Entrepreneur Rx_Allisa Song: Audio automatically transcribed by Sonix

Entrepreneur Rx_Allisa Song: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hey everybody! Welcome back to another amazing episode of Entrepreneur Rx. I'm today, I have the pleasure of hanging out with Allisa Song. I got to know Allisa because hers was a company that we evaluated and invested in for our venture capital company accelerant. Allisa, welcome.

Allisa Song:
Thank you, Dr. Shufeldt, for having me. Hi, everyone.

John Shufeldt:
Oh, my God, please call me John. We're way past the Dr. Shufeldt stage.

Allisa Song:
Oh, my God.

John Shufeldt:
Well, thanks for being honest. You're, you have a really cool background and a really interesting entrepreneurial background. Give people a little bit of perspective of kind of where this all started, where you started.

Allisa Song:
Yeah, with Nanodropper, which is my current company, it all started when I was applying for medical school, and just out of the blue I ran across this article in 2017 that was titled Drug Companies Make Eyedrops Too Big and You Pay for the Waste. And really, it talked about how eyedrops were oversized for the human eye physiology and patients were paying for those oversized eyedrops not only out of their pocket, but really with their vision when it came to expensive vision-saving medications like those for the treatment of glaucoma. And so my background actually it's kind of a mix of a whole bunch of things, but I actually went to school at the University of Washington in Seattle for biology and psychology and actually did neuroscience research during my undergrad and post-graduate years. And I had been studying the role of the Kappa opioid receptor in modulating chronic stress and addiction behaviors, and trying to see the real-life application of what I was studying in the lab, I started volunteering with a harm reduction alliance at a Needle Exchange in Seattle, and that really changed my perspective on what it means to problem solve for me. And I think the biggest takeaway from that experience was A, that I love working with people, I really wanted to be at the front lines and I found that really rewarding, which is what initially motivated me to switch career paths a little bit and apply to medical school in the first place, but second was about how to meet people's needs in a way where it is pragmatic and how it would fit in with people's lives instead of creating a solution that requires the end user to change their behavior or their lifestyle. How do we create solutions where we meet people, where they are? So with all of that, when I came across this article, my first thought was, Wow, we have all of these great medications that are, clinically have been shown to be efficacious and should be working, but the system has let our patients down because of the delivery and the barriers to care that exist. And at first, I think I felt a lot of anger, and that really drove me to try and find an end-user solution. And I was thinking kind of like an aftermarket part, and I was asking how can I create a solution that I could deliver into the hands of the patients and cutting everyone out of the picture if necessary. So I don't need to have anyone else on board to be able to solve this problem of oversized eyedrops. And that's how we came up with an adapter that reduces volume.

John Shufeldt:
Wow, so way back when, when I first met you, well I was impressed because you describe this problem so articulately and it was a problem I didn't even know. So I've never used an eyedrop in my life, I've never had contacts wearing glasses, and I've never used an eye drop. But I've put eyedrops in people, of course, in the emergency department. And you're right, half of it goes down their face. So then when you explain this, you know, I had my, it wasn't an aha moment at all because you gave it to me, but it was like, wow, you're absolutely right. I literally see people with eye drops dripping down their face trying to do this and had really no idea. You know, from my frame of reference, it was, well, it's making big, so he's, part of it gets in their eye. But the reality was is no it gets in their eye. They're just making it big to go through the bottle quicker. And I hate to think that's the reason why I, like to think nobody just thought through this like you did, but I don't know. I mean, these eyedrops are not cheap.

Allisa Song:
Yeah, they're really not, and the problem was compounded by the fact that, you know, these are patients who don't have the best dexterity. Inherently, a lot of them are losing parts of their vision, or partially, and so we're asking these patients to have perfect aim with perfect dexterity to be able to use every single one of their drops in their bottle. And so about a quarter of patients will actually run out before insurance will cover the next refill. So patients are really having to make a decision, even if they do have originally great coverage with their eyedrops. They're at the pharmacy counter only two weeks into their prescription, having to make that decision of whether they're going to pay out of pocket for these medications or not.

John Shufeldt:
Why? Because half of it stripped down their face.

Allisa Song:
Exactly, and not only is that wasteful, but it's actually causing patient harm right now. There's tons of clinical data that we have historically that demonstrate how smaller eyedrops are just as efficacious and they have reduced incidence rates and severity of both local and systemic side effects. So if you think about beta blockers for glaucoma medications, it's really just getting drained by your tear ducts, being absorbed through your nasal mucosa, and actually causing systemic side effects, and that's why it's contraindicated for patients with severe asthma or heart failure.

John Shufeldt:
Yeah, that's really interesting. Okay, so let's go back. When did you realize that you were, I mean, this, so I've done this in the past where I've read an article, read a book and said, you know, had my aha moment, I said, Oh, we can fix that. I was kind of, I was older than you are when I had that moment. How how did this all start for you? Were you in an entrepreneurial family?

Allisa Song:
I was not. I come from a family of artists, musicians, educators, and in Korea, what we call salarymen. A very stable, kind of risk-averse type of upbringing is what I had. Especially as an immigrant family, I think that without kind of a safety net of family around you or any kind of family legacy to support you, I think it drives a lot of people to be a little more risk averse. I'm the first medicine person in my family as well. There's like this big book with 28 generations of Songs, and we know from that that they were all scholars and business people, not medicine people. So I'm kind of the weird outlier in our family.

John Shufeldt:
You can go back 28 generations in your family?

Allisa Song:
Yeah, yeah, on my dad's side.

John Shufeldt:
To what year is that? It's got to be.

Allisa Song:
Oh, my gosh, I don't even know, but I think it goes back to the Song Dynasty.

John Shufeldt:
Wow.

Allisa Song:
Yeah.

John Shufeldt:
Oh, they're badass.

Allisa Song:
What's not super cool is that they don't include women in there, so it's only names of men, yeah, but I also know from just my grandparents and stuff like that that I'm part of the first generation of women Songs in my family to actually work and have, like, a full career. So we can safely assume that there weren't probably women strong doctors in my family.

John Shufeldt:
Wow, I mean, I just recently gone back one generation. So 28 is pretty, pretty impressive. Okay, you come from a family of a like that's salarymen and artists and professors. So, you know, your relatives and parents look at you like, what the hell, you're in medical school, and now you're doing this too, like, what's wrong with you?

Allisa Song:
Oh, my gosh, yeah, right, so we have like, a running joke that I'm, like, the greatest disappointment for my grandparents because at first I was like, I love research. They're like, Oh, but I thought you were pre-med. Are you not going into medical school? And then I drag them along for a couple of years and then finally get into med school and then I don't graduate and start this whole, like very, what they view as risky, a very risky path in my career, so that's the running joke. But I mean, to answer your question about where did this entrepreneurship come from, I didn't anticipate that this is where my life was going to take me. I didn't take any entrepreneurship classes or any formal education, I would say. But my friend, my best friend Olga, in my last year of undergrad thought it would be really cool to take this multidisciplinary class that was at the University of Washington, and it was a class where they brought together from undergrad to master's to PhD students, from all disciplines the sciences, engineering, we had physics students, and combined them with the business school students. And the idea was to create teams within the class and solve an environmental problem. I had spent that previous summer with the experimental farm at Eton just learning about sustainable farming practices, because my dream at the end of my career is to own a homestead farm and be completely off the grid and things like that. So I thought it was a cool opportunity, and all summer my job was to install drip irrigation and what that entails is carrying around these 50-pound rolls of drip tape, which was like more than half my weight at the time, and you lay them down, you run them down the rows and you have to stick them down into the ground with these six-inch staples. And it was, I mean, backbreaking labor and it was very time-consuming. It took so many of us volunteers to even install it in the first place. And I realized that even though drip irrigation is the most water-efficient irrigation system available, small-scale farmers don't have access to it because there are no tools to install it. The comparison that I learned was drip tape can be up to 95% effective in terms of having the water actually reach the roots of the plants instead of being evaporated into the air versus sprinklers, which are about 60% effective at best because you're literally spraying it into the air, and it's harmful for plants since it's getting water on the leaves and other parts of the plants that don't need it. And that gap made up for I mean, we're talking about billions of gallons per year in just waste of fresh water. And when 86% of freshwater goes to irrigation for crops, just looking at global numbers, there was a huge gap that could be made up if this, more water, more efficient irrigation system was available for farmers. So with that idea, I did my first pitch, very shaky pitch to the class. I just hated public speaking like many of my colleagues at the time, and we were the only team to actually complete the checklist and get a high enough score to move on to the competition portion. And so with that, we created my first company Tape-it-easy and we created very, I would say, low-tech and easy human-powered tool to lay down drip irrigation for small-scale farmers.

John Shufeldt:
Wow, do you see the analogy between that and what you're doing now? Because it was like instantly obvious to me.

Allisa Song:
Yeah, yeah, I think I didn't see it when I was developing Nanodropper, but yeah, I see a lot of analogies.

John Shufeldt:
It was pretty amazing. Okay, so you do biology, psychology, neuroscience. As you said, you dragged your parents along for a little bit. You get into medical school and you aim for the top in our medical school right now. So right now you're in the holding pattern waiting to graduate, right? Is that how you'd describe it?

Allisa Song:
That's correct, yeah, I finished all four years of my medical school curriculum and my school was very gracious in letting me start an academic leave of absence to be able to pursue Nanodropper. They really wanted to cultivate this unique experience and opportunity that I had. And so they're really supportive, which I know isn't always the case, whether it's because of resources of the school or policies.

John Shufeldt:
Well, you know, the way you, so one of the things that's always impressive about you is, right from the first moment I met you, I was kind of laughing after I met you, like, God, I've been to all the school and this young woman is much more articulate than I am. Because you just walked in, did your pitch, and just crushed it. I'm like.

Allisa Song:
Oh, my gosh.

John Shufeldt:
... School for, I clearly didn't need it, I just needed to be her. But you did something really smart because I think last time we talked, it was you know, I tell you, I was trying to help this kid who'd been out of medical school for a few years, try to get a residency slot. And he's struggling because they're saying, hey, I've been out of medical school a couple of years. Like, you know, you're, your knowledge base is gone. And what you said is, well, that's why I'm still in medical school. I didn't graduate on purpose, so nobody could ever say that. That was very genius.

Allisa Song:
That was my risk, medications, that for sure, yeah, you're too kind. I mean, I didn't come up with this on my own, so I have just benefited from all the mentorship around me into taking good steps to be able to focus on Nanodropper, but also to mitigate a lot of the risk that comes with entrepreneurship.

John Shufeldt:
Now, I can see where, again, once you explain this to me, it was like, I can't believe no one has thought of this yet, because it was so clear, no pun intended, that after you said, I'm like, Well, God, yeah. I mean, you're saving what percentage? How much longer do bottles last with Nanodropper? I can't remember.

Allisa Song:
Yeah, we make the bottles last 3 to 4 times as long.

John Shufeldt:
That is unbelievable. It seems like you'd be getting hate mail and death threats from pharma because all of a sudden now you've cut their revenue down by quite a bit, 60%.

Allisa Song:
Yes, so that was definitely our thought in the beginning. And I think our team just being a little bit maybe naive on the stronghold that pharma has was helpful in us being able to even take the stuff in the first place. But the more we learned about the landscape, the more we realized that we had really good timing and we had a lot of luck in the timing. What had previously been tried to solve this problem of oversized eyedrops is ophthalmologists have tried to create brand new packaging systems, basically creating a different eyedrop bottle that reduces or even doesn't have to reduce, they would just dispense smaller droplets in the first place. And this wasn't a new idea we saw in our patent search that there were at least three other attempts that had been filed for patents, and from that original article, we also knew that Dr. Alan Robin, who is a huge presence in the glaucoma world, he had worked in industry before and had developed his own version of a micro volume delivery device. But these are all complete packaging systems and that relies on the pharma companies to license it and then put their drugs into that device. And so they didn't gain much traction, and I wonder if that was now when all of these brand new medications now have expired patents and they have generics available, the landscape would be a little bit different for them. But all of that to say, I don't think Nanodropper would have been received kindly by pharma if this was 30 years ago when all of these brand new medications were still very active and there were, there wasn't any competition. 30 years later, when there's these generics available in ophthalmology, just want to prescribe the brand name, and these brand-name medications are now at the end of their life cycle, Nanodropper, by reducing the per-dose cost, makes it pragmatic for patients to actually buy the brand name instead of the generic, and ophthalmologists prefer that because of the inactive ingredients and there's evidently like an FDA loophole around generics and eyedrops that make the batch-to-batch consistency less reliable. Because of that, yeah, so because of that, even in Canada, where you have great coverage, we realized that we have a market. Nanodropper has a market in Canada because the ophthalmologists there still like to prescribe brand-name medications, which is not covered by the government health system. In addition to that, with this huge shift in our healthcare system right now towards value-based care, I think pharma is now taking a closer look at all of their medications and being like, how do we take the same medications that are developed not have to go through all the process of discovering a new drug, but take the medication and somehow create better outcomes for patients. And you can do that by changing the delivery of that medication. With micro-volume delivery, there's this promise of equivalent efficacy with reduced side effects, meaning better tolerability and adherence for patients. And adherence really is the currency when it comes to talking about value-based healthcare. And with an adaptor like Nanodropper, we're actually able to both elevate the patient experience, deliver better outcomes with better adherence and better tolerability of the medications, and reduce the cost of that care, really, the trifecta in the value equation. So I think because of that, pharma is now really interested in micro-volume delivery options. And our two competitors in this field, both have pharma either have acquired them or have a big licensing deal.

John Shufeldt:
With them. And so, just, so let me try to explain it then you correct me. I mean, what I saw and the demonstrations I've seen is that Nanodropper is basically a patented device that screws on top of these eyedrop bottles to lower the volume of the drop that's being received. Is that a good description?

Allisa Song:
Yeah, that's perfect.

John Shufeldt:
Yeah, excellent. Okay, so, and so, you know, again, this seems like it sounds like the person who started down this path said, we're just going to design a whole new bottle. And if you want, you pharma, wants put your drops in my bottle, you've got to buy the bottle for me. Your solution is, which is great, but your solution is much more elegant and much more diverse, I mean.

Allisa Song:
Thank you, I appreciate that, yeah.

John Shufeldt:
It fits on all sorts of different eyedrops, correct?

Allisa Song:
That's correct, we are compatible about, with about 90% of eyedrop bottles that are preservative-containing, we call them preservative-containing multi-dose bottles. So we're not compatible with preservative-free formulations because they have a one-way valve mechanism that we wouldn't want to adapt to.

John Shufeldt:
Interesting, okay, what's kind of been your biggest takeaway from this journey? Like, what was your biggest, I guess, surprise?

Allisa Song:
Yeah, I think, oh my gosh, I have a few big learning moments. I guess for me personally, I was surprised at how much waste there is, not in just medicine, whether that's purposeful or not, I really can't speak for the intentions, but not only is there waste in the actual delivery of medicine and healthcare but there's so much waste being created driving up the costs from the companies themselves, whether they're medical device or some kind of software solution. Just the R&D process, the marketing process, the swag, the wining and dining, like all of that to me is waste that is only driving up the cost of care for, at the end of the day, the patient. Like someone has to pay for that and it's not, and it's going to be the taxpayers and the patients. And so I realize that some of this healthcare burden that we're seeing is artificially, artificially inflated.

John Shufeldt:
Yeah, totally. You know, it's funny and it's, your era is so much different than my era, which is so much different than the era before me. So the era, so I kind of missed this one because of the discipline I'm in, but also was kind of going away when I got into it was, you know, I'd hear stories and it's just exactly what you said is that these huge dinners and ski trips and this and that where drug companies would pay physicians or device companies or orthopedic companies would pay physicians to go or sponsor physicians, go on these events, and there'd be an educational component to it, but it was really for fun and to get them to use their product. And again, I missed all that, but I mean, it sounded like just like you said, it was way over the top, and it's, I think it's come down a lot, but it's, obviously still goes on.

Allisa Song:
Yeah, especially if you look at these conferences. Yes, I agree that a lot of the wining and dining of physicians has gone away, but the same doesn't apply for the other staff members in the clinic. For example, if you look at private practices to get in the door, you have to wined and dined the managers and maybe the lead techs. And at these conferences, these booths are literally multimillion-dollar productions. We looked at the cost that was reported by the American Academy of Ophthalmology for their annual meeting, and they're literally in the millions of how much these device and drug companies have spent building their booths on sponsorships, and we all pay for that.

John Shufeldt:
Yeah, totally. Were you surprised at how difficult the entrepreneurial journey was, like compared to compared to medical school? So I always will tell people like, you know, I thought medical school was quite difficult. It was a lot of fun, I had a great time, but it was difficult. Of all the education I've done, medical school is the hardest. The word is out there, sorry, but it was. Further down your entrepreneurial journey, where do you think it stacks up?

Allisa Song:
Oh, man, I agree, medical school is not easy, but I think there was a much clearer border of, okay, so this is how much knowledge is out there, and if you know this percentage of it, or at least all the red flags, you feel safer, you know, where your safety margins are, you know, your own confidence level.

John Shufeldt:
In medical school.

Allisa Song:
Exactly, the guardrails aren't there for entrepreneurship, and I found that to be the hardest part of taking this leap in making decisions, just even everyday decisions with the company based on incomplete data is the best way I can put it. There aren't that many people who have done exactly what you have done before, if there are any, and so there's a limitation to how many advisors and mentors you can ask because they haven't done exactly what you have done. Unlike in med school, I can ask my seniors, I can ask my attending or consultant or I can look it up on up-to-date. There are so many resources where there are examples of exactly what I am seeing, and there just wasn't that in entrepreneurship. And I think that part is still the hardest part for me, making decisions on incomplete data.

John Shufeldt:
Yeah, it's funny. Well, first off, you don't seem like a guardrail girl. I'm sure your parents would not describe you as one who needs guardrails. For example, right, so for me, emergency medicine was making quick decisions with incomplete information, with this 90% confidence interval that you have to be okay with. And a lot of physicians and people, in general, are not okay in the 90% confidence interval, they're like, it's got to be 90, 95 plus, that was never me. But I do think your analogy is good, and as much as I mean, entrepreneurship is very challenging and I think it's medical school challenging, but one of the most challenging things is there's no playbook because like, like what you said is a lot of times you're doing things that, yeah, there's been people you can ask about, Hey, I've run into this barrier or this challenge, give me your advice, maybe you've done it before, but no one's done what you're doing. And so you're in, you know, you're in uncharted water in many respects.

Allisa Song:
Exactly, especially when it comes to the other players in this industry, and as the trends come and go, just like being on top of all of that. And it feels weird being, I guess our team holds almost all of the knowledge that's out there about micro-volume delivery. And I guess I'm just not used to that because, you know, in my research years for when I was studying the Kappa opioid receptor, there just seems like there was so much more to read about. There's an endless amount of literature out there, but we have, our team has read basically every single paper that there is in existence about micro-volume delivery comprehensively, all the companies that are working on it, all the prior attempts. And we're, I feel like we're really at the upper end of having this comprehensive knowledge about this very niche field. And it's such a different experience than med school or my research years for sure.

John Shufeldt:
Right, is there any other applications to what you're doing? You know, instantly, you think of eardrops, and again, I don't think I've ever used an eardrop on myself, but it seems to me that when I put eardrops in patients, again, most of them runs down their side of their face. Is it the same issue or different?

Allisa Song:
So we looked into ENT applications and there isn't clear research like there has been done like at the ocular surface in terms of the volume or the physiology that would say, okay, this is the minimum of volume that's necessary to have therapeutic effects. So because there wasn't very clear-cut research, it's still a big question mark, but a very clear application is in veterinary care and also dentistry. So everything from bonding agents to etching agents and things that they use to fill your teeth with or cosmetic procedures on your teeth, they all come in squeezable-like eyedrop-looking bottles, and they have a lot of waste in them. And although the patient doesn't necessarily see the price, it's a big overhead cost for the clinic and the dentists. And so there's quite a bit of waste in that area, and what's great is it doesn't even have to be sterile. Those drops aren't sterile drops, so we're looking into making a dental application version of the Nanodropper. I think there's a lot of applications that will be found in just like research and industry in terms of anything that you would use, like a mail-type header for where you don't need exactly the accuracy, I should say precise, but not necessarily as accurate. That's below 35 microliters, but let's say above five microliters, that would be a really good sweet spot for application like Nanodropper where the reagent that comes in a bottle, you can just put on a Nanodropper and we would have various sizes.

John Shufeldt:
Wow, it's amazing. Well, any parting thoughts to people who are out there saying that woman is really cool, I want to be her?

Allisa Song:
Let's see, I'm just a huge proponent of physician-led entrepreneurship. I think really the state of the current healthcare system that we have in the US could really be changed for the better, to be aligned with patient outcomes, with good patient care, and evidence-based medicine. If we had physicians leading every single sector of it from medical devices to policy, to insurances, I really think that even though we don't learn about it in med school, I feel like we have a lot of the tools needed and the training needed to be successful in these fields. And I think at the end of the day, like that alignment is what is going to drive down costs and bring up value.

John Shufeldt:
Totally agree, I mean, and you're going to physician-led, how you're in a physician-led health system. I mean, Mayo is an incredibly notable physician-led system with outcomes that speak for themselves. And I never had the fortune of going to Mayo, I never would have gotten into it, but they're doing something right. And the studies are very clear that the hospital systems led by physicians, their scores are much better, outcomes are better, and as you probably guessed, a big proponent of we've got to save ourselves and the and the patients because clearly, we're on a path, a nonphysician led path that's driving healthcare costs up.

Allisa Song:
Absolutely.

John Shufeldt:
I completely agree with you. So thank you for being part of that. That's again, very badass for someone still in medical school.

Allisa Song:
Thank you so much.

John Shufeldt:
My pleasure. Well, everybody, thanks for listening. It's been another really fun for me anyway, Entrepreneur Rx. We'll be back to you soon. Thank you all, be safe.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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