THE GOOD PYRAMID

There is something missing in the fight against COVID. Precision Medicine, and You.

Allow me to explain the role of Precision Medicine for COVID and healthcare in general, and how You can make a difference.

COVID-19 is putting tremendous pressure on the pharmaceutical industry to produce a solution. Continually promising great results based on but walking back expectations about time till readiness has produced a sense of unease in the public.

For me, this sense of unease is extremely acute. Having worked with diagnostics, I appreciate the capabilities and deficiencies of various types of tests. Even more troubling are the prospects of drug discovery and vaccination. The essence of the trouble is that current efforts, which we reviewed while cataloging COVID clinical trials by mechanism of action can be found here, is lack of individual specificity of treatments.

Such specificity of treatment is essential, because damage to COVID patients comes results from immune system attacking the body in various ways. The impact of COVID infection that differs widely based on individual response to the immune system, which needs to be strong enough to defeat the virus, but not hyper-activation of the immunity called the “cytokine storm”. The current drug development efforts are looking for a panacea, which is supposed to work for everyone.

A panacea for COVID is unlikely to exist. Treating people regardless of specifics of their health state and progress of the pathology with some treatment is extremely unlikely to exceed overall response rate of 30-50%. In other words, the treatments work for some people.

What is required is Precision Medicine to identify proper treatment. This precision treatment is sometimes called individual medicine, but “cohort medicine” is more accurate. “Cohort” is a common term used to describe a group of clinical patients. The use of biomarkers which correlate with positive response to specific treatments is illustrated below.

Figure 1: Biomarkers and Precision Medicine

As the figure above illustrates measurement of individual biology and pathology using biomarkers can potentially allow coverage of multiple groups of patients with several treatments.

Biomarkers identify individuals as belonging to a type a patient for whom successful treatments have been statistically validated, eliminating the guessing game of treatments, and opportunity cost of inappropriate drugs.

The figure below illustrates the financial aspect of Precision Medicine. Currently, after successful approval of New Drug Application (NDA) by FDA, treatments earn drug developer money regardless of outcomes. What is worse, there is typically little to no diligence on the part of the drug developer to ascertain likely efficacy for an individual. They are happy to roll the dice with your help because they get paid regardless. The blame for this situation lies primarily not with pharmaceutical companies, but with regulators. That outcome-independent reimbursement for drugs administered to patients may have been appropriate decades ago, when therapeutic options were extremely limited. Trying to cure a disease was enough. The situation of paucity of drugs has been significantly resolved, and patients need to transition from being beggars to choosers.

Figure 2: Outcomes-based medicine and precision treatments

Specifically, they need to insist of proper diligence for choice of drugs. That requires biological measurements, individual biomarkers, to direct treatment.

At the same time, the reimbursement paradigm needs to shift to outcomes-based medicine, to provide incentive for pharmaceutical companies to have a financial interest in ensuring positive outcome for the patient. From patient perspective if a medicine is unlikely to work, it is better to find an alternative. Pharmaceutical companies should have financial incentives aligned with patient.

What does Precision Medicine require on technical front? Biological discovery requires engineering solutions to accelerate and improve drug development processes. Specifically, the are pieces of clinical and pre-clinical research and development connected by Biomarkers. FlowCell is distributing tools for preclinical research. These tools combine microfluidic techniques with sophisticated biology (e.g. organoids) to increase physiological relevance of early development. The resulting platforms are called micro-physiological systems (MPS) and are particularly suitable for development of biomarkers.

FlowCell is developing its own enabling MPS platforms, as well as tools for clinical applications. The latter is particularly important for COVID, where clinical trials without biomarkers and headed for confusion and failure. Our tools will be compact, and integrated (turn-key) to automate many functions of processing biological samples (e.g. blood) at clinical trial sites, typically hospitals.

What role can you play in this process? As a scientist or a medical professional, you can help us to spread the message about Precision Medicine, and new tools that help to increase translational value of pre-clinical research.

Essentially, can you become part of our marketing network. There are lots of biologists in academia and industry who are not aware of availability of MPS tools, and their usage. How does being an Ambassador for Precision Medicine look in practice? Most people adopt the soft networking approach, and share information with their colleagues in drug development field. More committed individual lead workshops and have a more proactive outreach.

What do you get for being a FlowCell Ambassador? First, there is commission-based and long-term compensation, more about this later. Second, being a champion for precision medicine has its own rewards, both moral satisfaction and professional growth. The mission to change practice of medicine to outcomes-based, precision medicine is a wonderful humanitarian contribution. Communication about enhancing the translational value of drug development processes put these champions in the middle of a revolution in healthcare. Exposure to different companies, and communication about market and technology elevates scientists and teaches them useful skills for industry or entrepreneurship. Successful Ambassadors not only establish a revenue stream for themselves but also grow professionally. This can be especially useful to researchers seeking to transition from academia to industry.

Compensation & Incentives.

Starting out and laying groundwork for new processes is hard. Our incentive structure is aligned with rewarding early adopters, and those with managerial skills.

The key to this network marketing is indirect compensation, in a hierarchical organization. This is what we call the “good pyramid”. It is a modern way of sharing and growing efficiently. Some call it a growth hack. I consider it an essential part of a modern open corporation, which delivers new technologies that improve healthcare, and provide lots of value along the way.

Figure 3: Network marketing hierarchy

The essence the hierarchy, Figure 3, is a system of threes. After an Ambassador has found some success, he shares his findings with a small team of up to 3 people and becomes a leader. Every direct contribution that his “direct reports” make provides and indirect compensation benefit to the manager.

In this scheme, an Ambassador can progress by helping to educate and train others, rising in the hierarchy. There are not restrictions on the number of layers for indirect compensation to be credited, only time restrictions. For example, an L3 leader, collects indirect benefits from business development nine L1 Ambassadors, who are overseen by three L2 leaders. In this fashion, a leader is only responsible for a manageable fraction of the hierarchy, and the system favors vertical growth.

The key to long-term success is finding contacts among new potential customers for MPS and other microfluidic products distributed by FlowCell. If Ambassadors help with securing a deal with an existing customer organization, they get credit for that specific deal. However, new organization provides credit for subsequent purchases by this customer for up to 5 years. In the beginning, the field is particularly wide open, so early adopters (Ambassadors) have a distinct advantage in securing long-term indirect commission-based compensation.

Type Compensation Condition Duration
Direct 3% New deal Immediate, one-shot
Indirect 0.3% New customer 0-3 years
Indirect 0.1% New customer 3-5 years

Email us, and join our monthly seminar about becoming and Ambassador for Precision Medicine.