An Implant That Tracks And Treats Cancer Tumors - EP 82 Ben Woodington

Okay, we are breaking new ground on this episode, at least for me. We are talking to Ben Woodington, the CEO and co-founder of a company called Coherance that is partially based in the UK and partially in the US. The company is broadly in the brain-computer interface field. You will have probably heard a lot about this with companies like Neuralink putting chips in people's heads, folks with, uh, who are paralyzed, who have ALS, being able to use computers, being able to speak again through their thoughts alone. Coherence is quite different from everybody else. It is using chips in the brain for the moment to monitor, analyze, and try to control cancerous tumors. The early stuff coherence is doing is, is putting a Neuralink-like brain implant right into a brain tumor and then trying to use electricity to blunt the growth of the tumor and also to see if other medicines are working, not working with the tumor. It's this whole idea of, of putting chips in our bodies so that you actually know what's going on when you're having cancer treatments and then using these electrical impulses to control the underlying mechanisms behind the tumor to either slow its growth or perhaps even get rid of it. Um, typically people Go for MRIs and other scans every few months. The idea here is that you would have a chip that's constantly monitoring what's happening with your cancer and, and giving your doctor a ton more information. Coherence has been around for about 3 years. They've made what I consider to be remarkable progress. They already have a device they've been testing in mice, and they are heading toward human trials in Australia in the near future. Ben is very, very smart. He's got a fascinating story of how he got into all of this technology. And I think you're about to learn about this new field called neuro-oncology that I barely knew existed before doing this. I am Ashlee Vance. This is Core Memory. Here we go. Ben, hello.

Pleasure to be here, Ashlee Vance.

It's nice to meet you. We're meeting for the first time.

We are. Yeah. Although I feel like I know more about you because I see you on Twitter and your documentaries. So, you know, when you meet a celebrity for the first time and you say like, oh shit, I know all about you and they don't know you at all, it's embarrassing.

I let it all out there on Twitter. I try to let the personality go. But who did Erne introduce us?

Erne introduced us.

Okay. Okay. All right. Well, this is crazy because I felt like I cover BCI technology about as deep as anyone, I think. And just had— I had not heard of you guys. I had not heard of this like entire field of discovery and the idea that you could use electricity for Cancer therapy, also had not heard of that. So I feel like this is amazing for me because I just, I was reading about you guys last night, but I have to like learn all of this. So usually on these episodes, I try to set things up for people just to get their footing. But I think I'm out of my depth on this one other than what I read last night, which is we traditionally treat cancers with poison, uh, cut them out, um, what else, uh, burn them with radiotherapy, right? You know, so very drastic, uh, measures. And, and then this, this essentially, you guys are, you're not alone in this, but you're pursuing a whole fourth way to possibly treat cancer with electricity, modulating electricity.

Yep, that's, that's absolutely right.

Okay, okay. And then from— I'm gonna let you give the history here, but from everything I read, it's roughly like 10 years that researchers have really been going at this. And I think there's a woman at Stanford in particular who's published quite a bit on this. What is like the name of this field?

Yeah, the field broadly, you'd call it cancer neuroscience.

Okay.

And it's fields of oncology and neuroscience overlapping. And the person you're referring to is Michelle Monge over in Stanford, who really push this field forward, accelerate this field, probably, yeah, 10 years ago.

Okay.

Won the Brain Prize last year, which is sort of like the Nobel Prize of neuroscience, right? Um, for her work in, in this field as well.

Yeah. And I was like, oh, she's close. I'm gonna get her out there, see if I can get her.

Yeah.

So what— I mean, we're going to get into how all this works, but what if that's— if this started in earnest in some sense 10 years ago, what do we know the history of, like, Did people already suppose this was possible, or somebody made a discovery, or how did we start to get to this idea that electricity could have a role here?

Yeah, we can go back decades and decades and decades. And, you know, our field overlaps. You know, there's oncology that overlaps with neuroscience. We're throwing another technology layer on this neurotechnology. So we sort of think ourselves as cancer neurotechnologists. And you can go, you know, back decades and decades and look at how nerves are infiltrating tumors. You can look at how cancer cells express ion channels the same way neurons express ion channels. Or you can go back 25 years ago where this company that I'm sure we'll get into, Novocure, started using electrical stimulation to treat tumors as well. That was all happening and that was all stuff we knew about. 10 years ago, the piece that you're referring to is 10 years ago, research came around that says, you know, these tumors, yes, they respond to electrical stimulation, but they're not just living in isolation in a vacuum in your body. It's very easy for us to think about tumors just sort of floating around the body, but they're not. They're fully integrated with blood vessels in the body. They're like a living part of our tissue, of our body. And they integrate with neurons, with nerves that grow into them. They feed them.. And, you know, Michelle's group showed that in the brain, these, these cells, these, these cancerous cells, they're actually forming functional networks with the rest of the brain, which was the big— that's the big breakthrough.

Okay. Which is like sort of horrifying.

It's pretty terrifying. And then that has been built out over the last 10 years now to show how, you know, remarkable that is that these cells are doing that. They're forming communication networks within our brain. They're shaping the entire network of our brain. And someone with a glioblastoma,— as that glioblastoma, a very aggressive form of brain tumor, as that tumor grows, it completely rewires your brain. And then follow-on groups have come through and said this isn't actually just happening in the brain, this is happening all through the body. So whether you have colorectal cancer or pancreatic cancer or lung cancer, these same sort of networks are integrating with these tumors as well, which is even more horrifying. Yeah, it's terrifying on top of terrifying. Yeah.

Okay, well, let's start with glioblastoma just to anchor everybody and hold on to something specific. So it's this aggressive form of brain cancer. It's untreatable. You live— what I think it was, 12 months is—

Yeah, 14 months, maybe 15.

Yeah. Okay. Okay. So this— so, you know, untreatable, very— all very drastic. And so this is where you guys are starting as well. And then you mentioned, you mentioned Novocure. I'm going— for the people who are watching on YouTube, I am going to try to bring up the screen and focus here. I mean, this device is— it goes— I'll describe it for people. I mean, it's, it's a bunch of electrodes, um, around the scalp. You have to shave your head. Um, it's covering the entire scalp. And then it's connected via pretty chunky wires to this really large device that a woman is holding in her hands. I would say it's about the size of, I don't know, like a case of beer or something.

I mean, I thought it weighs about the same.

Yeah. Yeah. It's big. And so I was reading about it last night. So people have been using this device. You have to wear it for about 18 hours a day, ideally as much as possible. People get I think the camera can see this. People get— it irritates their skin. They have to shave their head. You have to go around with this clunky thing. What you guys are making looks much more similar to a Neuralink-style device, which is quite small. I think you say it's about the size of a button on a t-shirt, and you wouldn't have all this associated machinery. However, you would have to have it implanted in your brain. So there's like trade-offs there. And then on the most basic level, so for the people who have been using this device from Novocure, it's called the Optune Geo. And I think I saw something like 30,000 people are using this or—

I think 30,000 maybe have used it. I don't know what they've got currently running, you know, a few thousand at a time running it.

But it showed people were living longer than expected, at least from what I was reading.

It's the most significant breakthrough in glioblastoma over the last 25 years. Yeah, okay. Nothing has held anything to it in the last 25 years. Yeah.

And then to give people just the very basic science, so what's happening? I mean, there's electricity going in through your scalp and to the tumor, and then what's happening?

Yeah, yeah. So, uh, you, you gave a very, uh, you described the system very well. I mean, they have electrodes on the scalp, as you say. They've got good contact there with the scalp. They're carrying around a big battery pack all the time that's applying, uh, like a sinusoidal waveform, right, a stimulus. And that's creating an electric field in the brain, and they're trying to target that on the tumor side. And what they're trying to do there is, as those cells are dividing, you get a sort of skeleton that forms in that cell, holds it into shape, that pulls into shape as it's dividing. That skeleton is made of a charged molecule.. And if you apply a field across it, you can disrupt that. So as those cells are just, just dividing and splitting apart, you can disrupt that. Cells break down, they go into what's called apoptosis, they die, the immune system kicks in and tries to clean up that area. And why that works in the brain, of course, is nothing else in your brain or my brain should be dividing that fast. It's sort of the core of cancer therapy everywhere, right? You want to target the tissue that's growing very, very quickly. Yeah. And spare the tissue that's not growing very quickly. So that's one mechanism. Now, there are other sort of secondary mechanisms we can get into if you'd like to, but that's the sort of prevailing mechanism that Novocure claim to be building on top of.

So it's trying to just slow the progression of the tumor.

Yeah, absolutely. I mean, it's trying to disrupt and destroy those cells. And then when you stack a chemotherapy on top of this device, you get a really profound effect to the longevity of these patients, how long they live. So that's one element there. But of course, this is 25 years ago, 15 years prior to this whole—

So we knew this worked. They've been selling this device for a long time.

Yeah, they've been selling this device for a long time. It has a very, very steep usage effect curve. So if you're using it under 18 hours a day, it barely works. If you use it 22 or more hours a day, it works really, really well. And so then people then have to carry around this device with the wires and the batteries and everything for, you know, 22 hours a day or more. So they're sleeping with it, they're traveling with it, they're usually with carers so they can align all these pads and everything. But it works.

Yeah. Like, I don't want to come off as callous to this company, if companies have feelings, which I think in America—

My company has a feeling.

They do, apparently. But, you know, so like, miraculous that it works and is helping these people. I mean, it's like clearly cumbersome. And I mean, you would not want to wear this if you did not have to.

Yeah. Certainly not. And I think that's one of the main criticisms here of this technology. We have to be thinking about people's— especially in a disease this horrible. We have to be thinking about people's lives, the rest of their lives. And there's a major impact to your lifestyle, to your independence, to pain and everything else. And so we do have to make that equation. And when I speak to patients and I speak to many people that are using this technology, you will kind of always get the same feedback, which is, I'm so happy that this technology exists and that someone has done something here., but I don't like it.

Yeah. Yeah.

Like, that's annoying. Yeah. And it affects my life quite dramatically.

I, and I, I'm trying to calm down. I'm sort of overwhelmed with questions because this is so exciting for me to be in like a new area that I know nothing about. So anyway, try to do order of operations for the listener before we get into exactly what you guys are doing. So, okay, outside of this, these brain tumors, you already talked about, we think this can work in other parts of the body. Is it always doing the same thing? You're applying electricity to try to slow and disrupt the growth of the tumor, or is there an element of eradicating the tumor as well?

I mean, there absolutely is an element of eradicating the tumor, and you can stop these cells. You know, these cells are very hungry, and they die pretty rapidly if you inhibit their growth. And there are multiple ways you can attack this, right? So yes, there is the, you know, directly affecting cell division.. But then there are these second-order immune effects as well. So with these kinds of technologies, you can modify the immune system. And this shouldn't be, again, very shocking. There are companies out there, you may have even covered them at some point, that look at lowering immune function using electrical stimulation devices, bioelectronic devices, for things like autoimmune disease. And the inverse is true as well. You can upregulate the immune system in your body using electrical stimulation around it. So there are kind of like two, two things going on. There, direct function on cells and immune function as well. And that's a powerful thing in cancer.

Yeah, I mean, like, in some sense, this is weird and not. I mean, the body runs on electricity. It's just whenever I think about upregulating or downregulating something, you're messing with DNA, you're putting in a molecule to adjust these functions. You guys are just approaching this with electricity.

Yeah, absolutely. And drugs are a biochemical, bioelectrical process, right? There is an electrical process going on there on the single-cell level. We can just do that at a systems level as well, which is what we're looking at. So rather than using drugs directly, we're just looking at how we can modify single cell states using electricity, how we can modify the microenvironment. So how neurons and blood vessels are there using electricity, or how we can modify whole system immunity, for example, using electricity.

Okay. Okay. And then just to give people a comparison. So this is your company, Coherence, and Let me see if I can zoom in there. So this would be, I mean, very, um, for people who have seen some brain-computer interface type devices, very kind of similar. So there's a, um, well, you can't see it, but you know what I'm talking about. So, so there's this device, again, for people who are watching on YouTube or somewhere, um, so you've got, you've got a, a almost like a Bluetooth headset looking thing going over the ear for people who remember those, and then Um, and then there's a brain implant.

Yep.

Um, so, so you guys, okay, you're— and then I want to pull up a picture of the actual, um, implant. So when you have this like blown out image, yep, I mean, this looks very similar to Neuralink. Is this like, is this a render or does this exist?

No, this exists. This has gone into, into our safety studies already.

So it's, uh, it's like a coin-sized device. And so you've got, you've got some microchip in there. I assume you got a battery.

We actually don't have a battery.

You don't have a battery? Oh, the battery's in the—

battery's on the outside. Yeah. Okay. So there's some sort of quite specific engineering here that does differentiate it from that Neuralink device. And that form factor kind of looks similar because everyone kind of converges on this similar form factor, right? Something that you want to plug in the skull. Yeah, but it's quite different. So we have to take the battery out and the magnets out. And the major reason for that is these patients are still going to have MRI. So we don't want to cast big shadows on an MRI. We don't want magnets being, you know, fooling with the MRI. So we have to take all of that out, which is why we have to move those externals to the, to the, to the outside. But otherwise, the inside, the guts of the device are, yeah, there's a chip, there's a stimulator chip, there's electrodes that come out of the front of it, and we're delivering a stimulus and we're recording. So you can think of this conceptually similarly to Neuralink or those other BCI plays where you're Recording some electrical activity, you're doing some processing, you're stimulating.

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Yeah.

To have portions of the tumor removed.

Correct.

So the brain's open. Mm-hmm. And so, and this is going straight into the, you want it like as close to the tumor?

Yep.

As possible.

Yeah. Yeah, exactly.

Okay. And then, so it's going under the dura. Yep. And so you run the risk of infection, scarring, all these, these traditional issues.

You do, but, uh, For our first approach in glioblastoma, these are pretty gnarly surgeries. It's not a very simple, you know, in-and-out surgery. It's very complex. It takes some of the most specialist neurosurgeons in the world to do this, and we're piggybacking on top of that. So we're sort of marginal, you know, add to that.

Okay.

It's— they're performing this debulking, this resection, you know, we want to go in, leave this device behind. Compared to the damage you're doing from a resection, like, we're nothing. At all. And of course we take a lot of care in making sure that we're nothing, but yeah, pales in comparison.

And then does the skull get totally closed over the top?

Yep.

It does. Okay. So the, like the Neuralink chip kind of replaces the chunk of the skull.

Yeah. We go into a burr hole. So, uh, the little burr drill that they use, about 14 millimeters in diameter, uh, we, we plug into that.

Okay. Okay. And then, so there's like a wire that's kind of extruding out or?

No, that's just a coil. Just okay.

Okay. Okay. And so the rest of this device is handling the charging, some of the communication, some of the processing. And then you're— and I saw, so you can wear this for how many hours?

We're going to go for a day at a time.

A day.

So yeah, people would just be wearing this, this, you know, constantly.

And then you just recharge the earpiece.

Yeah. So we actually— this is our old form factor. We haven't shown our new form factor yet. It's going to be going live within the next month.

Okay.

That actually has a little magnet-connected battery module that you can just pop off and pop on a new one as well. So, you know, people can keep going and have to sit there charging the device all day.

Okay. So obviously you don't have to carry around this huge battery pack. You don't have to shave your head. You don't have to wear this thing across your entire scalp all the time. Does it have other benefits? Like, is it, is it more flexible on the sorts of charge it can put in and out of the brain?

And yeah, there's a few things. So number one, because you're up close and personal now with the tumor site, like you're getting— if your biggest problem is where do you concentrate your charge, your field, whatever, your stimulus, you're there, you're right there. That's great for us. But the other major part of this for us is the readouts, the ePHYS readouts. So that's just something that's really, really hard to do with these headsets on the outside, right? You record sort of low frequency-ish oscillations with these EEG caps. When you're inside, you get very, very high-density information. So the sort of second element of what we are doing as a company and as an eventual product is recording electrophysiology all the time, recording out from these neurons what's going on. And we can actually use that, train models on what the hell's going on in the tumor as well. So we can use that electrical information as a proxy for tumor size and volume and aggressiveness and whether it's responding to drugs and whether you're having a seizure and all of that kind of stuff. So we've been doing this in mouse models for now. We're kicking off our human work soon. And you get really nice readouts just from the ePHYS. The idea is to train these against MRI and do away with MRI, to overcome that second part of the patient journey, which is I now need to go to hospital every 3 months to get my scans to do this and that. And no, you stay at home. We'll just be monitoring you 24/7 all the time and looking for cues of when someone needs to intervene and do something different because you're getting this constant stream of data.

And so Optune device that we were looking at before, obviously it's outside of the skull.

So you're—

they're blunted by the skull and the skin and all the tissue, and you're right up against the tumor.

Absolutely. Which means we get nice spatial definition, but we can also record these higher frequency bands as well, which it turns out is the most interesting frequency area for cancer as well. And again, this is, you know, we're not building from zero here. There's a lot of incredible work going on at Stanford and UCSF looking at these patients during surgery, sticking grids on their brains and looking at what kind of differences you see between healthy tissue and a glioma-infiltrated tissue. And again, because of this called cancer neuroscience space that's showing that these neurons are functionally synapsing with the cancer, you get weird kind of electrical spiking activity because of that as well.

Okay. And then I didn't show this one piece, but you also have almost the not quite threads like Neuralink, but you have these long electrodes on a film. And so are like, do you have threads going into the tumor or this film is sitting on top of the tumor?

No, it's around the tumor. Yeah, it's around the tumor. So that, that sort of resection cavity, we want to stick electrodes around there and it's sort of like a macro scale Neuralink on the front, right? So the back end of the device is much, much smaller. Front of the device, we want these like nice long leads with, with good coverage so we can go around that tumor site as well.

Yeah, because I was having trouble with perspective because you were talking about like a shirt button size, whereas Neuralink is much more like a quarter.

Yeah. So it's about half the diameter.

Okay.

My numbers are right.

Okay. And I don't want to get you in trouble or anything, but, you know, I mean, I was just like really impressed with— because you guys started in 2023.

Yes.

Um, like when I see competitors to Neuralink and traditional BCI, usually their packaging on the device looks nowhere near as good as Neuralink's, whereas you guys really seem to have gotten this really nice tight package in this small device. And then, and then I have no idea what kind of intellectual property is around these, these thin— I guess it's probably nothing because it's really just a thin electrode layer, right? I mean, yeah.

So a lot of the engineering is not on the front of that device, but on the, on the back for sure. Yeah. We have very talented engineers that have built these systems before who know how to do this thing. But of course, one of our big benefits, right, is we can take the battery out. And the battery is taking up a lot of space in that Neuralink device. Power constraints are very, very hungry. So it's, you know, you need to, you need to. So I'm not going to come here saying in 3 years, you know, we've like blown Neuralink out of the water. That device is incredible. There's some amazing engineering that's been put into that.

It's nuts when you see them. I've been to the manufacturing line. I mean, it's like, I think people, their competitors still, and academics, frankly, like underestimate what it takes to do that.

It's always been my criticism as well of the people that were were crapping on Neuralink a few years ago, saying like, well, people have been doing this in academia for years. No, no, no, you haven't. You've not deployed a device in hundreds of people or thousands of people. That is an entirely different challenge. It's like 100% firing a toy rocket off in your garden versus getting a, you know, a rocket to the moon is like two different games that they're— that you're playing.

Yeah, yeah, yeah. When I went to their facility— I've been a few times now— and the exact same thing, the academics used to drive me nuts because they're like, oh, we've done this with monkeys before, and also they're just repeating our experiments. And I was like, yeah, but they're, you know, I mean, their goal might not be your goal, but they're trying to make millions of things and you guys are nowhere, you know, anywhere near making something like this device.

And your goal is to have none of them fail, right? You can't— oh, goddamn, something's not worked. Oh, well, yeah, it's like, no, no, everything has to work every single time. That's a really hard challenge. Yeah, it's a really hard challenge. And I've worked in this like medical technology space for years. And I can tell you, even with very, very simple devices, you know, things have gone wrong. And so to have something as complex as a Neuralink device or another BCI device and it work with all patients, not fail, is like not an easy thing to do. Yeah, you know this. Yeah.

No, no, no, no, no, no. It's good. Good context. And so where do you— do you make those? You guys are kind of split between the UK and SF?

Yeah, correct. We have a research site in Cambridge and the rest of our engineering teams in SF and a little bit in Palo Alto for some of our research work. And we're making a lot of those devices in-house or with manufacturing partners right now, depending on the clinical needs. Ultimately, we'll make everything in-house. Yeah.

Yeah. And when you do the work in mice, I mean, what size is that device?

It's a little bit smaller, but it's also externalized.

Okay. Okay.

So in the mouse, everything's sat on the top of the head and we can run those studies and that's fine because, you know, mice don't have to go to dinner parties and explain what that thing is on the top of their head.

Right.

Whereas in the human, we want everything inside. So it's approximately the same size.

Yeah.

You know, we just put the human version in inside the skull so it's nice and flush.

Okay. Okay. Okay. And then like, let's nerd out on the science again, just, just a bit. So in your, in your work with mice to date, you're, you're, when you put this device in the brain, like how long does it run for? What exactly is it doing? What are you guys seeing as a result of the work?

Yeah. So, you know, we can do everything again bidirectionally. So we're doing all these stimulation work across multiple, again, not just the brain, but across the body. And we're doing all this electrical readout work. And then we have, you know, constant studies running. And, you know, we really came at this from our core thesis was, look, this Novocure data is clear. It works. There's a massive overhaul you can do here to make it 10 times better. But the clinical effects are clear. You know, now it's a nice engineering space. Now there's this wonderful optimization problem you can do where you can get in nice and close with the tissue. You can take all of the learnings from the last 10 years of cancer neuroscience And now let's see what we can do. So our site here in Palo Alto is running a bunch of different studies, a bunch of different cancer models, various parts of the body, and looking both at that long-term diagnostics piece, whereas they say we're training models to predict tumor size and volume and when it's responding to drugs, what drug that animal may even be on, which is pretty cool just from the electrical readouts, and running a whole host then of new therapeutic studies to see, can we drive this even higher and can we do something, eventually cure it in these models as well.

So part of this is using the electricity to slow down tumor growth or eradicate it. And then part of this is just, this is the first time where we can have a device right against the tumor and monitor it and like begin to characterize tumor behavior in general with drugs, different environments.

And at home, I mean, in human, we don't have, no one's ever done that. No one has that data. We had data broadly on people wearing motor BCIs and seeing what we kind of know, like what happens with the brain and the motor cortex when you've got a device in there and this and the speech and everything else. In cancer, what's happening at the moment is someone has a surgery, you put a grid on there and electrode grid on there and you want to see what's going on. How much tissue can I take away? Then that device comes away and the patient's having an MRI every 3 months., and in between those, or maybe 6 months, and in between those, those points, like, we are completely blank. We have no idea what's going on. And this is going to be the first time that we, we run these studies where we can— of course, we'll be doing therapeutics, but we'll also be just, just generally trending what the hell is going on in their brain throughout that time. We're going to learn so much. We're going to learn so much. Um, I think we're going to be able to build very interesting models of, of tumor progression from people in their own homes and, uh, and get the kind of fidelity of information that we need to, to present to clinicians and say, hey, this person, their tumor is becoming more aggressive. It's growing over here. And you wouldn't have known about that for another 6 months. And in when maybe they've been given 12 or 14 months to live, that's, that's pretty huge information for those clinicians as well.

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Yeah, that's fair. Because we never talk about it publicly. So, you know, you hear it here first. We are broadly internally, we're building two platforms here, one for your brain, one for your body. Okay. So we're not trying to treat, you know, breast cancer or lung cancer by putting an implant in your brain. That's not what we're trying to do.

I see.

We are trying to target those communication pathways closer to the organs. So I work in pancreatic cancer, for example. We're putting a device down in the torso and we're stimulating various nerves around that point to control tumor growth as well.

Okay. Okay. Okay. And then— and then— sorry, I'm grilling you, man. I'm just— I'm fascinated.

It's all right. I'll talk about this all day. It's fun.

And then on your website, I mean, you kind of list out your pipeline. Yeah, but— but so if memory serves, human trial, the goal is 2027.

Well, we're doing our first human glioblastoma imminently. We have ethics approval to do this. We have a clinical trial up in Australia. Yeah, it's always, it's always in Australia. Yeah, God loves the Australians. So we're doing that first safety work imminently, ending by 2027. We're talking about this first sort of therapeutic trial, long-term trial. Yeah.

So this imminent test in Australia will be a device put in a human?

Yeah, but over a short period of time. So we're doing stimulation and recording, then we'll take the device out again. So that's sort of what we'd call like an acute safety study. Okay, we want to go in, we want to make sure, you know, we'll talk to the patient, make sure everything's fine, and then we'll come back out again before we do that long-term piece.

But then, and then you guys have the pancreas up pretty high on— Yeah, stuff.

Yeah, our, uh, mouse data on that has been pretty overwhelmingly positive, um, more than we— more positive than even we thought it would be internally. And, and the research group that we work with on that have said, you know, they have not seen a response like this in their models before with the drugs that they've been using. Um, and so we've bumped that to moving to sort of our first acute human studies as quickly as we can, actually.

Okay. Okay. And when I, you know, I throw all this stuff into many AIs before a guest comes on and, you know, they said, oh, well, these devices have been used, I think, already, you know, because the Optune device comes up really quickly. But then they were calling out other cancers where we have tried I don't think they were calling it like neuro-oncology, but it was all around the electric effect. Like, have we— beyond that Optune device, have we tried this? Are there other companies making stuff?

So we haven't with direct electrical interfaces. What does come up sometimes is, you know, this whole field of neuromodulation. There are many ways you can neuromodulate. There are many ways you can affect ion channels in cancer cells. And so people are obviously trying that with drugs as well. Okay. People are trying it with drugs like, how do we, how do we affect like a neural firing pattern in the brain, for example? What impact does that have on the tumor? So people are trying it with like anti-epilepsy drugs, anti-epileptic drugs, for example. Yeah, it's like, let's just give a load of anti-epileptic drugs. It'll dull some of that firing and like maybe we'll see effects there. So all of these studies are ongoing to see if you can chemo-modify, chemically modify this, this sort of like electrical activity as well.

Okay. And then, I mean, it's obviously early days in some sense with this, but yeah, the, the AIs, you know, also called out. I mean, they said, you know, the reason this hasn't exploded across the oncology field is that the benefit, while real, is meaningful but not miraculous. The median overall survival in newly diagnosed glioblastoma improved from 16 to 20 months. And then it seemed kind of like a little more skeptical. I mean, I guess we just don't know much on the rest. So yeah, and I know it's almost like you're trying to— there's like two things going on. One is the survival rate, the improving the tumor itself, and then the other is all this other new data that we would—

absolutely—

we would get. So I see the benefit.

Yeah.

On that.

But the other thing there is, you know, that survival rate is what you're seeing in the field. And I spoke earlier about this usage effect. If people are using it really, really well, they get a nice survival benefit. If they don't use it very well, they don't. And what a lot of what we're seeing is just the device is so cumbersome and difficult to use and annoying to use that people stop using it. They take it off, they take it off in the evenings. You can't blame them. They take it off at night. They stop wearing it. And so the real-world survival benefit starts dropping and dropping and dropping. But if you actually look at the survival data with people that they call them super users, people that use it like more than 90% or 95% per day, It's almost like a doubling of median, right? Which is, again, nothing does that. Not surgery doesn't even do that. Yeah. Which is pretty profound.

And then not to like totally slag off this company making this device, but I mean, I sort of saw this in Neuralink land and we hit on it a bit. I mean, it seems like there was some moment in time where, well, I think with medical devices, sometimes you get the device approved, you get it locked in, you almost like never want to touch it again because you have to go through all this mess sometimes to get it all recertified, approved, covered by insurance, things like that. I mean, it just looks like a product that hasn't changed in 20 years despite massive gains in electronics and computing. And you know, when I look at what Neuralink's doing versus like a Utah Array, you can just tell one of these things was kind of like in an academic laboratory and, and was in one setting and the other one is backed by startup funding and somebody who kind of knows how to do consumer electronics stuff and And I mean, is that sort of what went on? This thing just hasn't changed much in 20 years. And then you guys saw an opportunity to bring all this new technology to bear.

Yeah, I mean, there's been a lot of advancements, especially consumer electronics over the last 25 years for sure. I told the story before about a friend of mine who's actually— he's got glioblastoma. He lives in San Francisco as well. I won't outdox him, but he's a great guy. And he's like, I'm so happy this device exists. He's like, but I wish they just brought in a couple of Apple engineers. And like, that's what it feels like, right? You just got a little bit of like product taste and a little bit. And sometimes people have said before, like, it feels like they never gave it to the actual users. And like, I'm sure they, of course they did. They did this human factors work. But you can do so much more. You can just make these things so much more user-friendly and make it something that someone wants to use and wants to wear. Not something that's so burdensome. And we've seen this before, right? The jumps from Walkmans to iPods is like a big jump. There's nothing fundamental like, oh my God, we've invented new physics. It takes a special company to come along and say, let's just delete this and rebuild it from sort of first principles again and make something that people will feel comfortable and like.

I think there's like a mega trend going on here in some ways. I mean, if you look at the defense technology industry, It's just, you know, a lot of the stuff is like running on Windows 95, literally, like literally I've been out in the field with people. They're using radios from like the Vietnam era. It's just kind of crazy. Like, like none of what happened in consumer tech, you know, you know, like Google, all the tools we use on a day-to-day basis to do our work are way more advanced than what these people, you're like soldiers and even your, um, like CIA analysts and everything. Are using, you know, you just have this thing where things get frozen. I mean, space was exactly the same way. When I look at, like, medical devices, all the stuff like the pacemakers, the deep brain stimulation, I mean, they're all the same thing. It's just this clunky little thing that gets threaded in your chest with some wires coming off of it. And it clearly hasn't changed in a long time.

Yeah.

So this is just— it, like, between you guys, Neuralink, and some others, I mean, it's just, it's just this, like, rethinking of how we make medical devices. But then there's a— there is a big issue to overcome there, which is, like, the cost of what it takes to make a consumer electronics style device and, and going through all this, um, where you're getting funded like a startup as opposed to, to an academic research project. But, but clearly, I mean, this moment seems to have arrived where people are going to try this.

I think so. I think people care a lot more about that. And, and you're right, like you're hitting on this, things just get entrenched. This is the way we do it and this is what it looks like. And that's, that's it. That doesn't have to be the way, right? We're seeing this evolve in multiple industries now that you can reinvent things.

Yeah.

Yeah.

Okay. Okay. And then, okay, so in the biggest picture, like all this is, I mean, how— this is unfair because you're, you're, you're going to tell me it's amazing. But like when we, when we talk about applying this type of technology in the cancer space, I mean, how excited are people generally? It just feels like it's weird to me that I just never heard of this. I have no way to calibrate. Where this fits on, on if people think it's kind of like a nice to have and is going to give us some data, or we think this is just some massive revolution in how we treat cancer.

I mean, it's amazing. I, I, I obviously think it's incredible, but that's not coming from me. I mean, when I, when I started this company, that, you know, the first thing I did was because, because these ideas not come from me. I was a, I was a conventional neurotechnology guy. I was working spinal cord injury type stuff, more aligned to what Neuralink are working on. My co-founder Elise, she was working in this neuro-oncology space, and she was the one that introduced me to these concepts, to Michel's work, to the clinicians that were working in this space. She was like, I really think there's something that should be done here, something that should be done here. Okay, let's have a look. I read through some of the papers, and I was like, I want to speak to these people, I want to speak to these clinicians, to the, to the people, to the patients that you're speaking to. And I was, I was overwhelmed by the pull in this direction, the amount of people that are desperate for something, for new things, for breakthroughs. The people that are so inspired by Michelle's work and Sean Hervey-Jumper's work at UCSF and this whole cancer neuroscience field. The pull from, the pull from patients is always going to be great, right? Because patients just want new technology and new breakthroughs in oncology, as is their right. The pull from clinicians is really, really huge from surgeons to neurologists to neuro-oncologists, like, people are very, very excited about this sort of new avenue and how real it feels, because we've seen these devices. The cultural needle has moved. Like, Neuralink is going to be something that thousands of people are going to be getting. And it feels now that these technologies are so much more applicable and real, and they're going to be in people's hands over the next few years. Which moves the dial, I think, a lot more as well. Maybe even 10 years ago, if you were talking about something like this, people are like, oh yeah, sure. Like, when am I going to have something like this? Yeah, I know what DBS looks like and I don't really like implanting DBS devices either. So how's this going to be different? But it's going to be different.

Yeah. Okay. Okay. So you're, you're studying at Cambridge.

I was.

Yep. And you were pursuing a PhD tied to spinal— spinal what?

Like, like spinal cord injury. So I was working on flexible electronics. I was working out how you could You could introduce electronics through very, very small surgical windows and then change their shape in the body. So unfurl them and wrap them around the spinal cord or unfurl them and roll them across the surface of the, of the brain. So we want really large area electrode coverage in the body. We want to cover all the motor areas on the spine. But typically that's really tricky to do without doing crazy invasive surgery that no clinician wants and no patient wants. And a lot of people don't even qualify for.—

to restore movement?

Yeah, I mean, I was doing two things. I was looking at measuring and modulating. So can we map the whole spinal cord whilst people are moving around and walking and interacting with the world and then stimulate to look towards rehabilitation and restoring movement? Yeah. And I was doing all that with flexible thin film electronics.

Okay, so sort of like Onward.

Yeah, Onward. I mean, Onward, Gregory Courtine's work was some of the work that had really inspired our group. They were using obviously sort of off-the-shelf type spinal cord stimulators at the time. And we were figuring out what can we do if we've got hundreds of electrodes and they're covering all over the spine, how much do we move the needle there as well? So that was the work we were doing.

Okay. I love Grégoire. We've hung out in Switzerland a few times. He's very handsome. Very cool company. It's very cool. Dave Marver was just here. He's the CEO of Onward. So Onward makes a device with either 12 or 16 electrodes, I think.

And it's something— Yeah, something like this. I mean, somewhere between 12 and 32, I'm sure.

Yeah, yeah, yeah. And it sits on the spine. They have people— it's unbelievable. I've seen it with my very own eyes. They— Gregoire helped figure out the right way to stimulate the spinal cord in the right pattern to help people walk again, move their arms again. And I mean, it's incredible. It's both amazing. And then you kind of are left wanting more to a degree because the people walk again, but it's very— it requires a ton of effort on their part. It's very stilted is maybe the right word. And they often need sort of like a walker to help them. I mean, it's like a miracle. They're like moving again, but it's They're not like walking like they used to.

Still lower fidelity than just having complete, you know, control over, over, over motor.

Yeah. And so this is the question I've always asked them is like, you know, don't we want to put more electrodes on there? And then when I talk to Neuralink, they're like, oh, Onward doesn't go deep enough. We really want to, you know, Neuralink always wants to get in there and they're like, we want you. And yeah, because I think Onward just sits on the, on the outside of the spine.

I think that's right. Yeah. And that was my previous research record. And by the way, to caveat this, thing that I'm going to say next. Yeah, I think Olwood is an incredible company. Yeah, the work they've done is amazing. You know, the patient need is huge, not just in movement but also in blood pressure and all the other problems that come with spinal cord injury. I think their work is incredible. But I've done some of this work as well, where if you just cover the spinal cord with loads and loads of electrodes, you still don't get that high fidelity motor control. And the reason for that is just those, those large area, easy to recruit motor fibers— you can recruit them very easily using electrical stimulation, and you get this sort of more explosive, jarring movement if you try to do this, which I did. You get some control, you get multiple degrees of freedom, but it's not the way that anyone wants to walk like that. So, okay, Onward have done something I think very clever, and the whole research group behind that, where they're actually looking at these reflexive pathways as well to control more natural movement. But if you really wanted high-fidelity control, you would have to do what Neuralink is suggesting, which is just penetrate the spinal cord with a bunch of tiny little fibers to actually recruit the track you want. There's huge challenges to doing that.

Yeah, like, I mean, because when I've brought it up with Onward, they're like, oh, Neuralink has no idea what they would be getting into. Like, do you think, I mean, I get so excited about this technology, but then I honestly cannot tell if it has a path forward that's more dramatic.

I think I think I would say that these technologies are as crude and as unsafe as they will ever be. And that's exciting for me, that we're early, right? We're early in these technologies and that we're proving so much already from maybe 16 or 32 electrodes, whatever Onward is doing, I don't know, you know, to Neuralink putting their threads in there, 1,000 electrodes. These are still, these are as bad as these things are going to be over the next 10 years. You know, it's going to there's going to be a radical shift in the next 20 years. We're going to have much, much smaller, higher fidelity control over all of these nerves, and the things are only going to go up from here. So if we're impressed and it seems like magic to us already, I mean, what's it going to be like in 10 years? That's sort of how I view this field.

Okay, so you're at Cambridge, you're working at a company, I think, in the spinal field, or it was separate?

No, that was just all research. That was all research. Okay. Before that, I was doing drug development and delivery. Working on some other intelligent drug delivery devices. But my spinal cord work was all research.

I thought I read somewhere you were working somewhere and your company got acquired, or—

Oh, that was my— that was my— the old medical device company I was working for. Okay.

Okay. And then so you meet Elise. She's another— she's chasing a PhD.

Yep.

At Chalmers as well.

Yeah.

And you guys just chat up and you hear about neuro-oncology and then— and then what? And then in like 2023 you start Yeah, absolutely.

So it was a funny crossing of paths. Elise was a, still is, an electrical engineer, and she'd been working on all kinds of different projects.

Formula One.

Formula One. Yeah, very cool stuff. And then did this whole PhD that amounted to almost cancer biology. And I was like, okay, I'm just going to take a systems-level engineering, electrical engineering approach to cancer biology and see what there is there and built up a bunch of her own systems. And studied and revealed things in biology that we hadn't known before. And I was coming from the other end. I was a drug guy who was trying to learn to become an electrical engineer. And then we started collaborating on some things, you know, published some work together and then started kicking around this idea for the application of neurotech in cancer. Founded the company in '23. Yeah. '22, I think we closed our first round of funding in '23.

Did you get money from the UK or from the US?

Our money came from a little bit from the UK. The Australians lent in hard. So one of our favorite investors, Blackbird, led our pre-seed round. And then our seed round was led mostly by some Australians still and US.

Okay. I'm always shocked at like, every time I go to Cambridge, there's all these genius ideas that nobody seems to want to give anyone money. Yeah, yeah.

I've been saying for years as well.

Baffling.

If it's not a fintech product, it's not interesting.

Everyone I meet in the US who has biotech, they all have to come here to get their biotech. It's like, I have no idea what they're thinking over there. But, and so how did the Aussies, they just caught wind of this and got into it?

Yeah, I mean, Elise is Australian, so we had links through that. And then we met this fund and they were previously here where we're sat right now. They'd done some crazy stuff from surgical robotics to quantum, actually, PsiQuantum is one one of their companies just down the road from here. Yeah. And yeah, liked, liked Neuro, liked the application and lent in. And since then.

Okay. Yeah. PsiQuantum started in this building, Playground Global. There you go.

I know, I think two of them from my hometown in Bristol.

Yes. Yeah, yeah, yeah, yeah. They are. They are. Yeah. Jeremy and maybe Terry, I think is his name. Yeah. Oh, no, Terry might be Australian. Anyway, I'm going to mess this up. Doesn't matter. Okay. So and then over the last 3 years. So you have to make the device.

Yep.

And then you've kind of teamed up with some of these researchers here in the Bay Area to, to help with the studies and advancing the research around. Yeah.

I mean, advancing the fundamental biology. So we are, we as a company, we have one goal, which is to take these technologies into human beings and radically improve and extend their lives. Right. That's, that's our company goal. Along the way, there are a lot of interesting research groups, clinical adjacent or clinical research groups who want to learn more about this disease as well and want to take all of that data that we're doing, put these electrical stim and recording studies into their own rodents. And so we do that with partners around the Bay Area and also in Australia where we do some of our peripheral cancer work as well.

Okay.

But then we also have our own facility where we run those studies ourselves as well.

Like, could I just take a Neuralink device or a Precision Neuro device and instead of putting it in the motor cortex, just put it in the tumor and So you could do that acutely.

If you were just in a surgery, you could stick a device in and start reading some, some information. But that's not what we want to do, right? We want to leave these devices in for, for the rest of the person's life. And so then you need to be compliant or you need to be aligned with the clinical standard of care. And that means MRI, that means radiotherapy and everything else that comes with it.. And that's not so easy to do. The device that you showed earlier, it has a sapphire glass encapsulant. The whole thing's made out of sapphire, which is not as expensive as it sounds when you get it lab-made. To our investors, it's made of sapphire. Yeah, it's made of sapphire and platinum, but more expensive than my wedding ring. But The reason for that is really so we can be compliant with those clinical practices. And as I say, if you take a— maybe Precision device is a good example— if you take that to a person that's working in cancer and say, hey, we're going to have this. By the way, you won't be able to use MRI anymore to look at this person's tumor. The clinician will just say, well, no, I can't do that. That's just a non-starter for me. So there's a lot of work that's gone around in on that. Then how we do broad area coverage, how we connect lots and lots of channels through a very, very small hole. Like, this all takes a lot of engineering effort. The type of stimulation we use is all of that takes quite a unique sort of engineering effort as well.

And like, would the talent for that has been in the UK or it's a mix?

It's a mix of UK and US.

Okay. I mean, I was just like really impressed with what you guys have built. Yeah. Like, how big is your team?

We're 22, 23 people.

Yeah. I mean, you must have somebody really good at hardware.

We do have multiple people who are really good at hardware.

It was when I saw how old the company was and then I popped on, I'm like, this must be a render. This can't be real.

No, it exists. It's getting into humans really quickly.

Yeah.

No, we have some great hardware engineers. We have this guy, José, who leads our engineering team here in the Bay, and he's done the impossible. He's taken now, I think, 3 devices from sort conception through clinical studies and into market with different companies. You know, one of those companies has been acquired, one's probably just about to IPO, and one was a big corporate medtech company.

Okay.

And so he knows what he's doing and can do this in a sort of, I don't want to say one shot, but yeah, single-digit shots.

Yeah. Yeah. Okay. So you're sitting around with Elise one day and she's— you've like never heard of neuro-oncology. Before?

Never.

Never.

I'd worked a little bit in cancer, lung cancer, but never heard of— I was like you. Yeah, you were like, this is crazy, I've never come across this. I was working in neuro and I had previously worked in drugs. I had never heard of this either.

And so what happens? I mean, she tells you and then what, you start reading a bunch of papers or—

Yeah, I start reading a bunch of papers, I start speaking to a bunch of people, and I was kind of, oh, I'm gonna, you know, I've been doing these things in spinal cord injury, this seems like an avenue I want to go down. As soon as I got into the weeds on this, I thought, this is, this is fucking crazy. Yeah, this is insane. This is— the draw here is massive. The white space is huge. Like there's so much, there's such a beautiful engineering optimization piece here where you're nice up again, you're up close and personal with the biology and you can bidirectionally interface with it. Like this is clearly what, if we don't do it, someone else is going to do this. So it's necessary.

So, and like if that Optune device has been around for 20+ years and it's shown results, I'm befuddled as to why people would not have been trying this approach with with different tumors more than in a—

I mean, they have.

Okay.

They have, they have some programs. They just got approval for pancreatic cancer this year, I believe. They have approval for mesothelioma, lung cancer. And there are other, some groups that have tried to make these things implantable. It's not an easy problem, right? It takes a lot of grit and it takes the right level, the right mix of experience to do that pretty quickly. So that's, I think that's the reason for that. We've just got, we're just on a, we're just on a rising tide of these sort of technologies and that's a good place for us to be.

And when you said they, I mean, you, you're talking about university labs or you're talking about like the, the company that makes Optune? Well, both.

Both. Yeah.

Okay. What is it? NovaCare?

NovaCare.

NovaCare.

Yeah.

Okay. So they're looking at other applications.

Absolutely. Yeah.

Yeah. And then in BCI land, there's like, I don't know. 36 brain implant startups now. I mean, do you guys have a direct competitor?

There's a, there's a, uh, one company in, in the UK that's, uh, trying to do an implantable stim program in, in GBM as well. Uh, you know, I've spoken to other people, a lot of these BCI companies are founded by some of my friends, and I've spoken to multiple about them, and they are aware that this is a, this is a space that people should be looking at. Uh, some of them have had their own ideas, but none of them, to what I'm aware, are actually working on this.

So what does that say to you? I mean, are people— it's obviously hard. All this stuff is hard. But then if there's 36 people chasing the motor cortex and there's kind of you and a half other— yeah, I mean, does that mean there's skepticism around what this technology can do or just that it's newer?

I think that we just had an insight that others didn't have at that time. The cancer space wasn't thinking that much about neurotech. The neurotech people certainly weren't thinking about the cancer space. Most people in neurotech— I mean, you'd ask yourself the same thing. You're more in the neurotech world than anyone else, and you haven't had the idea of applying this. And I think another neurotech people were the same. I will say, when I've spoken to some of the, uh, I can't say which companies, but sort of lead neurosurgeons at some of the major BCI companies, they're like, I wanted to do this previously and I didn't do it. So I think it's more a case of just there's a nicely— there's a well-trodden path for motor from all of the DARPA days, from the Utah Array days. It's just like motor makes sense. It's like there's a very clear path there. So people focused on it.

It's like the things people need first. Move your body, speed, things like that.

It makes sense. It makes a lot of sense. But I do think when it comes to actually scaling those technologies into clinic, commercializing these technologies, I think it's going to be a hard fight there in the motor space as well, just because someone has to pay for this stuff.

Yeah, no, I agree. I agree. And the insurance companies, I mean, like we were talking about Onward before, and the most dramatic stuff they do, we talked about, is the paralyzed people moving again. Most obvious benefit is with the blood pressure.

Yeah.

Part of this where you have people who are paralyzed, they can't even get out of bed. They're passing out all the time. Their blood pressure is fluctuating all over the place. You turn on this device, their life goes back to normal. There's a woman I know in Belgium, Julie. She's like 23, 24 years old. She was on the assisted— had her name on the— she was ready to commit suicide basically, and got this device. She's like back in her PhD program. And, you know, it's incredible.

Incredible. That's what we're going after, right? That's what all of us are trying to strive for. Yeah.

But then like the insurance companies still are like reluctant to pay for this stuff.

I'm not here to defend the insurance companies today. That's—

I mean, it's insane. It's like, it's like getting this for people to pay for this is nuts.

I come from the UK, right? So I know more than anyone working within the NHS is hard. It's money, money, money is the main focus.

Yeah.

And the US, there's more flexibility there. But still, someone, whether it's an insurance company or the individual or whoever, has to pay for this. And again, with my commercial hat on, the pull in cancer is just so profound, both from a treatment side and from a diagnostic side. The pull is so profound. And there are ample reimbursement codes for getting technologies into cancer that don't necessarily exist in in sort of other areas at the moment.

Okay. I feel like I've been like processing in real time and then now I'm coming back to questions that I'm going to sort of re-ask you. But like, let's fast forward, I don't know, X number of years, 10, 15, whatever it is. I get colon cancer and you guys have a device working. So it's like I go in, I get diagnosed, I have a tumor, then I get a— I get this essentially like a little mini computer chip put as close to my tumor as possible. This is the goal.

This is the goal.

And then it is so from like day one, then it's like reporting on what my tumor is doing all the time. And so it's saying it's growing, it's— or you're getting treatment and it's shrinking and it's what? It's just taking measurements that—

taking electrical measurements all the time.

Just, just in that, from those electrical measurements, what are you able to—

you can see if things are growing, we can see if things are growing and shrinking. Yeah, we've, we've, even with, you know, relatively crude measurements at the moment in terms of low-density electrodes, we can already predict tumor size. We can, we get about 70-75% accuracy on the, on the tumor size. Okay.

Okay. So that would be like one major thing you're looking for. What else would I be sensing?

We're looking for, you know, something that we're super excited about is, is your drug working? So we don't believe that these things are going to be, you know, monotherapy. That's not my— that's not the world I believe. I don't think that world is going to evolve in cancer. I think you're always going to have some combination of things that you need, right? Multiple tools to get to a curative state or where we're holding you in a chronic state. Just you live the rest of your life, we're keeping this under wraps, under control. So another thing that we want to know is, you know, is your, is your drug working? Because if it's not, we want to switch on to a new drug as soon as possible or implement something, something different. So that's something else that we're spending time looking at.

And that's mostly— you would still be monitoring tumor size for that, or tumor size?

Yeah, but, but there's also some of this electrical activity, the spiking rate. Some people have published some data looking at how that is predictive of, of growth and metastasis. This as well. Uh, it's early days here on the research, but it blew my mind when I saw some of this, that just from looking at, you know, the electrical activity of these tumors, we can approximate when that tumor is going to grow, spread.

So the electrical activity of a cancer cell, of a tumor cell, of a tumor cell, and how it integrates with the surrounding— okay, I mean, I know nothing about this. How does it integrate with the surrounding tissue?

So, uh, you know, in the brain, as I said, there, there synapses that are forming. In the rest of the body, these nerves are sort of functionally feeding the tumor, right? We need nerves throughout our body to control everything. They're releasing neurotransmitters. An example might be norepinephrine. These nerves are releasing norepinephrine actually into the tumor sites as well, and a bunch of other transmitters as well. You've got sensory neurons there that you can sense what the hell is going on. And some of this is why these cancer patients have profound pain as well. So you have these, these nerves actually growing in and integrating again into the tissue. Again, we can read out all of that, we can modify all of that as well. And different nerves will do different things. We're interested in nerves very, very close to the tumor. We're also interested in nerves more upstream. I'll give you a— you know, a crazy piece of research that was published recently in which they grew a lung cancer model in a mouse. And then you're familiar with the vagus nerve that runs up to your brain. They just severed the vagus nerve. Now, there's reasons you wouldn't want to do that maybe in human beings, but in these rodents, they just severed the vagus nerve. And in these rodents where the vagus nerve was completely severed, they just never got metastatic cancer. Just never happened. The tumor just stayed local in the lung. And in all these other rodents where they didn't sever it, the tumor spread and went wild and went around the body and they got liver mets and whatever else. Now you're going to ask me, why? Why does that happen? The honest answer is we don't know yet. Yeah, this is early research. We don't know. But there's something really wild happening here in how the body, how the nervous system, how tumors and how the immune system is functioning and speaking to itself. That you can have that profound an effect in an animal model.

So it's— I mean, I'm sure I'm going to oversimplify this, but I mean, it's like a parasite and it's rewiring your body to supply itself with what it needs. And then you guys are trying to disrupt—

Absolutely.

—mechanisms.

Tumors are smart. Cancer cells are smart. They have an evolutionary advantage to grow and thrive, and they will hijack as many processes in your body to do that, right? From growing blood vessels in to nerves to neurotransmitters, whatever they can take, they do and they will grow. That's frightening. But also for a company like ours, we say, well, you know, we have the engineering tools to look at that, interface with that. People have been doing that for decades and we can do that as well.

And then tumors always come in sports ball sizes from golf ball to tennis ball to, I guess, well, then we get into fruit and softballs. You don't want grapefruit, right? Grapefruit is bad. Yes. Once you get into the fruits, it's usually bad. Yeah. But I mean, how many, how, How much coverage do you need on these tumors to get the data you want and then to affect a change?

Yeah, if we decouple again the brain versus the rest of the body, you know, anything sort of like fist size. Yeah, if you heard fist as well, fist size is a common one in the brain. You know, we can get good coverage over that, to be honest. Any bigger than that and it's probably past the point that anyone is going to be able to help at that point. You know, in the rest of the body, it's less about how large that tumor is for us, it's actually more about how, uh, um, distant is— distance to travel. So obviously if I'm tackling the pancreas right now and, uh, that has spread to my brain, um, that's going to be something that's like very, very challenging for anyone with like a physical means of constraint on, on that tumor. So that's not something that we're looking— it's not something we're actively doing right now. Now there is a path to, as I say, immune modification. There is a path to using these technologies in brain metastasis or other forms of mets. But right now we're function— we're focused on these like primary site tumors, like how do we control them, whether they're grapefruit size or tennis ball size or fist size. How do we control these things at the local point? And then, okay.

And so in this future scenario that I was talking about, I mean, I guess people start feeling bad or they're having some, some checkup and you see a mass and, and, but like in every case really, you guys, you would want to be putting this device in when you're at like the surgery stage of the—

It's our entry point. So right now it's a very, very low risk way of, of getting these technologies into as many people as possible. So, you know, when, when we talk about these implantable devices, the first question that everyone says is, okay, well, even if it's small, like surgery, really? I don't want surgery. So our path to getting into as many people as possible is, okay, let's, let's take this subpopulation who are already having surgeries. And in some of our disease areas, like 70 to 80% of them are having surgeries. And we'll do this. One of our friends called it like drive-by implant. Like, we'll just— yeah, okay, your surgical floor is there. We're gonna leave something behind. Now we need to do that. We want to do that to prove out how incredible this data stream capture is, but also the therapeutic side Eventually, of course, you know, we want to be preemptive. We want to go in before your surgery. Maybe it's, uh, it's like a neoadjuvant where I want to go in and shrink as much as I can before you go in and, and take the rest out or give you a drug or whatever else. Maybe in a future world, I want to go in, uh, just if you have a risk. Maybe, maybe you're suffering from, um, like pancreatic inflammation, uh, pancreatitis I think it's called, and you have a high risk of pancreatic cancer. Maybe you have a particular gene that suggests you're going to get breast cancer. You know, in the future where these worlds are— these devices are so safe, and they're safe as like maybe getting a contraceptive implant, we'd say, well, why don't we just leave this device with you and just monitor you for the rest of your life? Like, what's that? There's gonna be no harm in that. If your chance of getting one of these tumors is 20 or 30% in your life, then rest easy, rest assured, spend the rest of your time at home, and this thing will serve as a warning if anything does come up.

That was my question. That's kind of where my brain was heading. I mean, it just sounds like you're trying to create this cancer sensor network type thing over time. Absolutely. I mean, so like Ray Kurzweil has been talking about the nanobots circulating through our body forever. I mean, this is some early incarnation of that on some level.

Yeah. And again, these technologies are only going to get smaller and only get safer from here. There's nothing in the physical realm right now that people are looking at us saying it's physically impossible to make something small enough and safe enough that you and I can have these things preemptively. There's nothing that blocks us in the physics world. There's engineering challenges. We're just going to get more power efficient. We're going to get smaller. Chips are going to get smaller. Everything's going to get more powerful. That would be a wonderful world. Thinking about how we can vertically integrate and federate cancer care where we have all of this data under one roof, and the therapeutic avenues as well is something, you know, we certainly strive towards over the coming decades.

And then, okay, and then again, everything's working. This is the optimistic case scenario. You guys do this for 10 years. Like, what do you think we learn about tumors that we didn't know after monitoring whatever it is, hundreds or thousands of people for 10 years?

I think we're going to learn a lot about what some people call chronobiology, right? So like the time domain of, of, you know, cancer, just diseases generally, is really misunderstood at the moment. Um, how is your disease changing when we're awake versus when we're asleep? We have no idea. Like, should I be taking my drugs right before bed or when I wake up in the morning? There was this controversial paper, I don't know if you saw it, about, uh, time of day of immunotherapy where They posited that if you take— if you deliver immunotherapy before 11 a.m., you get almost a doubling of overall survival in lung cancer cases versus if you take it after lunchtime. I say it's controversial because someone's done a takedown, someone, but then someone else has replicated it in liver cancer. So, you know, not my work. To your listeners out there, do your own research and assess whether you think chronobiology is in immunotherapy is real or not. But it speaks to something pretty profound. Like there is clearly some time of day effect based on our circadian rhythm. You can tune the algorithms of deep brain stimulators to remove some of the symptoms by tuning things down at night and up again in the morning when the person might be interacting with the world. On the data side, we know none of that at the moment. As I say, we are 3-month time points. I get a scan and then I'm treated for 3 months and then I get another scan. And most clinicians go, "Mm, like maybe it's changed, maybe it's receded. Actually, maybe it's progressed a little bit. I will mark it down as like a pseudo-progression." and actually there's some swelling. Let's wait another 3 months. And I think when we have this very, very temporally fine dataset of what the hell is going on to you between 10 AM in the morning and 10 PM at night, we'll be able to do some pretty profound things in medicine as well.

Okay. Yeah. I mean, my wife was going through all this cancer stuff last year, and then she has to get checkups all the time. And it's just, it's just, it is all very, it always feels random to me. Usually like pay pick the— yeah, the time that you're going to come in for these MRIs and everything. And, and, you know, I mean, I don't know, like, we all live in these, um, just by nature of our calendars and clocks, you're just like, 6 months sounds good, you know? Yeah, you got to pick something, right?

It always feels like, you know, when someone uses a— yeah, 6 months, it's like, that's probably not the right time though. It's a nice round number, right? Yeah, we stimulate at 100 Hz. That seems too perfect for me. Yeah. And, you know, like I maybe alluded to at the beginning of our conversation, we want the world to look like in the future where people aren't being prodded and stabbed in scans and everything else. They don't want to feel like— people don't want to feel like guinea pigs when they're at the worst, lowest points of their life and they're going through this journey. Like, you do want— you want eventually all of this to be done remotely. You want to be monitored, you want to be treated, you want everything to be when you spend time hanging out with your kids and your family and going hiking, not trekking into a hospital every 3 months to get a scan.

I was like looking over the side effects too. I mean, almost all of them seem tied to the actual device itself. Like it's like skin, you know, irritation. And I read through all the side effects, but they all seem tied to like the cancer therapy drugs you're taking and not that Optune device.

Yeah, I mean, the Optune forms, it gives some skin blistering, But that's by nature of being outside the body. It gets hot. Yeah, it strips the skin. You've got a glue on your head kind of all the time, an adhesive. And so you get this effect. And I don't want to downplay that either. That's a pretty big thing for people. I mean, it gets quite painful and they stop using the thing and that affects how well it works. But it seems like the side effects of the actual stimulus is low or maybe Zero.

Like, yeah, I mean, yeah, I don't want to— again, I'm not giving medical advice or anything, but I was reading, yeah, the most common side effects when using Optune— what is it, Geo? Um, yeah, scalp irritation, headaches. And then other side effects, um, how they say, malaise, muscle, muscle twitching, skin ulcers.

Yeah, yeah, that's the big one.

The skin is the big one. But you guys are— you're not on the skin. We want to go inside.

Yeah, I, uh, I mean, we've had this conversation with people about the, you know, we use invasive and non-invasive quite a lot, and I come from the invasive world, which sounds so scary. Yeah, but we, we think a lot more about this sort of, um, how much does it affect your lifestyle, um, how intrusive is it, not how invasive is it. And, you know, some of these, some of these implants, like let's use Neuralink as an example, sure, it's invasive, but it's incredibly unobtrusive compared to a big EEG cap or this Utah Array pedestal, right? Where is it at home?

You can use it at home.

You can, you can just and live your life once it's in there. And yeah, we have to acknowledge that whenever we breach the skin, there's some risk of infection. We cannot ignore that. They'll get better, but we can't ignore that. But people care a lot more about the next 5 or 10 years of their life, of just living their life to the fullest and not worrying about this other thing that they have to manage all the time.

100%. I mean, I hang out with Nolan Arba, the first guy to get the Neuralink implant, all the time, and you would have no idea, really. And in fact, he'll be like talking to you and then he's like using his computer over on the side and you don't— but you don't— just like everyone else. Yeah. Yeah. And, and yeah, I mean, clearly you don't see anything on his, on his head or, you know, nothing. Okay. All right. Well, I've asked all the questions I can possibly think of. I mean, is there stuff that I missed that, that that someone far smarter than I would usually kind of pushes you on, or that people should know, I suppose?

I, I just have a— I think about medicine and what the future of medicine is going to look like a lot, and it's a lot smarter than it is today. Um, and I think, and Neuralink and others inspire this line of thinking as well. Have you ever heard this quote that people say? It's like, if AI could create a currency, it would basically create crypto. It's the perfect currency for AI to interact with. And I think that these neurotechnologies are that same analog. In a future where AI, whatever this means in our future, is going to be controlling medicine, it's going to want to be controlling something that has this bidirectionality to it, something that you have hugely rich datasets and something you can fundamentally single-cell and also system-level control biology. So again, today, if our future AI overlords could create a technology for diseases, let's say they're aligned to us and they want to do that, they would be making these technologies. They're not going to be making something where you take a drug and then you kick around for 3 months waiting to see what happens. That doesn't seem very future-proof. To me. Yeah. And that's why—

so, I mean, we humans do incredible things and we've come so far. And then, and then especially on the brain, you always realize our knowledge is so crude. And cancer is another area where you're just— it's just you're both super impressed by what people have accomplished and then very underwhelmed by what we, what we know.

It's, you know, as I said, I get into the weeds with patients and I think people, people are— people that have been affected by cancer, people have had loved ones die from cancer, they're mad. They're not— that I see— I meet mad people more than I meet sad people. People like, I've been watching the cure for cancer come up on the news every day for the last— feels like decades— right around the corner. And, um, and then someone gets diagnosed with glioblastoma and they find out the treatment is going to be basically exactly the same as what another guy got 25 years before. And they're like, what's happening here? I'm seeing these breakthroughs constantly in academia and research labs, seeing them announced all the time. Why isn't anything happening? Why isn't anything changing? And, um, and I, and I, I like to believe that we're on a bit of a takeoff moment for, for medicine generally. There's so many exciting things happen, both in the drug world, the immunotherapy world, you know, the, the, the, the, the cell-based medicine world, the device world. I think there's so much happening on the data side of things. I think it's a good time to be an optimist in cancer. But, um, you know, we don't want to see the same thing in 25 years, people saying I'm still— my friend has just been diagnosed with glioblastoma and they're still getting the thing that someone got 50 years ago. Yeah, that would suck.

Yeah. Yeah. The— and what is like Novocure's reaction to you guys been? I don't know.

I try to avoid the conversation.

So I mean, either they're being stealthy or they— you're not on the radar yet. I assume you must be. Actually, I put a tweet out about the device this morning and then And there's a guy who wrote that his wife is suffering from glioblastoma and she's about to be fitted for a device for a brain tumor. And then I pointed to you guys and he said that he's reached out to you to see if your wife could be an early tester. I don't know if you saw that.

I did not see that, but yeah, I would happily have the conversation with that person.

Yeah, he actually seemed— decently well-informed and, um, was into it. All right. Well, I'll, I think you saw, you saw my, my tweet. Just check, check his replies. We'll help Alex here or try to.

I did see, I did see your tweet and you know, that, that, that's why we do this, right? Like we want to, we want to move these things to patients. And by the way, like huge disclaimer, right? This is not a product that's in the world right now.

Yeah. Sorry. I don't want to give people, I wasn't trying to be cute.

No, no, no, absolutely not. And like, I, I, I, I just wanted to put that out there, right? Like, we're working as hard as we can and we're moving as fast as we can and we're killing ourselves and our engineers. Sorry, guys. By pushing this as aggressively as we can so that we can help people like Alex's wife as quickly as we can because there's a lot more to do. Yeah.

Yeah. Okay. Well, thank you so much for educating us all. And then you said in the next month there's like things There's things coming up.

Yeah, there's things coming up. We got it. We got a lot on. We've got our friends in Australia will be doing some of this early work. And then it's a, it's a pretty aggressive push for us to roll these out into long-term studies, both in the brain and other parts of the body as well, which obviously we're hugely excited about to start building that data layer and also running therapeutic studies as well.

And the product is called Soma. I don't think we— that's the device. That's the device. Before we moved to San Francisco, Yeah, I actually hadn't thought of that, which I should have. Okay. Okay. And then on the— on your pipeline. So you've got late preclinical trial for high-grade glioma and then another trial for low-grade and then another for brain metastasis. I can never say that.

Meaning Meaning cancers that are spreading or have spread to the brain.

But like, so it's a glioma that's spreading? No, no, no.

It's a peripheral cancer that's spread to the brain. So these gliomas, they tend to stay actually local, as in in the brain. But these other cancers, obviously, like most people who have like a significant amount of people that die of lung cancer or breast cancer, it's because it gets to the brain.

And then you're early preclinical on the pancreas.

Pancreas has been super promising. We'll be publishing some data on that this year as well, which has been, again, pretty profound so far.

And that's been mice. That's been mice. Okay. Okay. Okay. So everything's mice except we're heading to humans in Australia. Absolutely. Yeah. Okay. All right, Ben, thank you so much for your time. I'm sure we will, if you'll have us, we'll follow follow along. Absolutely.

Come, come to our lab, meet our, uh, meet our bionic cancer models.

Okay, okay, okay. I, I will. Is that part of the UK or— No, no, that's it.

Yeah, that's just down the road.

Okay, okay, okay. The ones in—

Yeah, yeah, you're always welcome to swing by.

Okay, I will 100% do that. Uh, that sounds fantastic. And, and thank you so much for your time.

Thank you for having me. It's been really fun to chat.

The Core Memory Podcast The podcast is hosted by me, Ashlee Vance, and/or Kylee Robison, or both of us together. It is produced by me and David Nicholson. Our theme song is by James Mercer and John Sortland, and the show is edited always by the John Sortland. Thank you so much to Brex and Send Cut Send for all your support, and thank you most of all to everybody for listening or watching. We love you. Please leave us a like, a review, a subscribe, all those tremendous things. Thank you, and we'll see you again.