SPEAKER_02 0:03

Welcome to the Future Adventures Scaling with Clarity Show. Today I'm joined by the Honorable Dr. Lyle Oberk, a physician, former Obord Cabinet Minister and Health Systems Leader who now serves as CEO and Chief Medical Officer of Axracellular Diagnostic. Extracellular is a is developing a blood-based liquid biopsy platform designed to detect and monitor cancer by measuring membrane-bound HSP70 on humidived extracellular vesicles. Lau brings a rare combination of clinical political governance and commercialization experience today. We'll explore whether detecting cancer earlier and monitoring it more continuously could fundamentally change how cancer is treated. Lyo, welcome to welcome to the show. Thank you very much, Max. It's great to be here. I'm super excited about the conversation today. I mean, uh cancer is uh is a disease that unfortunately impacts way too many people. And so um you guys are doing something pretty amazing in terms of uh in terms of detecting cancer and and monitoring cancer. But why don't we just kind of start with with you and um kind of like your your very background, you've moved between medicine, politics, healthcare, governance, biotechnology. Kind of like which of these experiences most change your understanding of why promising healthcare innovations fail to reach patients?

SPEAKER_03 1:36

It it's interesting. Obviously, I've done a lot of things in my career. I started off as a medical doctor in rural Alberta. I uh then went on to into politics as to be fair, is almost a bit of a lark at one point in time, but I uh quite enjoyed it. I became Minister of Social Services, Minister of Learning, Minister of Infrastructure and Transportation, and finally minister of finance in the province of Alberta. So it certainly was a varied career. Um, I then went on and became CEO of a couple of companies and uh became the executive board chairman of Alberta Health Services, which was was at that point in time the second largest company in Canada. 130,000 employees, a budget of roughly 25 to 27 billion dollars. Um I learned a lot uh doing these things, and much of it was how to navigate the political landscape. And and whether we like it or not, um medicine is heavily involved in politics, whether it's getting grants, whether it's getting approvals, whether it's regulatory, and there's an art to um navigating that. So I like to think that uh I've had experience in that, and uh it's one of the reasons why I'm here with Exocellular.

SPEAKER_02 3:07

So I want to double-click on this. What specifically attracted you to Exocellular?

SPEAKER_03 3:14

Well, you know, I again being a medical doctor, your kind of base instinct is to help people, right? Um it's to find things that will help people. And when I was presented with this, the owners of the company presented it to me, uh I was quite fascinated. Um, I knew, for example, that only 30% of people who have an elevated PSA actually have prostate cancer. So if you want to carry that forward, and I'll use my finance background as well. Um obviously being minister of finance, I saw the budgetary pressures that you know everyday Albertans and you know that can carry this red across the country are under. And the choices that have to be made. So if you're wasting money or if you can find a way to save money, what it means is not only do you save money and not waste money, but you can actually delegate that money into something else that's needed. So on prostate cancer, what I saw is that 30%, yeah, actually did have with an elevated PSA, actually did have prostate cancer, but 70% of people didn't. And those 70% of people went through MRIs, um, they went through uh prostate biopsies, which to be honest, I haven't had one, but they're not the most fun thing in the world that you'll ever have. Um, it's not something you do on a Saturday afternoon, and it's also a um a very expensive procedure. So this was money that was was being put into these biopsies that could have been spent elsewhere to better the life of Albertans. And what I was presented with was some research that came out of Germany that showed that that there was a test called uh membrane HSP 70, which could actually differentiate that other 70 percent. So it could tell you um whether or not uh you had cancer, and and that became an extremely valuable scenario, both from the patient point of view. Like I in my medical practice, I had lots of patients who were waiting and waiting and waiting for you know their prostate biopsy, for their further investigations, and the anxiety of these people is just incredible, it really is. So if you have something um that can tell them you don't have cancer or you do have cancer, I think both of those are useful because if you do have cancer, you get that in your mindset, right? It's it's time I've got to get on with my treatment. So I think overall, um, that's what attracted me to it. It was one of those tests that had the ability to save money, to give better care, and to alleviate the anxiety of the patient. So it was a very impressive test when I looked at it.

SPEAKER_02 6:05

So I mean, I I I can't help to um to be astounded by the number that 70% of the PSA tests are false positive. What's the cost? I mean, obviously, there's a massive mental anguish and cost to the patient of not knowing or and and not knowing how to proceed forward, but what is the cost to the healthcare system? And and one day the point that that has been stuck in my mind forever since I read the report. Uh, a few years back, the parliamentary budgetary office here in Canada produced a report saying the maritime provinces will be bankrupt. I think at that time it said by 2030, because the healthcare costs, the bulk of the healthcare cost is incurred in the last five years of someone's life, and a lot of people will end up retiring in the maritime provinces. And obviously, oncology treatment is is is kind of like the older you are, the the more likely to get. So, kind of like what is the cost um of regular PSA screening, uh uh prostate screening versus like using the HP 70 test?

SPEAKER_03 7:13

So the the PSA test is relatively inexpensive. It's a test that is done uh you know across large numbers. There's roughly two to two and a half million tests a year that are done in Canada. Um, and of those two to two and a half million, probably 15, anywhere between 10 and 15 percent are deemed concerning or are elevated. So there's a significant number there. What then happens is people follow through on the tests, as you can imagine. Uh and as I mentioned, there's an MRI and culminating in a prostate biopsy. But before I get into the issue with the um the cost, if you imagine what a biopsy is, so a biopsy is no fun. Yeah, yeah. Well, it's no fun, but on the other hand, what occurs is you're sticking a needle into a prostate, which is you know roughly that big around, and you're kind of aiming like this, and you're hoping that you hit the cancer. So it's not necessary that every biopsy is definitive, so that's an issue as well. Um, the average cost of investigation of prostate cancer is anywhere from ten to fifteen thousand dollars in Canada, depending on how many tests you actually end up having. So if you can save 70% of those, there's roughly you know two to three hundred thousand people that are investigated this way in Canada a year. So do the math. Like it's substantial. Um, the cost savings of the government and governments, and as I say, it's money that can be used for other things. And you know, not to be crass, but it can be used for a uh recreation center, it can be used for all of these other things. But the key to this is that these dollars are not being spent well, they're they're being spent um on something that isn't work or isn't true. So if we can find something, which we think we have, that has the ability to differentiate that to say to people, yeah, you better go on and have a biopsy, or no, you don't need to go on and have a biopsy. Let's just monitor for a bit. Yeah, our test is showing that you're safe. So it's uh, you know, it's for me personally, it checked all the boxes, Max. It's you know cost effective, um, it helps society, it makes patients' lives better, and so on. The amounts that we're looking at, what it will cost, will be roughly $400. Oh, okay. You compare that to the $10,000 to $15,000 that the system pays for uh investigation of a uh prostential elevated PSA or prostate cancer. This is like a 30 times savings. Yeah, and hey, that's why I'm here. Um like it really quite fascinated me, and obviously I've been heavily involved in medical economics. Yeah, and uh this just made so much sense to me. So when I was given the opportunity to come aboard, I jumped at it.

SPEAKER_02 10:25

Of course. What does um I'm I'm I'm curious, I mean, obviously the the savings, the anguish, those are really important. Um and and and obviously um the earlier that you can detect the cancer, the more effectively you can you can treat it or deal with it. Um what does extracellular tests see that conventional uh imaging, tissue biopsies, PSA testing, or circulating tumor DNA may not see? And kind of like what's the level of precision accuracy based on the clinical studies conducted to date?

SPEAKER_03 11:01

Yeah, so the the basis behind the HSP70 test, the membrane HSP70 test is that tumor cells put off membrane HSP70 and normal cells don't. So what that means is as a tumor, and the other key is that live tumor cells do this. So you're not waiting for the tumor cells to die and checking for DNA and all of these things. You're actually seeing it early as the tumor cell, as the tumor is growing, it's putting off these uh vesicles called exosomes, which contain the HSP70. And the research that was done in Germany came up with a quite an elegant way to determine um the amount of HSP70 that was being given off by these tumors. So, as you can imagine, the tumor cells are small, and as they grow, they're putting these uh exosomes off that contain the membrane HSP70, and we can measure that. And the cool thing is that normal cells don't. So it's and the other thing I will say as well, it's not just prostate cancer. Um, what the studies have shown is that it's many other types of cancers. Well, we're concentrating on prostate cancer at this point in time because of all the things I've said so far. There is a great need on that 70% of patients that um end up not having cancer. So being able to tell them, you know, no, you don't have cancer at this point is is huge. But also just being able to look into other types of cancers and the potential for this being a general cancer screen, we're not there yet. We haven't done all the research to do that yet, but the potential's there.

SPEAKER_02 12:51

That's amazing. Um, where where do you believe the technology provides its greatest initial clinical value? Is it in the population screening, clarifying the uncertain diagnosis, the monitoring treatment response, detecting recurrence, selecting therapies? Do you see like the the test being administered to kind of like anyone that's over the age of 50, just kind of like maybe it's on a quarterly basis? Kind of like what does what does the roadmap look like?

SPEAKER_03 13:19

Well, what I would suggest at the moment in prostate cancer is PSA is a is a reasonable screening test and it's a very low-cost test. So I think that that's a good first step in the screening procedure for prostate cancer. I think though, where P HSP70 um fits in really nicely is in those people who have had an elevated PSA. So again, as I mentioned, that you can differentiate that. So I think that's one, you know, I think that's an obvious one. But the second one is really very, very important too, and that's when you've gone through you have prostate cancer, you've gone through treatment, and you want to follow up on recurrences. So you want to the thing about cancer, almost empirically, is that the earlier you catch it, the better chance you have of beating it. And by being able to catch the cancer early, which ACE HSP 70 has the ability to do, um, we think that that's a very strong niche for this product to be in as well. Ultimately, it may well turn out that it does become a general screen, but I don't feel it's there at this particular point in time. Obviously, you know, being a medical doctor with a heavy science background, you kind of want to prove things first. And I I see the potential on that down the road, but it's not there yet. But on the prostate cancer, on the people who have had elevated PSA, the monitoring of recurrences, I think it's going to be very, very strong.

SPEAKER_02 14:57

So if I understand correctly what you just said, it's really the goal is not necessarily to replace any kind of existing diagnostic method, but it's it's to give physicians the additional clarity, the signal that they need to improve both the timing and quality of their decisions. So kind of like your point, like, okay, we've had an elevated PSA. Now let's rule it in or rule it out.

SPEAKER_03 15:19

Yeah, and that's exactly the point. Um, you know, anytime you have a test that's only 30% positive, it's like, you know, any decision you make in life, you get the odds that are only 30% on your side. Um, I think it's problematic. So if we can anything we can do to improve that diagnosis without going through the all the cost and the time consuming and the painful uh modalities of diagnosis, I think it's worth it.

SPEAKER_02 15:51

Fantastic. Um follow-up question because you talked about like like the the goal is to to apply to multiple cancer types. Um I guess what I'm wondering is like what would it need to take place for it to become pen cancer detection tool?

SPEAKER_03 16:17

Well, what what we have to do is we have to do the studies in a few more cancers. Um prostate cancer was very good because there's a a concern um a definite uh mass of patients that we have the ability to identify. But I think as you move forward, you'll we'll be looking and the studies, for example, that were done in Germany were also done on non-small cell cancers uh or non-small cell cancer of the lung, where it proved very effective in in um addressing the um the how severe the cancer was and whether or not it had metastasized to the lymph nodes. So the aggressiveness of the cancer is another area where it seems to be pretty good. But I you know, but I think that um what is going to happen eventually is we're going to do more studies into other cancers. And I'll I'll give you one here, and and please, for your listeners, um, we have not done the research into this yet. Uh there's been some done, but not enough to be safe for sure. But uh ovarian cancer is another one. Ovarine cancer is a silent cancer, which means there really is no screening screening test that determines when you have it or when you don't. Um there are again another test that is about 30% positive or 30% effective. But the interesting part about ovarian cancer is there is high risk categories. Like people that are BRCA1 and BRCA2 positive have a high risk of um of uh getting ovarian cancer. So, you know, it's logical that if this test is good in detecting ovarian cancer, that people like that would be screened using it. So it's kind of the one in one equals two um question. So I think that there is a lot of you know potential for this. I think that um as with anything in in cancer treatment under screen, you have to be a little cautious. You have to make sure that what you're saying is correct. So we'll be doing more studies down the road, but prostate cancer is um seems to be the obvious one at this point in time. Breast cancer is another one. Um you know, if you can imagine not having to have the painful mammograms that women go through, uh things like that. I'm not saying that this will replace them, I'm not saying that at all. But there is potential there as this as more and more research gets done on this.

SPEAKER_02 18:50

On the science, I have a follow-up question. Can can the platform that can the test distinguish between an aggressive cancer that requires immediate intervention and an indolent cancer that may never become clinically dangerous?

SPEAKER_03 19:06

Yeah, some of the research is showing that it can do just that. Um for example, a non-small cell carcinoma of the lung, it is seems to be good in detecting. We're seeing an elevated level in those cancers which are aggressive and decreased level in those cancers which are not. So I can't definitively say that, but there certainly is some evidence pointing in that direction. And again, flipping back to the prostate, that's one of the questions that medicine, medical doctors and medicine in general have been looking at for years. What is what cancer in prostate cancer is going to be there and not kill you down the road? And why is another cancer so aggressive? And I can't answer that now, but certainly there's a potential.

SPEAKER_02 19:54

Interesting. Well, I I know I'm kind of peppering your question, but like I'm super interested in this. What evidence will physicians need before they trust an HSP 70-based test enough to just make the consequence to make a consequential clinical decision?

SPEAKER_03 20:12

Well, again, what what you've got to remember is that HSP 70 is just one tool in the armament of physicians. I think that they have to obviously know the patient, they have to know what's going on with the patient, know the risk factors and all of this. But this is one really important tool that will allow the physicians to make a clinical diagnosis as to whether or not a person with prostate cancer needs more treatment and needs more going on and when to treat. So that kind of thing. So rather than having a patient that is delayed out six or eight or ten or twelve months, um, you can say, well, this patient needs it today, that patient needs it three months from now, that kind of thing. So that's the world that I think we need to move towards. And uh hopefully HSP 70 will be a part of that.

SPEAKER_02 21:07

Hopefully. Um, what would cause you to conclude that the technology is scientifically promising but not yet ready for broad clinical adoption? Um, is is is um is is is the test ready for clinical adoption? Is the test ready to be rolled out to physician? Kind of like walk me through kind of where where is the the test um in terms of its uh it its evolution?

SPEAKER_03 21:31

Well, right now we're just finishing up a study with the Alberta Cancer uh Prostate Cancer Center in Calgary. And we're going to be getting a group of results within the next couple of weeks. So that will yeah, so that will certainly point us in the direction. There's an interesting thing in diagnostics, and when people, when investors, for example, think about bio um bio pharmaceuticals, when they think about um investing in biotech. They often think about returns that are, you know, five, ten years down the road. This see those three vaunted letters, which are F D A and all that kind of thing going through. Yeah, exactly. Um, but the advantage of a diagnostic is that you can do what is called a um laboratory um diagnostic test, an LDT. And that'll allows you to do the test without it going through the FDA at that point in time. Because physicians then, as I mentioned, physicians are critical in this. Physicians make the make the call as to whether or not their patients should have the test. And by having the ability to do it early, um, we theoretically can commercialize, you know, within six or eight months on this test. So rather than waiting, we we still will go through the FDA and we'll still go through Health Canada, but rather than waiting to commercialize, you can actually commercialize these tests early.

SPEAKER_02 23:02

And and are there specific requirements and conditions that they're uh set in place with regards to LDT. Um, does it have to be, I don't know, specific laboratory, like kind of like any any conditions that have to be met?

SPEAKER_03 23:16

Yeah, it has to be an approved um CLIA laboratory, and we're fortunate in that our our partners, the Alberta Prostate Cancer Center, um, have this laboratory. They're fully accredited. So, and they feel that they're quite excited about it, to be honest. And they feel that um they would be the ones that would be doing the test. So we have all that commercialization potential lined up um once we get the uh results from these studies.

SPEAKER_02 23:46

So we're talking about commercialization, we're talking about the LT pathway. Um, where do you believe would be the hardest path, uh, hardest part of the commercialization journey today? I know that's the yeah, go ahead.

SPEAKER_03 23:59

No, well, I I I think one of the one of the big issues on any new medicine or any new diagnostic tests is getting general acceptance by the physician population. Um we're very very lucky at the Alberta Prostate Cancer Center because all the process the urologists in Calgary are there and they'll actually be seeing the results. So there's 16 of them there. So it's a very yeah, it's very good. So if they buy into it and start it in their practice, what you find is it spreads out dramatically, you know, across the country. Um, this historically, though, has been one of the issues when it comes to any new test. Um and physicians are busy, um, they don't necessarily follow uh what's going on, but um, you know, again, if it's as exciting as I feel it will be, I think you'll see a general acceptance from physicians pretty quick. And and to be fair, the other thing, of course, is physicians are not happy with PSA, they're not happy with the 30% positive results.

SPEAKER_02 25:07

So I agree that and and it shouldn't be. I mean, if if we have more tools in our tool chests, why would we not use them to uh to provide better patient care and uh uh you know improve the patient outcomes? What is the minimum clinical and economic evidence that a provincial health authority or system or insurer would need before they decide to pay for this test?

SPEAKER_03 25:32

Well, the the big one would be is the usage by the physicians, the usage by, in this case, the urologists, where they would go and say, listen, um, we don't want uh only private pay patients to be able to access this. We want to use this in our practice, we think it's important in our practice, we think it can save you money, and uh it's better for patients. All the things that I've you know just been saying, I'm not gonna be the one who takes it forward. I think that the general physician population is hopefully going to be very excited about this and we'll be the ones carrying it forward. Ultimately, we want to put it into the provincial laboratory so that everyone has access to it, but up until that time, um it will be a private pay type of situation.

SPEAKER_02 26:25

So, in essence, the demand created by the physician creates the signal to the health authority that this is something that's needed, and then that kind of triggers the um the health systems to to take this on and and pay for it.

SPEAKER_03 26:41

Yeah, that's correct. And um the general acceptance of it at that point in time.

SPEAKER_02 26:49

Makes sense. Um this is a question that I've that I struggled for for for some time. Um healthcare, um, and and many people refer to healthcare as sick care. Um, so healthcare systems are often willing to pay for treatment once a patient is sick, but a lot more caution is involving prevention and and and early detection. Why does this imbalance persist?

SPEAKER_03 27:19

Well, I I think ultimately, and again, this is kind of the medical economics of it, is that people who are sick need attention right away. And unfortunately, um, what happens in government budgeting is sometimes it's easier to push things down the road. So if you if you have ten dollars and that ten doll can save this person's life today, you're gonna spend that per that ten dollars on this person, as opposed to spending the ten dollars to say, well, we'll help a hundred people over the next 20 years. So unfortunately, sometimes politicians, and I can say this because I was one, um, is sometimes they're a little short-sighted when it comes to health care because you don't get immediate returns. Sometimes you've got to put money into the system today to see results five and ten years down the road.

SPEAKER_02 28:12

Yeah. I I understand, uh, I understand the argument. Uh it to me, it seems very myopic. I think 2021 or 2022 marked the turnaround in terms of uh abyssity in North America, and it's all largely attributed to the um the um GPT drugs, the the um the Ozempics. And so from I mean, from my perspective, um, and we had a portfolio company that kind of focused on how do you incentivize physicians to award points or gamify the experience in such a way that like um people were incentivized to stay healthy because if they stay healthy, then uh it it's kind of like insurance company paying paying for uh uh uh uh uh aviation companies to go and see the cloud so that we we have less scale. I mean, that's kind of uh how I view this. It's like why would we not do this? Keep people healthy, more productive. There's a massive return, but it's it's not, I guess, directly correlated or directly visible.

SPEAKER_03 29:19

Well, to be fair, Max, that's kind of the human human condition. You know, why do people why do people smoke? Okay, we know people who smoke are going to get lung cancer. We know if they smoke long enough, and the general rule is kind of 20 pack years or above. We know at some time in the life they're going to get lung cancer. We know what lung cancer means, we know what lung cancer does, yet people still smoke. Um we know that obesity uh leads to cardiovascular disease, um uh um arthritic disease, uh, diabetes, all of this, yet people are still obese. So I would love to be able to answer that question, Max, but that's not something that I have the capability of doing.

SPEAKER_01 30:07

Yeah, yeah.

SPEAKER_02 30:08

Um I want to follow up on this kind of economics theme, but as a former finance minister of the province of Albord, how do you evaluate capital allocation in biotechnology where development cycles are long, outcomes are uncertain, uh pseudo clinical result can materially change a company's value?

SPEAKER_03 30:29

Well, that's a tough one, and that's that's a dilemma that politicians are under at the moment.

SPEAKER_04 30:33

Yeah.

SPEAKER_03 30:34

Um, do you allocate the $10 to a new test, or do you allocate the $10 to a treatment, or the $10 to roads, or the $10 to a recreational center? There's only a limited pot of money, and you've got to work on what evidence is put before you. So ultimately, um when I was in politics, it came down to the business plan. So you basically said, okay, this business plan can track out and save this much money over this period of time. And to me, that's a very compelling argument. Um, you need to put it down to the dollars and cents to and track it out very much the same way as you would in any business. Medicine, and I'm I know I'm gonna get chastised when I say this, Max, so please take it as such. But medicine is a business. Anytime where you have this much many dollars spent um by governments in healthcare, it is a business, and you want to make sure you your business is efficient, that it's doing the right thing, and that it's helping people.

SPEAKER_02 31:36

Yeah. I mean, my guess, I think you mentioned the the number of 130,000, the top of our conversation. My guess is that Alberta Health is the largest employer in in the province.

SPEAKER_03 31:49

Yeah, it was. Um it was okay. Yeah, it's pared down now. It's been broken up into three or four different parts, so it's pared down now. Um, but it was a huge employer, and uh, you know, it had a huge monopoly.

SPEAKER_02 32:06

This is more of a um investor question, but this the Canadian capo industry understands the agnostic and life sciences well enough. Are are Canadian companies still forced to look elsewhere once they once they achieve uh clinical validation and they're at the commercialization stage? Um, what is your perspective?

SPEAKER_03 32:29

Well, it's interesting. Um, being in Canada is I guess two things. So, first of all, everyone assumes that healthcare is a cost, not a revenue. And everyone sees it as government's responsibility. So the venture capitalists um are very, you know, there's not a lot of venture capital that goes into um the biotechs. Uh yeah, there's some. There's some that are very forward-thinking, and you know, they see where it potentially could go. But typically healthcare in Canada has been the realm of governments, and um that's unfortunate. In the US, um, it's different. You have you know a lot of venture capital, they see like the use the example of Ozampic. Um I don't know offhand what the uh revenue is from Ozampic and uh the GOP1s, but I will guarantee that it's huge and that type of thing. Like it's uh hitting a true home run. And um many venture capitalists want to try for the fence, but um in Canada they think you know very much that that's government's job. Well, we're at the point now in Canada when we're spending so much money on health care that it's not just government's job. Um, the private sector and private uh um entrepreneurs have a huge role to play in in Canada, or else what ends up happening is that um inventions and and um medications will ultimately just go down to the US because that's what money is, and that's a shame for the Canadian economy. That's the true heart of the Canadian coming up there, man.

SPEAKER_02 34:22

Yeah, yeah, yeah. Uh it's I mean you see um you see a number of different initiatives that that they're spearheaded, be it at the municipal, provincial, or federal level, where Canada wants to play a bigger role in in IP and research and commercialization. Um and um um Jim Balselli, the former CEO of uh of uh uh Research in Motion, is leading some of those. Um what what I'm seeing in other countries is just because we work a lot with the Nordic countries uh in Europe, there's uh, for example, in Denmark, then there's Export Innovation Fund. In Norway, there's the Sovereign Wealth Fund, they're investing heavily. In the US, you have the US chips and science side that focuses on how do we create security independence. Um, do you see the Canadian government setting up something similar? That like it it's it's not necessarily picking winners and losers in terms of companies, but dedicated comp uh dedicated funds towards particularly industry where Canada can play at the global stage?

SPEAKER_03 35:24

Well, I think ultimately that's exactly what should happen. Um it's hard though, and I I don't want to say it's as simple as government writing a check. Um, it's harder than that. And what they don't want to do is in the winners and losers category, politicians in general, they're static when they're on the winner's side, but when they're on the loser side, you know, it's horrible.

SPEAKER_01 35:48

And um the same goes success has one fodder, um, but uh failure is orphaned. No, success has many fodder, but failure is orphaned to one person, yeah.

SPEAKER_03 35:59

Yeah, exactly. Exactly. And so what happens is they're they're you know, they hesitate in picking the pinners, winners, and losers. And what you see is in the bureaucracies, there's not a huge amount of researchers, for example. Like a researcher who's researching on the cusp of medical science is not going to say, Well, gee, I think I want to be a bureaucrat one day, so I want to go in and sit in an office for 30 hours a day, 30 hours a week, that kind of thing. So it sounds easy like government should just set it up here, but there's also something about the entrepreneurial spirit where you have skin in the game, and you know, that's the problem with government. They don't necessarily have skin in the game because it's not their money, it's the taxpayers' money. And so, you know, it's it's a that's a tough one. Um, I personally, my belief is that we shouldn't, you know, put it all in government to do everything for everyone all the time.

SPEAKER_02 37:02

Yeah. It it's interesting. Uh we'll we we play uh in the biotechnology space quite a bit. And uh in terms of who we're looking, um who we're looking as the investors in biotech, it's uh it's two categories in in particular. VCs absolutely they they play a massive role, but they typically want a company to be kind of like post-clinical studies, where we see more patient capital is really in two categories, and it's like family offices and CVC, corporate venture capital. Um, that's kind of where we see in the a lot of patients, particularly if if on the CVC side, if there's ability for whatever the corporate parent is to deploy resources or uh additional services.

SPEAKER_03 37:46

Yeah, and you know, and and just kind of stepping back one sec here about about government, you know, maybe what government needs to do is not pick the winners and losers, but provide incentives to the investor to invest in biotech, saying, okay, we'll give you X number percentage back if it goes south, that kind of thing. Maybe that's a direction where government and entrepreneurs work together to better society health care. I think that's a perfect mix, uh Max. Interesting.

SPEAKER_02 38:20

That's interesting. Are there programs like that in Canada currently? Or is this very few?

SPEAKER_03 38:27

Yeah, okay. Yeah, very few. There are examples of programs similar to that around the world. Australia has a good one. Um, so that type of thing to encourage the investment. So you're not really using taxpayer money to pick the winners and losers, you're encouraging entrepreneurs to come in. And if the entrepreneurs happen to pick a winner, fabulous. But if they happen to pick a loser, maybe you know you should encourage them to invest again.

SPEAKER_02 38:55

That's kind of it almost becomes like an insurance. The it's private capital that flows into the company, but hey, should the outcome be uh not what you expected? Uh or like here's kind of like some kind of a downside protection.

SPEAKER_03 39:10

Yeah, it's a downside protection, and it allows the entrepreneur to have skin in the game, and they become and and they look at it, and it also allows the taxpayer not to be on the hook. And um, I'm just not confident personally, and I've been in government a lot of years. I'm just not confident that government can pick the winners and losers.

SPEAKER_02 39:33

Agreed, agreed. Um, how should a biotech CEO balance the urgency of raising capital with a responsibility not to overstate what the science can currently prove? And I mean, through the conversation, I think you have been very careful to say it's going there, we're not there yet. Um, so I'm just uh looking for your take.

SPEAKER_03 39:54

Well, I think ultimately a CEO has to be realistic, and he he cannot be the type of person who is simply a marketer. Um where you go out and you market your product at whatever cost. That's not what we're trying to do. Um, what we have to do, I'm a firm believer that if you have a good product, the money is going to follow and you're going to have a good return. Um, the important thing though is the first one, which you've got to have a good product. Um, it's got to be something that works, it's got to be something that uh has the ability to be incorporated into the medical community and biotech in general. CEO cannot just be a raw-raw cheerleader. Um, he's got to know what's going on, he's got to know the pros and cons. And everything, like here's one for you, Max. So when I went into politics, um, I was very much a obviously a physician, but I was very much a binary decision person. It was either black or white. What you soon you soon find is that everything is a measure of graze. Um, some things are just a little more gray than other things. So there's always uh pros and cons to every test, to every procedure. There's things that can go wrong, there's things that can go right. And as CEOs, we have to ensure that the investor knows exactly what those are. Nothing is 100% sure.

SPEAKER_02 41:28

On that point, um surety, precision. Um, I mean, probably the the the biggest benefit of the C of AI is the ability to go from one-to-many to one-to-one, precision medicine, like personalized treatment. You have long argued that Canada possesses um extraordinarily valuable longitudinal healthcare data. Why has that data not yet become a decisive competitive advantage in diagnostic and precision medicine?

SPEAKER_03 42:01

That's a tough question. Um, we have such wonderful data in a single payer system. Probably the single benefit of a single payer system is the data that's collected, the longitudinal data, the demographic data, absolutely fabulous. But there's a hesitancy amongst the politicians to utilize that data. Um the the privacy of the individual, isn't important? Absolutely, it's important. But maybe we should be using AI to look at, and the problem is AI has the ability to look at large data sets to distill down to save 30 years in in medical research. And are we as a population, as we as are a society, going to throw that away because someone might find out that I have a particular disease? That's my personal thoughts, Max. But we've got to use that data. AI is going to be the best thing in healthcare since life.

SPEAKER_02 43:03

I agree. It's interesting. Um, on a podcast, um, two or three weeks ago, we had uh this year I'm founder of a healthcare company in Ontario. And so um uh he's he's a tech entrepreneur first. Um so he was telling us that it's actually an initiative uh in Canada with the different provincial health authorities to bring these data together into one so that there's one record that follows the patient. In this case, his healthcare company provides in-home care. Um, so essentially, how do we uh uh how do we have a precise, accurate picture of the patient um and provide that care at a significantly lower cost? And so he was I don't remember specifically what was the program, but there's a there's an initiative in place right now to uh to kind of aggregate these data.

SPEAKER_03 43:56

So a couple of things. So the initiative that you're talking about, um I believe it was first destined to take get rid of fax machines. And fax machines are still around in healthcare. You have to fax your results. Um, and there was an initiative to do similar things that the federal government put through, and they spent $250 million. And guess what? Everyone is still using fax machines. Oh my gosh. Okay. No one, no one still has the integrated health care record right across the country. Alberta is number one in the country because they took the the they had the fortitude to actually go and move to in one direction. The connect care that they have is great. But even in Alberta, the general practical general physicians use different um uh electronic health records. So yeah, it's crazy.

SPEAKER_02 44:51

It's interesting. I mean, I was just looking in my app. Um, my physicians constantly tell me, um, just just go use U MyChart app, right? Like it tells you everything that you that you need. It it's all it's already there. Um, but obviously not not quite. So um, where's the real barrier for this? Like, is this like privacy legislation? Because obviously in the US we have the HIPAA Act, in Canada we have the equivalent. Uh is it the fragmented uh provincial system? Is institutional risk aversion important to operability, absence of incentives to share data?

SPEAKER_03 45:25

Collect I I would suggest I would suggest the answer is E, all of the above. Okay. Um let's start. So privacy, obviously important. Um I feel the privacy commissioners have to have the bigger picture in focus. They're looking at the individual, they need to look at society and say, if we can use non-identifying data, let's use it in AI. I think that's important. I think in in electronic medical records, you have a lot of different vendors. So which vendor is the lucky one that you pick? Um, at the moment, a lot of the vendors are not interconnected, you can't simply bolt on one to the other. So that's an issue, and I think the issues just keep going on that you've identified with. But that doesn't mean we just sit here and lament about all the issues, it's incredibly important. We've got to get this fixed in Canada, and Canada being the single pair has a huge advantage. Um, so let's get it done, Canada. Come on.

SPEAKER_00 46:33

Agreed, agreed.

SPEAKER_02 46:35

Um suppose a block test identifies significantly more cancers at an early stage, but uh the system lacks imaging oncology so surgical capacity. Have we improved care or simply moved the bottleneck downstream?

SPEAKER_03 46:54

Well, yeah, a bit of both, actually. Um, in that you have improved care because of early detection. You have moved the bottleneck because whether or not these people require surgery or chemotherapy or radiation therapy, cancer therapy in general, you have the potential to create the bottleneck. But again, using an economic argument, um, people who go through and are stage three or stage four uh cancers are much more use much more of the system than someone when they're stage one cancer and are detected and treated early. So you have the ability to save lives and you have the ability to save costs down the road. And that's the key to this is we have to recognize that some procedures actually save money, despite the fact maybe they cost $100 today, um, but they'll save $2,000 in the next 20 years. So that's the recognition that we have to have in this system. And I think ultimately, obviously, people want to be cured of cancer, and so that helps significantly as well. So the resources from the government have to be ineffective tests, they have to be able to be put there and say, okay, we're going to solve this problem in society early.

SPEAKER_02 48:15

So given given what you just said, um with with with regards to some of these policy reimbursement changes uh that that that we could adopt as a society, um, could technology such as exocellular reduce the disparity that exists between urban and rural cancer care? Um will this sophisticated diagnostic initially um how how would it impact them in like we we always hear about like you know, like that there's no there are no doctors that they're going to rural, everyone wants to be in urban centers kind of like what is your perspective on this?

SPEAKER_03 48:56

Sure. Simply by removing tests that are not needed, by removing biopsies that are not needed, by saving money that is utilized in the healthcare system that is not needed, you can reallocate that to where the money should be. You know, you can reallocate it to the treatment of cancers at an earlier stage, all of these things. It and again, it comes down to that economic argument where you're saving money, reallocating it to something that actually works, and that's the key that actually has the ability to help people, and um, that's what healthcare economics is all about.

SPEAKER_02 49:35

Interesting. What is the most wild widely accepted assumption about cancer screening that you believe will prove wrong over the next decade?

SPEAKER_03 49:47

Um, that's a tough one. I I think that as we start hitting the general screens, which we're doing now, the screens are very general, the screening will come down much more specific. And I think you'll see more and more screening that is more and more specific for particular cancers. And I think that will be a huge benefit where you can give a definitive yes or no. And that's what we you know, that's what we're up against. Prostate PSA is a wonderful example because you can't give that definitive yes or no until you're down the road in biopsy and MRIs, things like that. Yeah, so I think you're going to see more and more of that. I think AI is going to be a big tool in that because it will be able to identify very quickly. Um, for example, maybe it is PSA, maybe it is HSP 70, but the correlation between the two, AI will be able to identify that, and what it will do is be able to pick the risk factors. So it's you know, if you're 53 years old and you run a mile every day, and maybe you have a risk factor for this. And all of a sudden, then they're saying you should come in and have this test. And you know, again, the key to cancer treatment is cancer early detection.

SPEAKER_02 51:14

Agreed, agree. Um, we we're working with a number of biotechnology companies, and and one one of the one of them is based out of Palo Alto, and and for them, the the the biggest challenge is is um data. Um because because you if you have the data, you you have your biomarkers, you have your screen, you have your results, uh you you can uh um triangulate uh different biomarkers using AI and kind of see what what what what exactly tell you? But but the like the the most common feedback that we get from our biotechnology companies is is like data. I just need more data. I'm like and in some cases physicians are amazing, they're willingly like taking the time to to take the samples and ship the samples to work with the companies. And so it's more it's almost like more grassroots than orchestrated. So how do we change this?

SPEAKER_03 52:11

Well, again, that is one place where governments need to come in in Canada. Yeah, they need to make this data available, and they need to be able to say, you know, he in in Alberta, for example, um, we have four and a half million complete longitudinal records of a demographically different population. And there's nothing like that anywhere in the world. And the Alberta, I I did a report and I estimated the ability uh or the value of that data at around $2.7 billion yearly. Wow. And so these are the kinds of and not just take the monetary argument and economic argument out of it. This is how AI and large data sets is how we're going to help the human condition.

SPEAKER_02 53:03

Okay. Um close to the end of the interview, but uh, I'm curious. 10 years from now, what would need to be drawn for you to say that exocellular materially changed cancer care? Not merely that you build a successful company, but it really like kind of like your reason for becoming a physician, like like you want to drive a patient outcome, kind of like what does success look like for extracellular?

SPEAKER_03 53:29

Well, success looks to me in exocellular that it becomes a generalized screening test for cancer. And it has could could have the ability to detect cancer early. And early cancer detection, as I've said numerous times, Max, early cancer detection leads to a better cancer treatment. And yeah, so success for me um in this endeavor is to decrease the mortality related to cancer in the world.

SPEAKER_02 54:04

Yeah. Well, well said. Um, I like to close all of my interviews with a choice of a question, or you can answer both. Um, one of them is uh what's the best advice you have ever received, or you had a question is what's the kindest thing that anyone has ever done for you?

SPEAKER_03 54:27

Um probably the best advice that I've ever received is to you know stand behind your facts, um, to persevere. Um, biotech is not for the weak of heart, and to keep your eyes on the long-term goal, because if you are successful, you can truly change the world. And I've been told that several times, and I certainly agree with it. I think it's um biotech is extremely important, and uh we the the tools that are before us today are like nothing we've ever seen before, and uh we can do some truly great things.

SPEAKER_00 55:15

Agreed, agreed, agreed.

SPEAKER_02 55:17

I I think that uh I think that biotechnology is at an inflection point, one with more data, two with the advancement of AI and quantum. I think that we're going to see a lot of breakthrough discoveries, and and then you have like the Zacob or Priscilla Chin initiative in terms of so there's it's going to be huge.

SPEAKER_03 55:38

Um, the next 10 years is going to define healthcare and define medicine in a completely different route. One of the challenges is governments and regulatory bodies have to keep up. And um, it's gonna be interesting to see if they actually can, but they do have to keep up because some of the um breakthroughs that are coming are coming so quickly. You know, we've seen we've seen tests and studies that show that you can take away the plaques in Alzheimer's disease and people regain their memories. Um, these are the kinds of things that have to be done. And uh I see the next 10 years as being truly revolutionary in biotech and and pharmaceuticals in general and healthcare in general.

SPEAKER_02 56:26

Yeah. Um, the future is bright. Um, it's it and I think that we're gonna see um significant improvement in not just in longevity, because longevity for longevity's sake is is is is not the goal. It's how do you improve like the quality of life for people as they age?

SPEAKER_03 56:44

Yeah, I think it's quality and longevity. And uh I I think you're going to see significant improvements over that 10 years as well.

SPEAKER_02 56:54

It was an absolute honor having Dr. Oberg on the show. Any parting thoughts before we uh we end the recording?

SPEAKER_03 57:01

No, I I just like to thank you, Max. I think um giving um people the ability to put their message out so that to other people who can hear it and either agree or disagree with it, but having the ability to put the message out that's an unfiltered message, I think is huge. So thank you very much. And to you and all your podcasters, fellow podcasters that are out there, I think you're doing a great service.

SPEAKER_02 57:28

Amazing. Thank you. It was an absolute pleasure having you on.

SPEAKER_03 57:32

Thanks.