So where do you see things in the vision field going into development as a whole? Ankur For ophthalmology, or maybe even more broadly for eye care I'm privileged to see based on the ecosystems I'm a part of here in the Bay Area, many of which are either startup focused or Health IT focused. A lot more data about what's going on with your body and in my field, particularly what's going on with your eye. There's a lot of either widgets that you can apply to your own phone to sort of see and track like is your eye prescription getting better or worse, but also, there's a lot more connectivity with the broader healthcare infrastructure. So with your mobile phone, you can see your electronic medical record and understand what's going on with your eye health. And so I think that's, that's one trend that I've been particularly interested in. But generally speaking for the field and just an eye health. There are some incremental improvements in terms of how we treat various diseases like glaucoma or diabetes or cataracts. But those will continue, I think at an incremental pace. I think that type of input. Innovation is generally bottlenecked by the various regulatory infrastructure that's already in place, FDA and otherwise. But in terms of using digital platforms to improve our ability to understand our own health, I see that as potentially a pretty big inflection point as more and more people get comfortable with, for example, putting a cheek swab in the mail and a company has your whole DNA. I think similar things like that will apply an IQ and other aspects of healthcare so that you'll just have a better understanding of what's going on about your eyes in this case. Alan Well come back and visit here today with Ankur Gupta. And we've been talking about the the developments in the AI industry ophthalmology and you studied to be a doctor but you ended up being a researcher. Is being a doctor on hold or where are we at now? Ankur It is on hold. Although you're once you're a doctor, you're always a doctor. So thankfully, I can make my Indian parents proud. That statement. That being said, for me, as I was doing the math, anyone, eye surgeon can probably do upwards of 15,000 to 20,000 surgeries in their lifetime or in their career, and I was witnessing a lot of opportunities having again gone to school at state difference, looking at ways to make higher leverage career moves, ways to make an impact on many more several fold more people than what one cataract surgeon could do in their career. And so for me, when we found this problem of diabetes, and specifically diabetic blindness or diabetic retinopathy, that's something that 30 million people are afflicted with. And to me, that's, and that's just in the US to be able to make an even a difference in 1% of those people's lives and preventing them from going blind would be, to me much more gratifying impact because a lot of people have this disease of diabetes but don't know that it could potentially blind them and so for me, it wasn't just totally should I put my medical career on hold? It was a greater calling, that there, there are a lot more people in need than just the 10,000 people that need cataract surgery for me. Alan What causes the blindness from the diabetes? Ankur With it without, I think getting too technical. Generally we know diabetes to be something that has high sugar in our blood. And that affects various organs in various ways. You may be familiar that it affects to your kidneys, it can affect your nerves and your feet. In the same way, it actually affects the blood vessels in your eye. And when your any organ doesn't have blood, it starts to get damaged or rot or die in various ways. And that's actually what's happening in the back of your eye, which is also fed by very, very small blood vessels. And so for the sugar to be high there can cause these complications and it silently takes your vision from you. It's not something people know to expect or if they do, they're in the minority of people who actually are able to go see an eye doctor an eye specialist once a year, which is the recommendation, the vast majority of people don't have access to that or can't take a full day off work, or are even situationally aware that this is something that requires annual attention. So that's something that I viewed as a very large unmet problem that we could potentially address. Alan Is diabetes as a whole? Is it more concentrated in this country due to diet than other third world countries? Or is it pretty much across the world? Ankur I think at this point, based on the epidemiological studies that I've seen, it's pretty categorically affecting the whole planet. I think initially, if you watch enough netflix documentaries, it's something that was largely stemming from the Western diet or processed foods. And as that becomes more and more pervasive, the diabetic epidemic would generally follow suit. But that's not a Exactly what I went to school for. So I can tell you with authority there, but certainly seems to be the case that wherever the western diet becomes more prevalent diabetes follows. Alan The problem is pretty clear, yet 30 million people are losing their eyesight due to diabetes. And do you feel that the medical industry is on the cusp of bringing some type of solution to turn that around? Ankur So, yes and no, in that we have really expensive medicines that we would otherwise inject into your eyeball to prevent that blindness from happening as eye surgeons, but not a lot of people have the wherewithal to afford that or the access to an eye doctor to have that done. And so that's sort of like a band aid is kind of after the fact what we're trying to do is identify these people before that blindness even happens and kind of keep them stable at 2020 vision. And so there are medicines to treat it but it's a that's a very it's a very expensive route. It's much more cost effective for a health care system who we were targeting. To address this before becomes a problem. Alan When you're, when you went through your medical training, and then later on to the Oh, by the way, I want to I wanted to do a footnote here. There's something really neat, huge over in India, in the industry and medical industry and what was that? Ankur Sure, yeah. So when I was in college, at Stanford, the emergency department was working on a way to take what we consider sort of routine standard care, which is when we dial 911 a paramedic shows up. In India there was no such concept or infrastructure. At best they if you were to dial the equivalent phone number in India, a 2000 pound steel box with wheels would show up but the personnel there only knew how to put you in a stretcher and bring you back. And so being a part of the design of an educational curriculum in a country without any notion of paramedic care or prehospital care, and train them on becoming proficient in some of the basic maneuvers on how to save your life, if you had lost a limb or had a heart attack or a car accident or something like that... It was something that I was privy to and part of and so designing curricula for healthcare workers abroad in order for them to then further teach that curriculum to others. It was more of a teach the teachers model so that now over 100,000, paramedics have been trained with our curriculum. countless numbers of lives I would assume have been saved in the field meaning in, you know, in the middle of traffic or in middle people's homes, places where previously at best again, a stretcher would come and you would cross your fingers and hope that you still were alive by the time you got to the hospital. In this case, we can actually do a lot that life saving intervention on route. Alan Wow, excellent. So you're, you're truly a pioneer in that country, although you're your silent pioneer because you you get the credibility in the voice that it deserves for all the lives that you've saved. So with that process, but let me switch back into guy Thank you. You know, and I think you're doing so many neat things here with with science and the research and development I you know, there's a lot of people are I surgeons, but few people actually going to identifying the problem and preventative medicine or how do we, how do we turn this around so you know, when you're looking at the The condition of the world today of looking at the problem, what do you see as a solution to? How would you go about solving the problem of diabetes or, or in a way, you know, looking at five to 10 years down the road, what we should do to be in a better place? Ankur I think it's a good question. I think the lens that I use to evaluate what problems are worth solving is actually something I learned at a program called bio design. It's also a Stanford based program. And we're taught there how to actually rank and compare various opportunities for inefficiencies or problems in healthcare broadly, and those that are among the top trying to understand what the parameters of a potential solution could be before actually coming up with the solution itself. And so that was a curriculum that very inspired by Dr. Paul Yock, came up with that here in Palo Alto. In fact, I even taught his curriculum at my home. medical school at UT Southwestern for five years. And having gone through the motions several times. It wasn't until I sort of saw my own maternal grandfather actually go completely blind due to glaucoma. And just watching him go from fully functional adult to barely being able to read the headline of a newspaper was telling to me that there could be more interventions or more ability for our medical system here to identify these people and get them I care before they lose their vision. And so that then spurred me to start thinking about ways to get people earlier access to eye care. And just so happened that in the family, my paternal grandfather, who's actually an ophthalmologist in India, was working on various retinal camera solutions to actually make them more mobile or less tethered to an actual doctor's office. And so there was a little bit of that paramedic curriculum experience where we actually put people in vans and sent them into rural areas, married with medical imaging in this case, because that's the main way that I doctors evaluate your i, where we started to come up with solutions to basically make telemedicine a part of early access to eye care. And that's actually the area where I'm innovating and now, and we wouldn't have been able to identify that as a potential problem area, had I not applied some of that basic kind of framework that we were taught in bio design. To understand is this a large enough patient population that's suffering from this is a potential solution going to be impactful enough and actually move the needle in some way. And so using those criteria, were able to think of various solutions that would even work in the US, specifically using mobile phones to actually image your eye and use software to actually connect you with eye doctors virtually. And so that's a lot of the work that I'm doing now, that wouldn't have been possible had some of these other formative experiences or this way of approaching new medical opportunities if I hadn't been exposed to that in the past. Alan In terms of technology, what are some of the things that can be done to put more preventative tools in place to protect our vision? Ankur Great question, especially from diabetes. Yeah, I think I'll use as a more commonplace example, just the Apple Watch, I think to most electrophysiologist, or heart doctors that are following your heart signals to their chagrin. Now everybody's got a heart monitor on their wrist, much of which is creating and what they would view as noise. But what Apple has done beautifully in this case is create quite a lot of noise that can be then cleaned, and then we can actually use that to identify new ways to identify rather heart disease much earlier and it wouldn't just be atrial fibrillation in this case, but many other applications. So in that same way that Apple is approached, in this case, heart care in the same way that actually Tesla's approaching self driving cars, we view our solution, which is imaging the AI using mobile phones and democratizing it or making it accessible for everyone, something that's going to give us access to enough data that not only can we monitor diabetes, and its effect on your vision, but many other things. In fact, most doctors know this to be true, and many more people are becoming aware of it, we can actually see signs of high blood pressure and high cholesterol in your eye already. And with the with more data and cleaner data, we actually think we can predict when or if you may get Alzheimer's or a stroke or even a heart attack. And so what's fascinating about this application of AI imaging is that it's become substrate for a lot of other non AI related applications. And I think the Apple Watch is probably similar in the same way that You probably didn't assume that an electric car was going to become the next Uber either. Once you have really rich data to work with, you can do a lot of interesting things with it for people's health in this case. And so we're very laser focused on diabetic eye disease, but I think it has ramifications for people's health far beyond just their eyesight.

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