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Each week, Health Affairs' Rob Lott brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.
A Health Podyssey goes beyond the pages of the health policy journal Health Affairs to tell stories behind the research and share policy implications. Learn how academics and economists frame their research questions and journey to the intersection of health, health care, and policy. Health policy nerds rejoice! This podcast is for you.
Hello, and welcome to a health podocy. I'm your host, Rob Lott. Friends, it's another very special episode of the podcast where we look beyond the authors of specific health affairs articles and welcome a guest who's making their mark on the health policy landscape in creative and thoughtful ways. A guest who can maybe, help us look at something familiar and see it in a new light. And today, I'm thrilled to welcome to the pod, Tristeyson, the leader of Challengeworks, which runs challenge prizes aimed at supporting innovation across the scientific fields, including health care.
Rob Lott:In just a moment, we'll hear a little more about what that work means in practice. Previously, Trist cofounded and led a social enterprise organization called SPICE, which developed time credits as a low cost and sustainable methodology for engaging people in communities as active participants in public and community services. I can't wait to hear about his experiences and his vision for Challenge Prizes in health and health policy. Triste Tyson, thanks so much for joining us today.
Tris Dyson:It's a pleasure to be here and thanks for the lovely introduction.
Rob Lott:Absolutely. Well, let's just dig right in. ChallengeWorks is a project of Nesta, which is, if I'm understanding it correctly, a sort of British social enterprise organisation. Can you tell us a little more about what that is and sort of how you ended up where you are today?
Tris Dyson:Yeah, so Nesta is The UK's innovation foundation. It has an endowment of about half a billion pounds which is relatively small in foundation terms. I remember we had a visitor, Mike Bloomberg, came along a few years ago and he called our endowment cute. But nonetheless, it's enough to live on. The purpose of Nesta is to support and promote innovation for public benefit in The UK.
Tris Dyson:I run, as you said, Challengeworks, which is a subsidiary of Nesta, as part of the Nesta Group, And we specialize in challenge prizes, and these are mechanisms to create innovation contests and competitions to solve meaningful problems using science and technology.
Rob Lott:Got it. Well, I want to ask a little more about sort of challenge prizes generally, but before we do, maybe we can start with a specific example to give our listeners something to kind of hold on to, to dig their teeth into. This summer, you just launched what is called the Longitude Prize on ALS. Tell us a little more about that. What's the goal and how does it work?
Tris Dyson:Yeah, so it's called, firstly, it's called the Longitude Prize because the original challenge prize, which was three hundred years ago, was a contest for how can you find a way of measuring longitude at sea. Nobody could figure it out. Galileo, Newton, lots of people had tried. So they launched a big contest, that came up with the chronometer, the H4 chronometer, which obviously changed the world. The Longitude Prize series has been reinvented in the modern era to solve similar sticky problems.
Tris Dyson:And as you say, we've just launched the third modern Longitude Prize, and this time it is focused on ALS. People in The United States may know it as Lou Gehrig's disease, after the famous baseball player who came down with the condition. And it's known elsewhere as motor neuron disease. But I think the image that people will probably recognize is Stephen Hawking. That's what he had.
Tris Dyson:With Stephen Hawking it took a long time for it to finish him off, but for most people it's much shorter than that. But it's essentially a disease of progressive paralysis followed by death. And there are no treatments, at least none that are to be particularly commented on. And since the disease was discovered one hundred and fifty years ago, both the diagnosis and the treatment of the disease hasn't changed. People essentially watch you twitch the treatments, as I said, are really nothing that has any serious effect.
Tris Dyson:But we think that's about to change. And this is because one of the problems with ALS, as with other neurodegenerative diseases, is that it's extremely complex and it's been very hard for people to grapple with, researchers to grapple with. But as Stephen Hawking predicted at an event in Google in 2015, AI is now at a level at which it's able to handle that level of complexity. And at the same time, the data is now available for the AI to interrogate in order to start to come up with solutions. So basically the prize is that.
Tris Dyson:It's saying, Here's a huge amount of data that we're making available, both American, European, Australian, international data are being made available to participate in teams and money. And the job is to identify targets that could then ultimately become drugs. And the overall prize pot is $10,000,000 and you get an increasing amount of money the further you progress through the competition, but obviously teams get knocked out as you go along. That's it.
Rob Lott:Okay, great. Let's dig in a little bit on the process. This sounds kind of fun. Is anyone welcome to join the project? What are the milestones kind of look like?
Rob Lott:And at the end of the day, how is it determined whether or not someone sort of achieved the goal?
Tris Dyson:Yeah. So the first milestone is December 3, at which point At
Rob Lott:the three months from now, two months from now.
Tris Dyson:Yeah, that's right. So that's how long teams have got to apply. You can come from anywhere in the world. You can be for profit, not for profit, doesn't matter. And we will select 20 teams and those teams will get about $135,000 on the current exchange.
Tris Dyson:They'll get nine months in access to this data, plus they'll get compute and a bunch of other stuff to look for targets. They then need to start to hypothesize around which of those targets will have the greatest potential. And then the following year we will down select to 10 teams, and those 10 teams will get about $250,000 exchange rates change, so it's probably a bit more than that. And they will need to prioritize those targets and look for how druggable they are, Again, largely in silicone data, but also probably some lab work needed at that point as well. And then we go down to five teams.
Tris Dyson:Those five teams will get about 3 quarters of a million dollars, something like that, and then they will move into the lab. And if they are highly competent on the AI but not so competent on the lab work and the search work, we will support them to match up with people that can help them on that. Then the job in the lab is to demonstrate the potential druggability of those targets. And then there will be a winner, and the winner will get £1,000,000 so $1,300,000 something like that. But really, by that point, we should be feeding pharma and investors so that should really start to take off at that point.
Rob Lott:My understanding is that you have a very personal connection to this particular challenge as well. Can you say a little more about that and how it's sort of shaping your approach in this space?
Tris Dyson:Yeah, well, I mean, I'm one of the unfortunate people that was being diagnosed with this disease. I was diagnosed about two and a half years ago. You can imagine it's quite a shock. I was told that I had three to five years to live, which seems wrong now, fortunately. But that's the kind of average.
Tris Dyson:Some people go much more quickly than that, some people it takes longer. And yeah, I mean, I sort of work in innovation all around the world in all sorts of different technologies and sectors and I was quite amazed that I was seeing a consultant in London who was basically tapping me with a lollipop stick and told me that there's no treatment. And it doesn't matter where you are. Mean, in The US, you've got a couple more licensed drugs than we do in The UK, but they don't really work. So it's not great wherever you are.
Tris Dyson:That made me realize that this really needed some impetus and some new approaches and models. It has to be said, though, there are things already starting to happen. So we're kind of at the beginning of a new wave, I think. Partly this is because there's so much data available now that wasn't true ten, fifteen years ago. You might remember the ice bucket challenge.
Tris Dyson:That was the kind of example from your side of the Atlantic of someone raising money research. Well, lot of that went into data collection. The data is significant, but also we're starting to see progress. So there is a drug now on the market called Tufersen. I think the brand name has actually changed, but anyway, was originally called Tufersen.
Tris Dyson:I think it might be called Quasaldi now. I don't know. Anyway, it was a Boston company, that for a very small group of patients, about two percent, that have this inherited particular gene, SOD1 gene, it essentially more or less stops or significantly slows the disease down. It's a remarkable change for these patients who otherwise have a death sentence completely. You're also starting to see drugs come through in Alzheimer's and other neurodegenerative diseases.
Tris Dyson:They're not knockout drugs, but they are progress. So the change is happening now, basically.
Rob Lott:Well, that's a good segue, I think, to sort of think about how this project fits in the kind of bigger structure of how we approach drug development in The US and around the world. I think the sort of typical approach, if I could broadly and probably aggressively oversimplify things, is the typical approach is basically a combination of public sector grants to scientists conducting basic research. And then as that science kind of develops and gets more sophisticated and moves further down the pipeline, private investors step in to fund research and clinical trials generally with the aim of returning or getting a return on their investment. Is that a fair description of the process? And I'm wondering if you can say a little bit about how that's maybe fallen short, especially in terms of rare diseases like ALS, but many others.
Tris Dyson:I think, yeah, the problem for so firstly, ALS is a rare disease, as you said. But it's a rare disease because the patients die so quickly. So there aren't that many patients around. But actually, you have a one in three hundred chance over the course of a lifetime of getting the disease. So it's not common, but if it was treatable, it would be more like something like MS, for example.
Tris Dyson:One of the problems there has been for drug companies is that there are not highly credible targets for them to get behind and develop drugs around. They haven't really been, until recently, coming out of universities of basic research. It's been quite hard for pharma to decide to invest in it in a significant way, with some exceptions. And again, the problem with that is the basic research that was coming out of the universities, firstly, it's not been very well funded. A lot of it has been funded through patient and public advocacy.
Tris Dyson:But secondly, it's extremely difficult because it's a highly complicated disease, as with all neurodegenerative diseases. But also, because it's in the brain, you can only really properly look at the brain when somebody is already dead, basically. So that's a huge problem. But these things are, as I said, significantly changing. The level of understanding in universities across the world and a significant number in The US is way more than it was ten, fifteen years ago because of this research that's been funded through the patients and public advocacy.
Tris Dyson:The understanding of the disease is really so much better, so there's quite strong foundations. I think the other big difference is what AI can do now with big data sets in terms of improving target and drug discovery, making it much more accurate, and reducing the cost because you can do it quicker. That should start to change the economic formula for pharma and biotech. I think the other thing you're seeing is with some of the AI first biotechs, in other disease areas, in some cases they're bypassing pharma. They're just going straight to drug development, again because the cost equation is significantly different.
Tris Dyson:So we're at a moment in history where things are changing very, very rapidly, and there's lots of things to be concerned about from the point of view of AI. But in healthcare and in drug discovery, it's transformational.
Rob Lott:Well, that's some really interesting context in terms of both the areas where traditional approach falls short, but also we're seeing a lot of opportunity or maybe some transformational innovation that's going to sort of change the outlook going forward. Now let's plug in challenge prizes. How do those sort of fit into this new universe? How do they represent an alternative to the old approach?
Tris Dyson:Challenge prizes have been around for, as I said, three hundred years. The original prize was this long issue prize. And there's lots of examples in European history of challenge prizes that have completely moved the needle on a technology and have helped to transform a new industry or sector. More recently, things like Transatlantic Flight, that was an American European prize or set of prizes or a bunch of prizes. But up until the mid part of twentieth century, it sort of fell out of favor and stopped happening.
Tris Dyson:It was The US that really, in the latter part of the twentieth century, kind of fell back in love with challenge prizes. And their example, you've got XPRIZE on the West Coast. Their most famous prize was just after the millennium, which was like if you could put a spaceship into orbit, sub orbit, and back onto Earth with two passengers over the period of a week and do it twice, you'd win the Ansari X Prize. So that was a big moment. And then the US government had done lots of these challenge prizes.
Tris Dyson:DARPA reviews them a lot around the autonomous self driving cars basically came out of a bunch of challenges that was run by DARPA that are now sort of huge companies on the West Coast. It's a stimulus. It's a way of provoking You put a problem in front of innovators, whether they be entrepreneurs, scientists, technologists, you give them a bit of money, you give them some publicity, you give them support in the form of data or whatever it might be, and everybody loves it. They all think they're going to win and you wind up with a winner. But the sums of money are not huge, but they don't need to be because you're getting over a valley of death.
Tris Dyson:And at the other end, if you've the problem definition right, there's a big market and a big opportunity on the other side of it.
Rob Lott:Great. Well, in just a moment, I want to ask you a little more about what makes something a good fit for a Challenge Prize. But first, let's take a quick break. And we're back. I'm here with Trish Dyson talking about, challenge prizes.
Rob Lott:Just a moment ago, talked about some of the history and some previous examples we've seen over the last few years. Challengeworks is sort of maybe supercharging some of those opportunities and kind of raising the the kind of attention level to some of this work. Is there a way to scale this opportunity or challenge prizes as sort of a long term viable opportunity for spurring research beyond just, you know, a kind of interesting or fun project here or there. What's stopping governments from making this a much bigger part of their innovation strategies?
Tris Dyson:The US has, in the past, used them more than we have in Europe anyway. Within the White House, within the Office of Science and Technology Policy, there used to be challenge prize people and then different government departments, DARPA, NASA NASA has used them quite a lot have used them. But they tend to be the more innovative agencies anyway that do them. I think they are not as widely used as they might be. You think in crude terms it's payment on results.
Tris Dyson:You took the Anasari XPRIZE example. If you didn't get the spaceship up into sub orbit, don't get the $10,000,000 So it's quite good value for money. There are other related funding mechanisms that are bigger, that are similar. You have advanced market commitment models and procurement that's run much more like a challenge prize contest, they tend to be a little less exciting and the public don't get behind them in a kind of way, but the mechanism is similar. In Canada, there was a big proliferation of challenge prizes under the last Liberal government that was run out of the Canadian government.
Tris Dyson:And obviously they've re elected a Liberal Prime Minister, so that might well continue. They do use them across government. It's been a bit slow. It's more sporadic in Europe. It's seen as a Rolls Royce.
Tris Dyson:It's seen as quite a sort of splashy and of know, garish kind of thing to do and not as sensible as good old fashioned grant funding. But it is quite bizarre because if you think grant funding involves a bunch of people sitting around a table stroking their beards, deciding who to give the money to. Basically that will often mean that the money goes to the usual people, Harvard, Yale, Oxford, Cambridge. And others then don't get a look in because they're basing it on track record and prestige and all that sort of stuff. One of the reasons I think it's not changed significantly, like it is still 99% of science funding is grants, is because of the very strong lobby group in the science community that quite like their grants.
Rob Lott:They're used to the way things are.
Tris Dyson:Yeah, yeah. Particularly if they're at Harvard or Oxford University or wherever it might be. And it just comes down to political will and how interested the politicians are in it. I mean, under Obama, you might remember Biden wanted to do an enormous challenge on cancer. Think it was like a billion dollars or something like that.
Tris Dyson:Sometimes you get these politicians who really want to bite the bullet. I think where you do see it in health or similar in health is through the Gates grand challenges. Now they're much bigger and they're much longer term, but basically Gates will say, We want to get rid of malaria, and then they'll have incremental funding for breakthrough innovation that addresses that goal, and they've got a number of those. And that model is being picked up more and more internationally by health and development agencies.
Rob Lott:Well, it's about time for us to wrap up, but before we do, I want to sort of maybe get your pair of fresh eyes from The UK on sort of the current state of play here in The United States. We've seen obviously a sudden and dramatic shock to our biomedical research enterprise in the form of cuts to NIH research grants, layoffs at our public health agencies, a much more hostile stance from the administration toward institutions of higher ed. Less well covered, I think, is the damage that we're seeing to the pipeline of young researchers who may just be getting started today, but they're the ones we're counting on to be running these projects ten, fifteen years down the road as principal investigators. Now in sort of the state of the funding universe here in The United States, these researchers may be having second thoughts, wondering if it's worth going into these fields at all, especially when it comes to rare diseases. And so I'm wondering what you might say to a young researcher just starting to enter this field who's maybe just beginning to think about their career.
Rob Lott:Why should they go for it? And what is the opportunity down the road that you might pitch to them?
Tris Dyson:Well, I understand that there are the problems that you listed and they're pretty bad. But I don't think these are long term problems because they can't be. And it's less dramatic that in Europe we've also had funding issues and our economies haven't been doing very well and so there's just less money around. All of our science and technology is built on our research institutions and our universities. If those things are not continued and invested in some form or another, everything else is going to go wrong.
Tris Dyson:So I would have thought that these definite problems, but I would think they must be short term problems because it would be completely counterproductive for The US to seriously divest from research. You've got the world's leading research institutions. If I was a student, think you've got a bumpy couple of years, I I can't imagine it would be worse than that. Since the financial crisis, Europe has flatlined and America has completely gone way beyond us, and that's all because of your tech companies. And those tech companies are built on the foundations that come from your research institutions and your universities.
Tris Dyson:And health, biotech is the next really big revolution. We can see what's happened with cancer is that in many cases it's become almost a chronic disease, and that's happening more and more and more. But there's a new revolution coming, which is this AI powered revolution, and it's going to open up neurodegenerative diseases and other diseases in a way that's just not been possible. The world's going look very different in ten, twenty years' time because of that. So you're entering an area where there's huge growth, where there's huge potential for social impact because you can affect people's lives dramatically, and where in the long term there's going to be lots of money sloshing about, even if there are some short term challenges, I think.
Rob Lott:Great. Well, an optimistic note to end on. We'll definitely be following your work and the efforts at ChallengeWorks. Trist Eisen, I had such a great time chatting with you today. Thanks so much for joining us.
Tris Dyson:It was a pleasure. Thank you.
Rob Lott:To our listeners, if you enjoyed this episode, please recommend it to a friend, leave a review, and, of course, tune in next week. Thanks, everyone. Thanks for listening. If you enjoyed today's episode, I hope you'll tell a friend about a healthy policy.