AI Is Rebuilding Clinical Trials

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Hey everyone, and welcome to Built This Week, the podcast where we share what we're building, how we're building it, and what it means for the world of AI and startups. I'm Sam Nadler, co-founder here at Rise Labs. And each and every week I'm joined by my friend, co-host and business partner Jordan Metzner. How are you doing today, Jordan?

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Yo, Sam, another new episode. Exciting week. Great new guest. Lots going on in the world of AI. Like every week. I mean some crazy news, both in politics of AI and just, you know, a lot of new, a lot of new AI features and products coming out of Frontier Labs. So exciting new episode and looking forward to chat.

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Absolutely. And

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I do love to introduce our guest Doctor Jordy from Right Eye.

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You know. Right. AI is an AI platform that builds digital twins. Doctor Chadi, welcome to the podcast. Tell us a little bit about yourself and what you're building. Thanks for having me. Great to be with you guys.

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I'm a medical oncologist and a hematologist.

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By training. I practice on the provider side for two decades, for about 20 years, and then I transitioned after that, to the, to industry. So I held several positions. One of them was with Cardinal Health as chief medical officer, and then Caris Life Sciences as the chair of the Precision Oncology Alliance. Caris Life Sciences, you know, focuses on genomics and, and

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multi-omics.

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And then I have joined,

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right. I,

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about two years ago as chief medical officer and head of strategy.

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What we're doing is right. That's right. We are

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we we strongly believe that clinical trials that could bring life saving therapies to patients need to move faster, need to be more efficient, and need to be cheaper.

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And if we do that, we'll be able to get faster, life saving therapies to patients.

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So we are focused on enhancing and accelerating clinical trial operations by matching any clinical trial of any therapeutic area against the most precise and the best sites that are going to execute on this clinical trial at scale and globally. To do that, we have built digital twins for every clinical trial site in the world that have done any kind of clinical trial in any therapeutic areas.

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We have a secure,

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platform that,

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that really allows us to match,

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the clinical trial against all of these sites,

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using,

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again, a genetic AI and generative AI platform. So that's what we're doing. We'll go into more detail, I'm sure, with that. But that's really very,

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high level

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perfect. I love it. And we will go into more detail.

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every week with great guests like we do today. Hit that, button and be reminded on every Friday. And the docket, we're going to

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something we built with right in mind. And, you know, like we do in every episode, this may be totally off base.

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I did my best to try and kind of capture,

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maybe something that would be interesting for. Right.

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But as you can see, this is a digital twin dashboard and, and could show the difference between manually selecting,

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a site versus using AI. So let me kind of walk you through,

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this trial,

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trial strategy snapshot.

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And let's start a tour. Actually, I think that would be really helpful. So, you know, first, the digital twin,

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this dashboard simulates the clinical trial network using historical performance data and predicts enrollment velocity, diversity and risk in real time. Obviously, you know,

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these trials, the goal is to, I'm assuming, finish on time and either under or at cost and with the right markers involved.

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So the status quo problem, we're currently simulating a standard manual site selection strategy. Most sponsors overindex on tier one academic centers.

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Where enrollment could be slow and diversity could be below target. With that, there could be financial consequence. So inefficiency has a price. You know, you could run over time. You can run over,

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in terms of cost.

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There could be regulatory risk.

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And without we can have AI optimized output. So the strategic advantage is,

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you know, we can recover the two month delay and diversity target. So, you know,

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with this I optimize output in terms of site selection. Maybe, you know, Emory Healthcare could be a great option versus, you know,

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a tier one clinic that's ranked a little bit lower, like the Mayo Clinic.

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So is this somehow, you know, and you could, like, trigger these simulation parameters that have, you know, biomarker complexity. How does that change the ranking of the sites, which could be a better fit for the clinical trial?

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You know, overlay the census overlay, you know, you have the potential,

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strategic tension with equity is, is this somewhere in the realm of, like, how your business is thinking about,

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site selection and and why it matters?

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Yeah. I mean, I think I think somewhat so obviously, you know, but for the sites to execute on any clinical trial, they need to have qualitative capabilities for this specific study, the quantitative capabilities in terms of what they can actually do,

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in terms of enrollment and getting patients on. And these vary between sites. And you earlier point, there are large academic sites.

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There are also the smaller community sites, there are sites worse. There are sites in Europe, Australia and so on. Our goal is to help rapidly identify the best sites for this specific study. If I step back,

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Sam, I will say, why do clinical trials fail? First of all, they're costly. It takes 10 to 15 years to get a clinical trial to enroll.

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These are the trials is going to change standard of therapy, standard of care and 1 to $3 billion. And by the way, 90% of drugs in trials don't really, you know, get you a drug to market. But trials fail because either the drug doesn't work, that you are studying

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or because toxic. So you cannot give it because it's really it could work, but it's just too toxic or simply because the trial did not enroll.

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So you never really got to the yes or no. You never got to that point. And when you look at the statistics, the statistic don't lie. 80% of trials run behind schedule. 50% of sites enroll just 0 to 1 patients. And from a sponsor perspective, time is money. This is a lot of money to activate the sites and then don't enroll.

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So we wanted to disrupt this by focusing on the third element. We're not making drugs. We're not really reducing toxicity, but what we can do, we can help sponsors identify the sites, start best for this particular for this particular,

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study.

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And we also connect them with the right principal investigator, with the right person who's going to bring that trial and champion it internally, because that's going to help.

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That's going to help with enrollment. Subsequent to that, we also automate a lot of the mundane work. So we allow actually the exchange between,

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between sponsors, between sites and so on. So there's really this end to end solution between the two major stakeholders in in that space. So your point is well-taken that you have all of these,

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sites, but maybe the side that is ranked in this particular list as number 20, it could be the best site for this specific trial that is going on.

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There. And the only way to do that is by linking the trial and the specific needs of that trial against the capabilities of that site. And I'll just say one other thing is

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there are nuances. So we're talking with the sponsor that have a specific interest,

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of having that

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particular trial enroll in Europe because they have a regulatory goal

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in Europe.

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As an example, strategically, what where do you go in Europe if you have a specific,

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regulatory, component that you need to actually achieve? So we select the right sites that are able to execute on that.

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So I like what you're built here. I think it's pretty. And you certainly pick up on what we're doing. We're literally I mean, that's what we're doing.

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We're trying to make that link and and be able to really rank these sites. So when whenever we get these sites, we end up having a score. We, we tier the sites into three tiers tier one, tier two, tier three and the tier one, usually the ones that are most likely to succeed enrollment tier two less and tier three.

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The the least.

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Incredibly interesting.

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Tell me a little bit about we we talked about in our call, but how does kind of diversity and the biomarker biomarker complexity kind of influence

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the results and or just the, the trials themselves? You know, it's really important question that, you know, when you look at existing clinical trials in the US and, you know, cancer takes the lion's share of these trials.

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But even cardiovascular metabolic neuroscience and so on.

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Most patients that are enrolled in these clinical trials do not represent the demographics of the US.

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So you see, often 90 to 99% of patients enrolled are Caucasian, while 25% of patients in the US are considered non Caucasian.

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You see a lot of folks who are enrolled who have good socio economic status, they're able to travel, they have good psychosocial support and so on.

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And that's really not what you see in real life. So what do we do? Because we have the digital twins globally, at least in the US, we have the ability to link that against the US census. And I think you have that the census overlay, which is, which is really interesting. So you're able to actually tell in the using the US census and API into the US census, what are the demographics of the patient population each particular site serves?

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So if you have a particular study that requires 20 or 25% underrepresented minorities, then that becomes actually high on the list. When you are deciding to tier these sites and you're able to recommence sites that serve this patient populations that the denominator is is higher. The biomarker overlay is really critical. And as you know, at least in cancer,

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in cancer,

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all of the trials now have biomarkers or mutations or things that you have to actually,

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look at the way we do that is, is several ways.

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But,

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as you know,

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we have ability to look at every clinical trial, the at each site has done in the past

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because we are linked to ClinicalTrials.gov, where you have the repository of all clinical trials have been done at each particular site.

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And if you know that the specific site has conducted prior studies that required biomarker testing,

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then at least you know they have that capability.

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If you know more granular details that this particular site has conducted studies in the EGFR mutated tumors, then you know that if they have the patient population, so they you actually rank them higher because that information is available through clinicaltrials.gov. So we basically look at past experience of these sites that allows us to predict also future success. If you have a sponsor that have come back and forth to this specific site many times before for their particular studies, then that site must have been successful in enrollment and so on.

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So that sensors and biomarker is key, especially in the cancer world. And I think it's going to be beyond cancer as well. But that's how we do it for now. And we're able to try to partner. Also, we're trying to form strategic partnerships with a lot of entities out there that we can layer out the genomic data on the digital twins.

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That's work in progress on the roadmap.

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that's awesome.

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I guess I think kind of following up on what Sam has said,

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I'm sure a lot of like kind of site matching has like always been a problem in this circumstance.

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How has AI,

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specifically, I mean, you start to talk about like the ability to leverage, like, you know, the DNA markers, etc..

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But how has I kind of, like, pivoted the business in the sense of, like, giving it like, of acceleration,

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or ability to kind of make these twins,

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you know, and how is it I mean, obviously previously was done with like, I guess, like sequel type data, right? You would like, run these kind of data queries and try to find, you know, some type of data information.

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But I guess with a, with a larger data set, obviously AI becomes incredibly more powerful. But yeah, maybe. How has I made it like a really big impact? Yeah. I mean, I mean, as you said,

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Jordan, I mean, the mass of data just you can't really do this. And you have this manual at this point. But but a couple of things are really important just to explain maybe a use case.

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Some of the, you know, there are there are ability there are AI agents that we actually have built that allow us to find the right context individual for each particular site that's downstream after you select the sites. But before that,

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the AI is able to infer a lot of the capabilities of a specific site based on prior studies that they have conducted.

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An example, if site A has conducted a phase one trial, and whether it's a basket trial, umbrella trial, or or one tumor trial, just because they've conducted a phase one trial and the trial has opened, we know that they can conduct pharmacogenomics studies, pharmacokinetic studies. We know that they're able to do x, y, and z. So the AI infers the information from prior experience and gives us the capabilities of this particular site.

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The only thing we would leverage AI is reading the protocol. So when we upload a particular study that could be 200 page study in any therapeutic area. We have 13 AI agents that dissect and parse out, read the entire protocol. We have an AI agent that reads the title, an AI agent for the schedule events, an AI agent for the biomarker and AI agents for the endpoints, and so on.

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So bypassing the protocol in a matter of seconds.

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By the time you upload the protocol and click on the AI and so on it just within seconds, the, read all of the protocol and what it requires. What does it actually require to what you know, what does this trial requires? It requires a site that has an MRI machine.

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They need a CT scanner, all of these things. And then it matches that against digital twins. So reading the protocol is an example. Inference is an example. And the third example is,

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the AI agent that brings you the best contact person for this specific site, for this specific trial.

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That's awesome.

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You know, this is the second or third, I think, healthcare focused,

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AI enabled,

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guest we've had on our podcast and both,

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and wildly different areas, but just showing how AI it becomes like a super enabler,

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even for industries that are obviously like, you know, more traditional, like health care.

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Sam, what do you think? We go to the news?

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Unknown
Yeah. Well, no, actually, I have one more question, if you don't mind. Like I can and maybe this highlights my unfamiliarity with the space, but, you know, I can totally see why crows and sponsors are coming to you for the tool. Do sites themselves also who maybe, you know, less recognized and new who want to do more of these kind of are they reaching out and saying, hey, like these are capabilities.

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Unknown
Like how do we add is, is that something that happens? I think Sam should be working with us. I think he probably was is, I think you were on our call last week. Oh, Alex called or something. The the answer is absolutely yes. But as you know, Sam, I mean, you know,

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we have just to be strategic.

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And we have to think what we could do today versus the roadmap and so on. But absolutely, we have a side strategy. And one of this is exactly what you said. There are so many sites out there that have certain capabilities, but they could be what had gotten because nobody really has reached out to them and them. So we are building the entire platform for the sites where the sites actually go in, and they're able to a,

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you know, update the information, tell us the information that they have, because maybe they can add more information we cannot get.

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Unknown
I mean, we can only get information that is available out there, but there are certain proprietary information that I may not be able to have unless the slides volunteer that. And we're building this. We're also connecting the sites with the sponsors to make sure that if a site. I was having conversation with this site just about last week and they said, you know, one of our interest is studies in colorectal cancer.

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Unknown
And for whatever reason, we haven't had a lot of trials in colorectal cancer because the investigators that we have are not necessarily well known. You'd like to build their their clinical trial portfolio. So it's not like this would come to our platform and, and, and show that they have a lot of interest in colorectal cancer. They have capabilities.

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Unknown
They just have not gotten the chance. And then they get ranked higher because we have that information and we're able to link. So the answer is a resounding yes.

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Unknown
And that's actually happening. Hopefully by the next time we meet again you'll see a lot of this progressing. I mean, this is very, very close actually, where you're going to hear about what we're doing on this site.

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Unknown
I would say in less than a couple of months, you're going to hear on a press release for that.

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Unknown
All right. We wanted to choose something a little bit health focused. Obviously. You know sleep is really important. I think there's been a lot of,

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recent trends,

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in the health care, pop culture news about how important sleep is in the last couple years.

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Maybe it's always been important.

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Maybe it's always been trending important. But I feel like lately. And eat, sleep. This,

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nothing too familiar about the product. And then this. It's really this high end mattress where you can personalize it with,

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cold air, warm air,

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you know, elevation, etc. just raised,

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50 million at a $1.5 billion valuation.

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So obviously doing doing pretty well. I'm assuming,

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in a have you either view use date sleep or are you,

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I believe it's a subscription model. Are you subscribers? Have you sat on the bed? Have you tried it? And what do you think in general of,

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of this news?

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I am not I was I read the article for now is a bit fascinated by the valuation.

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I'm like, oh my God.

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Unknown
But clearly there's a huge market for this. I, I need something like this. I don't sleep well, but things like, you know,

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Unknown
Yeah, I mean, I don't know what draws and things. I, I was a bit fascinated by the technology and more fascinated, honestly, by

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the not the market, the valuation, but more of the there's such a huge market for this.

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Unknown
Like, I didn't I didn't I didn't appreciate that much until I read this.

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Unknown
Yeah. So I, I don't have an eight sleep, but I've read both sides, kind of like customers that are fanatical about it and saying that's changed the way they sleep. And then also heard like, horror stories of like, water leakage in their house and kind of not having a great experience.

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Unknown
Maybe that's, you know, both are kind of like vocal minorities, but,

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Unknown
yeah, I mean, obviously I'm not a doctor. So I think that was like, it would be interesting to get your take on it. But,

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Unknown
you know, I think the idea of being able to lower your body temperature while sleeping for people who sleep hot and,

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Unknown
and I guess maybe the same, the opposite direction, but,

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you know, in an effort to kind of, you know, improve the quality of sleep for the time that you have it,

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Unknown
as an interesting idea, I think this is I'm not exactly sure how the subscription aligns.

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Unknown
And, like, what happens if you stop paying the subscription?

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Unknown
But,

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this there's no longer sleep on your own bed. Yeah, yeah. You have to stay hot at night. You have to sleep on the couch. I mean, sleep and sleep is important. I think this would be a perfect infomercial at 2:00 am on all the channels when you're, like, trying to flick through the TV at 2 a.m. and then you get the infomercial for this.

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Unknown
Yeah. I wonder, I wonder if they have a solution for my,

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Unknown
you know,

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the anxiety that keeps me up at night?

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Unknown
I don't feel it's like a comfort issue. It's more of a mind issue, but,

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Unknown
Yeah, just a fun article. I need to, like, see a and can you see these in a store, or is it just,

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Unknown
An e-commerce solution?

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Unknown
I don't know if they have a retail location, and I don't believe so, but yeah, it's e-commerce mostly, but that actually. What what you said, Sam, is really important. I mean, when people have insomnia or don't sleep, how much of this is really because of the posture and the actual comfort versus whatever? I mean, all of these things anxiety, work, burnout, there's so many things.

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Unknown
And that's not going to be fixed with, with, with, with the mattress. But,

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Unknown
the market is telling us otherwise.

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Unknown
Yeah, totally. Well, speaking of retail, you know, one of our, you know, the arguably one of the biggest retailers in the world, if not the biggest. I,

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Unknown
Apple just released a,

00:21:11:18 - 00:21:18:05
Unknown
low cost or lower cost MacBook, a 599 version.

00:21:18:05 - 00:21:20:18
Unknown
I think it's a competitor to the Chromebook.

00:21:20:18 - 00:21:23:23
Unknown
I'm personally having two children really excited about this.

00:21:23:23 - 00:21:24:23
Unknown
But yeah, I think it was,

00:21:24:23 - 00:21:27:04
Unknown
a long time coming to get a,

00:21:27:06 - 00:21:36:00
Unknown
an Apple computer at this price point. But what's the I could I mean, I think the the power and the memory, like, I didn't get a chance to finish the whole thing, like,

00:21:36:02 - 00:21:37:19
Unknown
I wasn't sure what the,

00:21:37:23 - 00:21:38:07
Unknown
it's quite.

00:21:38:09 - 00:21:41:04
Unknown
I mean, obviously it doesn't have the same capabilities as the larger ones. No,

00:21:41:09 - 00:21:43:01
Unknown
Yeah. I mean, they have smaller,

00:21:43:01 - 00:21:54:17
Unknown
hard drives in memory for, for Ram, but I think the key is that they're using the A series of chips that's available on the iPhone versus using the M-series of chips that are historically in the iPad and in the Mac,

00:21:54:19 - 00:21:56:05
Unknown
though the rest of the Mac series.

00:21:56:07 - 00:22:02:05
Unknown
So I think that's like the biggest step down, whether that has like a significant performance impact,

00:22:02:07 - 00:22:06:02
Unknown
is to be seen as this is like a new series of computers on an, on,

00:22:06:02 - 00:22:10:09
Unknown
untested yet. But to Sam's point, you know, it competes with a Chromebook.

00:22:10:11 - 00:22:14:12
Unknown
And I probably have a prefer a low powered Mac than a Chromebook.

00:22:14:14 - 00:22:17:17
Unknown
Just because you get kind of the access to the entire operating system.

00:22:17:19 - 00:22:18:05
Unknown
But,

00:22:18:05 - 00:22:24:17
Unknown
yeah, I don't know. I haven't tried them yet, but, you know, $600 is a pretty good entry entry price point to get someone to use a mac computer.

00:22:24:19 - 00:22:30:06
Unknown
chatty. Before we wrap up a thank you for joining, I also want to plug that you're an author,

00:22:30:08 - 00:22:33:01
Unknown
with multiple books and a new book,

00:22:33:01 - 00:22:36:15
Unknown
coming out as, just recently came out or coming out.

00:22:36:17 - 00:22:38:21
Unknown
Yeah, it's coming out in, in a couple of months.

00:22:38:21 - 00:22:54:16
Unknown
It's I in cancer care and it's it's not a tech book. It's not a medical book. It's really a book that's written for everyone who wants to understand a bit about AI, to have an intelligent conversation, not to be intimidated by all of these.

00:22:54:16 - 00:22:57:20
Unknown
AI jargon that they hear everywhere.

00:22:57:20 - 00:23:01:08
Unknown
But more importantly, how does it affect the cancer journey and,

00:23:01:08 - 00:23:02:10
Unknown
their cancer care?

00:23:02:13 - 00:23:07:23
Unknown
So it's really written in a very simple conversation, so I appreciate it. Yeah, it should be coming out in a few months.

00:23:08:02 - 00:23:09:10
Unknown
What's the name of the great. Yeah.

00:23:09:12 - 00:23:15:03
Unknown
Yeah. How can people find it? Yeah, it's called the AI and Cancer Care. When machines meet modern medicine.

00:23:15:03 - 00:23:21:12
Unknown
I have a website. Chatting up.com, and I think they will. People will have,

00:23:21:12 - 00:23:28:19
Unknown
information on my prior books and my upcoming books as well on my podcast. Which is very health care focused.

00:23:28:20 - 00:23:29:19
Unknown
Health healthcare unfiltered.

00:23:30:00 - 00:23:33:02
Unknown
I've got a last question. So I've always heard that,

00:23:33:02 - 00:23:51:20
Unknown
Google is a doctor's worst nightmare because the patients would come in saying, I googled on my symptoms and I got this disease, I got this thing is that now ten times worse with ChatGPT all the patients are calling in pre diagnosing themselves or does it does it is it actually helpful

00:23:52:00 - 00:23:53:20
Unknown
I, I think it's very helpful.

00:23:53:20 - 00:24:12:17
Unknown
And I actually write that in, in the book in the prior book which is called The Cancer Journey. I think having an informed patient and family is ten times better than having someone who is not informed. And I really don't think any physician is ever going to meet a patient or a family today, at least in the US, right?

00:24:12:19 - 00:24:31:07
Unknown
You know, it's like in under in different countries, maybe different, but in the US people are going to look things up. They're going to talk to their family, their friends, they're going to be advised. So there's no the idea that somebody is going to come to you and they're going to who for the first time about a diagnosis or a prognosis is just not practical.

00:24:31:09 - 00:24:51:22
Unknown
So a lot of times what's really important for the physician is to help patients and families really separate the signal from noise, the myths from facts, and guide them into online sources that are really more reputable and more, you know, you know, you can trust them more trustworthy as opposed to not,

00:24:52:00 - 00:24:54:02
Unknown
you know, you go on Twitter or you go everywhere.

00:24:54:02 - 00:25:15:14
Unknown
There's no filter, there's no peer review. I could tweet anything I want, I could put a video on YouTube and so on. When I have time, sometimes I go in and I see some of the videos that really drive me crazy, and I feel I have to really counter that and put, you know, put on my channel just to explain to patients and family that some of the information that is really incorrect, but people are going to use online.

00:25:15:14 - 00:25:22:06
Unknown
I personally embrace it. I just guide people and say, you know, you're going to do this anyway. May as well,

00:25:22:08 - 00:25:31:01
Unknown
do it differently. I'll just, say one more thing is, I think in the future that ChatGPT and all of these airlines are going to be

00:25:31:04 - 00:25:38:20
Unknown
100 times better. I think we all agree to that. But also, they're going to be attuned to every specific patient.

00:25:38:22 - 00:25:51:19
Unknown
They're going to almost know that patient and know what they want and so on. And the information is going to be really customized to this particular individual. And I think it's going to help a lot of patients. And,

00:25:51:19 - 00:25:52:23
Unknown
that's what I project.

00:25:52:23 - 00:25:56:17
Unknown
So I think it's going to be net positive as opposed to net negative.

00:25:56:21 - 00:25:57:02
Unknown
Yeah.

00:25:57:03 - 00:25:58:02
Unknown
Totally agree.

00:25:58:04 - 00:26:02:06
Unknown
Obviously we there's a lot to come with. I just the early days and

00:26:02:06 - 00:26:11:04
Unknown
yeah, it seems like definitely in health care it's going to be a net positive for, for patients, for doctors, for the system overall. And that's that's super exciting. All right Sam, great episode.

00:26:11:04 - 00:26:13:13
Unknown
Great to meet you, doctor. Great. Thanks for joining us today.

00:26:13:16 - 00:26:14:14
Unknown
Thanks, everyone.

00:26:14:14 - 00:26:15:17
Unknown
See you all next week.

00:26:15:17 - 00:26:20:07
Unknown
every week we got a new episode on built this week. And thanks, doctor, for joining us and see you soon.

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