Colloque : La neurotechnologie
Conférence du 14 juin 2024 : Panel Discussion
Patient-Centered Neurotechnologies: Navigating the Innovation Landscape
Modératrice : Karen Rommelfanger, Institute of Neuroethics.
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Chaire Innovation technologique Liliane Bettencourt
Professeure : Stéphanie Lacour
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https://www.college-de-france.fr/fr/chaire/stephanie-lacour-innovation-technologique-liliane-bettencourt-chaire-annuelle
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[Music] [Music] okay so now you you can ask at this point um I want to give that the speakers a chance to respond to each other a little bit and we’ve had some questions that um have come up a little recurring questions so I’d like to address those too actually I thought I would be able to see you better if I stood here but I think I think maybe I’m going to move if the if the chair is not trapped okay that’s fine maybe we can so a number of you have have talked about this challenge of difficulty put this away difficulty of [Music] translation oh you don’t see it but there’s a hole under here so if you see me disappear that’s what happened okay so number of you’ve asked was a very good question why does it take so long to to translate this this technology and a few of you have speculated on why um and I wonder if you could all kind of react to some of the reasons you’ve put forward uh or some of the reasons others have put forward so some have said well it’s related to maybe this Tech pushing uh reality where Engineers are trying to push their interesting Solutions um I think Brandy you also brought up some interesting ones about outcome measures and this is a a challenge with other neurotechnologies is that maybe our outcome measures aren’t the right ones to effectively measure what we’re doing with these new technologies and then there other points that were brought up about who it is that we’re using to the push poll mechanism who’s polling some of our ideas so in your case you were able to interact with Physicians we’ve also talked and Tim you’ve done a great job with your uh patient councel so I wonder if you could just comment on what do you think are the the reasons amongst those or others that we’re not seeing the kind of Rapid speed of development that we would really like to see yeah uh perhaps I’ll get started with um coming back to the example that uh that Dr D CR spoke about this is this is not a Sprint this is a marathon but it it’s a marathon that’s it’s also as expensive as playing Polo right so you you it’s it’s an endurance sport but it’s one of the most expensive sports and so um The Continuous access to Capital um I think is um uh one one of the questions came up about you know buzzwords and so on and if the VCS are going in a certain direction if there’s a rising tide for these types of companies in this particular indication um I think that is uh um the principal question is that you you develop a prototype as as Dr showed all all the phases where you can you know raise a seed funding and convertible loan and maybe you’re living off of grants for five or six or seven years before you can attract investors but what happens is that you reach a m Stone and uh it could be your first patient or it could be the first prototype and then you got to stop everything uh and go raise money and say I reached this Milestone so will you give me money for the next Milestone and uh you think that happens the day after the Milestone but it doesn’t because uh for example uh our uh very first acute patient in in 2002 um until we got to that first acute patient like nobody believed that this was directionality was going to work right and so everybody’s just watching like can you actually decrease side effects and increase the beneficial effects of DBS and then it’s like yes but it’s patient number one so you know it’s like well yeah but you only have one patient so come and see us when you have 10 or 13 or 20 and so um the the uh and before that even the people that are willing to invest after that Milestone when you’re speaking to them they’re like well you haven’t met the Milestone yet so well I will invest um or support the company after you reach the Milestone and so there’s a there’s a gap uh and you you could be in a lot of trouble in that gap between um your demonstration of the technology de your clinical demonstration or patient uh outcome measurements and your ability to raise capital and so that um I think is a is a very important factor especially for projects that are very long because the world can move on and they got you know they can get interested in another medical device field or another biotechn olical field or something completely different and capital moves in that direction and so you can find yourself as Dr CRA said any project that is lasting more than 10 years it’s it’s in a tough spot it’s in a tough spot because the world has definitely moved on after 10 years that’s interesting and I I’ve also heard that from investors that this is just a tricky spot for them to even desire to invest in and that’s an unusual investment space as you pointed out where you have you know that your typical investor maybe doesn’t want to wait so long to see effects there worried about getting that return but so in filling in that Gap or or maybe these billionaires who have different kinds of incentive structures who maybe aren’t beholden to other Str guard rails that we might have in place um did you want to add into this as as well um you you mean the type of investor or general question how you yes the general yeah um I would probably want first to go just one step back before before you reach your deadline or Milestones when you run out of cash it’s that if you want to introduce a new material or a new technology in the brain or in the body you have to demonstrate that it will stay stable in the body and that it will not be uh toxic or carcinogenic and all these kind of things so and these are long studies you have to put your materials for long tests first you do passive tests and we are we are talking you know things that are going to reside in the body for 20 plus years when you talk about pediatric applications like clear implants as well they could stay a lifelong in those people and even if we can accelerate the Aging of materials it’s never exactly the way it ages in the body so in theory you would want to wait for 25 years to know that your device is will really not be bad for people and you have to build them you can’t sell them so you make no Revenue it’s a disaster right so you have to accelerate you have to take a certain risk of putting something in a body that has not been fully demonstrated not to disintegrate and cause illness after 15 years and yet this forces you to wait for one two three years with many samples in the lab and you have you need a process that is going to be the process that that you will have in your final product otherwise it’s not uh representative so first you need to develop your process have your process stable then you need to to produce samples and put them in the lab Aging for literally years that’s an incompressible timeline you can give me a billion I won’t be able to do it quicker you can give me 200 people I won’t be able to do it quicker [Music] okay thank you Brandon the other element I think is a real challenge so I agree with the finance and the the other regulatory considerations but fundamentally many of the disorders we’re looking to help clinicians come up with solutions for we don’t fully understand the Neuroscience basis of the disease state or how the intervention um might impact it or how we optimize it and so to come back the the the one area where there was success you know really in brain stimulation today has been in Parkinson’s I would say but that’s also because historically there was a well-known surgical Target and so they could go in and replace a static surgical lesion with a tonic stimulation pattern and that we benefited from that um in a way um kind of set us up maybe for some false hope of then expanding into other areas such as depression but I’d even say epilepsy and so I think part of our opportunity in the neurotech space and each one of us will have a slightly different strategy so we don’t 100% agree but it’s creative tension so see it is that it’s creative tension amongst us but we each choose different strategies um when I was where I’ve worked in at metronic but also now as an academic is working on devices that also have scientific instrumentation embedded in them um to try to bootstrap and learn and so it’s to the gentleman’s earlier point about incremental so it’s definitely an incremental approach because we’re building on what’s already there but it also gives us faster access to try out new ideas and the image I’d have for us of how I see the space is I spent a lot of money at companies building these instruments and it doesn’t make you popular with the investors and so I was called into account for our some of our investments in research search tools and I showed a video that’s on YouTube and it was you know early flight 1905 and it showed all these people building airplanes so they the airplanes were flapping you know their wings they were crashing they were out of control and then you know and so all the the board of directors are laughing they’re saying haha what a bunch of Fools and then at the end the Wright brothers it shows them actually taking off and flying and I showed that video because I said 100 years from now what are they going to look at us at neurom modulation and laugh at us because we’re going to look so silly for what we did and and the reason I share it actually today as well is the wri brothers and others you know French Pioneers in aviation as well stepped back and actually worked on the foundation of wind tunnels and doing measurements and understanding aerodynamics and the like and that allowed them to have controlled flight and I think we’re actually at that very interesting space where there’s an opportunity to build that equivalent to the wind tunnels and understand the neuroscience and then when we understand aerodynamics as a model we can start to apply better therapies and I think that’s kind of from my perspective where are we sit in 2024 and why I spend so much time on the instrumentation because I think that fundamentally is what’s holding us back is just understanding the Neuroscience the only thing I would like to add to that is is just the nature of of the conditions that we’re dealing with is you don’t become depressed instantly you don’t you know develop Parkin instantly is these are all conditions that take a long time to develop and in the case of you know mental illness when you are trying to recover from them it takes a long time and you can’t be continuing on on with your experimental process while you’re you know waiting for the first person um you know you you have to wait and let them get well and see if it worked and that takes time because nothing that we’re doing um for these conditions is is instantaneous I know that the videos with regard to Parkinson’s are very exciting but when you’re deal with things that are mental illness related or are not things you can anticipate like seizures um that the video of waiting would be very boring which is why they don’t make those videos so you have to understand that that time is an in integral component not just in the getting to are we going to let somebody put this in somebody’s body but also did this work for somebody once we put it in their body um and those questions aren’t going to be quick that’s that one key element is the time that it takes and it actually comes full circle back to the investment is the um well you’ve probably had Helen tell you about there were two studies from companies that were started and they ended up not you know hitting for other reasons we won’t get into they just didn’t continue on but even epilepsy there was a a failed study at metronic when I was there and part of it was we stopped the trial too soon because we’re so used to this fast readout in Parkinson’s disease and what’s ended up being the case in epilepsy is it takes months to years for the full effect to actually be occurring no one’s still 100% sure why that’s the case but that’s the calculus is that time it takes to get the full effect to show the clinical benefit is directly opposed to the investors who want a quick read out and a fast return on their investment and so that’s one of those real challenges right now in that space yeah and and and what what those kind of events cause is that when the investors in the field see such a major study failing for for a sad reason basically they don’t care about the sad reason everybody’s cold you know for a while for for several years think nearly a decade you won’t be able to raise money to do new studies on depression using DBS or something like that because they they always all have cold feet and all these these timelines they add up to each other before you know it it’s 20 years right MH did you have something else you wanted to add no I think that’s okay I I think you know it’s it’s always impressed me just the more I hear from people like you just just how extremely different difficult this is and also just how critical um the translation by the private sector is and how almost insurmountable if it feels to go into that space um you know there’s this so when I want to move to this um the whole theme of this is certainly patient centered neurot Technologies how do you do that on top of all the other procedures that are so difficult and processes um you know Brandy I think you did a wonderful job of sharing what you thought that meant Tim you have a Young Person’s Council I think that you’ve deployed in your setting and and I’m guessing that’s more in this academic setting um you’ve talked about working with with Physicians um what are some we know a lot of the things that aren’t working but what are some things that that can work and be compatible in this very difficult environment I’ll just start one thing which I think um Randy underlined quite clearly is that um I again taking the perspective of the engineer and and and and the entrepreneurial engineer um the clinical needs don’t just have to come from Physicians they they they uh they come also from from patient interviews um and from observing patient in the uh in the therapeutic context or in the treatment context or in the hospital context or in their in their personal context so um the the observation um and the clinical needs identification um um is very efficient when it’s between a physician and an engineer I I would I would I would say but but it’s arguable and and and um it’s it’s no less efficient when you have observation of of a patient and and and the data of of those patients like you were saying having large data um uh large databases of uh of of patient measurements and following the patient outcomes uh um with respect to the therapies that they’re undergoing um is is an observation at at a large scale but at a personal scale you can also find quite quite a bit and we we saw that in um in DBS and Parkinson’s and and uh because the engineers were there while the patients were being programmed and and we would see things that we or we would you know hear things from the patients that is not a design requirement in all of our documents and it’s nothing that we had ever thought of you know um one one thing that struck me was um uh in part Parkinson’s disease how um motivated those patients are to stop their levodopa right they really want to stop taking this medication and that that hadn’t really um we we knew that because it was one of our study end points MH but until you hear every single patient say how much less levadopa will I be able to take after you turn this on um I’m sure this there’s equivalent in in in Psychiatry as well so uh that is something that that you know doesn’t come out in the Publications and it doesn’t come come out in physician interviews that necessarily it comes out in observing the patients so um I think that’s you know getting back to question what what is the step to to bring this around I think that the design process and The Innovation process absolutely has to include the patient and uh it and it’s not just from The Physician it’s it’s from the patient’s uh Journey as well thank you I I’ve got to I’m interest in your perspective on something Brandy that’s so and Jen French is going to talk later she she exposed me to this idea a while back and we we we we used the word patient and Jen said part of it is I don’t want to be thought of as a patient anymore I want to be a cons think of me as a consumer of your technology I’m a patient when I’m in the hospital but think of me as a consumer instead and that that actually really sunk deep into my my thought process and I think that’s the part of you mentioned investing or so thought on that I’d welcome of how you’d like to be thought of in these engagements early and often and I’m always just surprised as you’re saying about understanding what the real objectives are um and I think sometimes from The Regulators that’s lost sight of so they have to have some metrics to make decisions and they’re getting better bringing in lived experienc people to panels when they’re making a decision but you know when I’m when I talked to people who are trying our technology you know one really struck me I have to of course filter it for confidentiality but you know we had all the we had pages of objective measurements and I said what’s your goal in this trial and it was twofold one is to participate and give something back because it’s a degenerative condition he says I know this is not a cure so but maybe I can participate and give some dignity at the end of my life towards providing scientific you know data for the future that others will benefit from and then two they just wanted to go to an important family event and be able to walk without it can and it says if you if you actually give me that one moment then then and I actually this is the part of Engineers checking our egos in at the door I said well I could provide that by actually just giving you my arm and I can escort you in that event and he said that would also probably be acceptable to me and I think that’s I think but getting a deep understanding of what really people are looking for we sometimes lose sight of that I do think that it is important when we’re talking about incorporating lived experience and patient perspectives is I while I do speak all the time often and to anybody who will listen about my experience it is my experience is I am not a monolith for people who experienced severe major depressive disorder or treatment resistant depression or any of the other conditions that I’ve I’ve gone through is incorporating my guidance you know my experience isn’t sufficient is no two patients are going to have the same experience so it’s not strictly incorporating their you know data or their thoughts as a patient but also understanding all of the other aspects of their life that are impacting what kind of care they’re getting whether they’re getting you know more aggressive or less aggressive care those things need to be factored in and having one patient as your lack of a better term poster child for what you’re doing that’s not what we’re talking about when we talk about incorporating these perspectives we are talking about a diversity of experiences of opinions of you know life choices of treatments of histories is you need the full spectrum and limiting it to who might look good on your poster is isn’t going to get you there so there are no shortcuts in what we’re talking about when you’re trying to actually benefit people benefit Society benefit you know the future sufferers of Any Given condition thank you um I want to we have a we’re going to try to head to lunch at once but I do want to give an opportunity for the the audience to ask some of your questions if not I certainly have more but I want to by maybe you could share share your hand and uh Stephanie can Olivia do you have a question okay goe thank you [Music]