Growth in Urology Through Innovation - Abel Ang

October 23, 2019

Abel Ang highlights recently launched devices for endourology.  He discusses larger themes about the future of urology and how we can support that growth and innovation. 

Biography:

Abel Ang, Group Chief Executive Officer Advanced MedTech Holdings. Abel has served as the Senior Advisor to the CEO of Greatbatch Inc (NYSE: ITGR), providing guidance relative to the commercialization of medical device technologies in the cardiac, neurology, vascular and orthopedic markets.
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Abel Ang: I really took quite seriously the topic of the conversation we were trying to have. So I'm going to rather than talk about the 16 devices that we've launched at this meeting, I'm going to talk about some of the things I'm thinking about and try and maybe get a little bit of discussion going about where everyone sees urology going. As Professor Landman has said, I am not a urologist. My background is in computational biology, but I am actually running a urology company now.

I wanted to just maybe share a little bit. I know that many of the people in the room probably recognize the bucket that you see in the middle. This is the... Dornier MedTech is the company that pioneered the whole field of shock wave lithotripsy. This picture is particularly special to me because of a good friend... I think he's probably in the crowd, Christian Schossee is here or he said he would be here. Oh, there he is, and his lovely wife is also there.

That's him. He still looks as good as he does in that picture there, but this is him at a time when he was trying to figure out how to get this into the market. That was at the time 40 years ago, a real challenge. I see that as one of the challenges in translation that I would like for our companies or the companies that I'm associated with to think about. I think as Jaime as said, there are many people on the stage who are really pushing at the envelope of what is possible today. I think this example of coming up with not a minimally invasive surgery, but a non-invasive procedure still continues to be a gold standard and is something to aspire to.

This is a bit of an eye [inaudible 00:01:50]. I won't spend too much time, but we have been growing quite quickly. We are generating reasonable profitability, and we spend a lot of money on research. That's essentially what we get away from that.

The bit about the shareholding of the firm. We are a company that's owned by a fund called Temasek Holdings. This is a fund which also owns a sizeable chunk of a couple of other companies. One of them perhaps of note in the health care area is Verily, which is the arm of Google that's involved in medical devices. So that is a sister company to us.

Maybe just to share a little bit about some of the things that we think about and this chart maybe summarizes that. We are trying to build basically an integrated platform in urology. When we talk about urology, as I will share later, not just on a device to device level, but trying to handle and understand some of the larger themes of where urology is going and how we can support that growth and that innovation that's heading in that direction.

Another area that we are actually pretty active in is outside of urology. We happened to be pretty active in the field of nephrology. We are also pretty active in the area of providing components to robotic surgery companies, and that's perhaps something we can talk about a later date.

Just to maybe share a little bit about what we have done, perhaps the background of where we are right now. I think many people know Dornier MedTech as either an equipment provider so to speak, whether it's a laser, whether it's a shock wave lithotripter, but as Professor Landman has said, we have launched some 16 consumables at the meeting. Endourology continues to be an area of great interest for us and we continue to want to drive innovation in that area.

But this is where maybe specifically, one of the things that I'm spending a lot of my time thinking about. I do see this as a challenge in translation right now and was particularly interested in Dr. Chang's presentation earlier about AI and machine learning related methods as it relates to the field of urology. I'm using an example from the field of oncology here. This is a company in New York called Flat Iron Health and I know that Jamie's from there so this may be of special interest or have a special place for him, but what this company has done or have been doing over the last five years is they have been trying to develop a repository of oncology data. Be it laboratory data, practice data, genomic information and so on and so forth and basically make sense of this data in a really meaningful way.

I think that this is something which I have not seen in urology. I am very keen if there's somebody or some parties that are active in this area. This is something that we would be very interested to explore with collaborators and with other partners.

Why's that? Because I think that having had some interactions with the Flat Iron folks, I think that what they have been able to do by developing the Flat Iron platform is they have been able to significantly accelerate a lot of innovation in the field of oncology. I think that this is something that perhaps if we can solve this problem, I do think that it will put the innovation that we see in urology on a different track than we have seen thus far.

The other thing that I wanted to share very briefly about is some of the work that we are doing in another area. That's in the area of renal dialysis. We have a... One of the companies that we have invested in, which is not in urology is a company called AWAK Technologies. AWAK standing for basically is an artificial, wearable kidney. That's where they first started in life, and I will share a little bit about the challenges that we faced here.

This is a company that plays primarily in the peritoneal dialysis area. If any of you have any exposure to dialysis, you will know that this is something that you would not wish on your worst enemy. What they have basically been able to do, this company is to basically miniaturize a peritoneal dialysis machine to something which is actually about slightly more than three pounds. So you can actually have mobile dialysis today. Instead of using the typical 10 liters of fluid for peritoneal dialysis treatment, we eventually brought it down to less than 15% of that.

So basically, less solution and a portable machine so that you no longer are tethered to a peritoneal dialysis device every night from 10 pm to 8 am in the morning, and sometimes even longer than that. So I think that what this allows us to do is it allows us to explore very different types of... And I won't spend too much time on this. I will share a little bit about the challenges that we faced here. I think that the challenges that we face here really are... You know this is a fundamentally different technology than what we have seen in the practice today. Naturally, because it's fundamentally different, the solvent is different. The modality is different. The amount of fluid is different and so on and so forth.

This created huge challenges in terms of adoption and in terms of getting people to even think about this because you have an infrastructure today in dialysis which is built around delivering 70 liters of fluid to a patient home every week. One week's worth of solution, and that's not the only thing. There's a whole lot of other consumables that gets delivered.

Imagine if you only need less than 10% or less than 20% of that being delivered to the home. What are the logistical opportunities and efficiencies that you could achieve from something like that?

This has been a long journey with this company. They have been at it for 10 years. We have been with them for the last two, but I'm happy to report that we've been able to overcome some of these challenges, and they recently received a breakthrough indication from the FDA so we now have an accelerated approval path for the US.

We finished first in man trials. I am told that we have not seen a first in man trial in this area for at least the last 20 years. I stand to be corrected on that front, but I think that this is something that we continue to pursue and gives a bit of a sense of some of the challenges that we will definitely face a hit. This is no sure thing. I think that the nature of translation is that it's a tough business. I think that everyone on the stage has probably gone through that. I'm sure many people in the room have gone through that.

I won't spend too much time on the patents, but what's the game plan? What we are trying to achieve here really is this, I think that probably 80% of the people in the room are users of Netflix. I think that the question for me really is how do we change the way the business works today? Where you can really have a, what I call, consumer-friendly consumption model, where for one price, you can basically get all the dialysis that you want. Or for one price, you can get all the urology consumables, all the stone solutions that you need without having to think about oh, do I need a catheter? Oh, do I need a dilation balloon? Do I need this or that or the other thing?

I think that that would bring a lot of simplicity, I think, into the world of care especially not just in dialysis but perhaps also in urology. I think that could perhaps also be more... would then give people the chance to spend the time not thinking about CPT codes and cost and the amount of consumable that you're using, but really focus on the patient and the good that we are trying to do for every single patient that comes through the door.

So I'll leave you with the thought, this is the disposable scope that we launched at this meeting. My email address is up there. Happy to collaborate, to explore with anyone in the room.