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This is the Leap Together podcast, where we highlight top leaders driving breakthroughs in clinical research and life sciences.
And that's kind of where this last small part of my career has gone, is
Dr. Douglas:breaking down some of those barriers to getting not just national, but international access for patients for clinical trials, for opportunities for new therapies, but then also trying to take the basic science that we already know and understand and how to translate that into the next step into a novel therapy.
Leapcure:Welcome to Leap Together, where we bring you conversations with the pioneers shaping modern medicine. Today, our host, Zach Gobst, CEO of Leapcure, is honored to welcome Doctor Raymond Douglas, an internationally recognized oculoplastic surgeon and leading authority in thyroid eye disease. Dr. Douglas is not only a skilled aesthetic and reconstructive surgeon, but is also one of the lead scientists behind the development of TEPEZZA, the first and only FDA approved treatment for thyroid eye disease.
Leapcure:Dr. Douglas has dedicated his career to redefining what is possible in eye health and aesthetics. Join us as we explore his journey, innovations, and the holistic philosophy driving his practice.
Zach:Hi, Zach Gobst here. I'm the host of the Leap Together podcast where I talk with leaders in clinical trials and patient advocacy to explore how medical breakthroughs come to life. This episode is brought to you by Leapcure, the leader in patient engagement and recruitment for clinical trials. Leapcure's equitable and empathetic process accelerates research while empowering patient advocacy. Hundreds of studies in millions of patients across more than 50 countries have used Leapcure to contribute participation average of 62%.
Zach:Visit leapcure.com to learn more. I'm excited for today's guests. We have, Doctor. Ray Douglas. Doctor.
Zach:Douglas is a globally respected oculoplastic surgeon and a true leader in the treatment of thyroid eye disease. He's a key principal investigator for the development of TEPEZZA, first FDA approved therapy for thyroid eye disease, and was the first physician worldwide to treat patients with it. I'd like to add what really sets Doctor. Douglas apart is how patient centered and collaborative he is, not only advancing science and surgical innovation, but also showing up as a trusted partner across the patient advocacy and research communities, whether it's in the OR leading trials or supporting others in the field. He brings deep expertise with genuine openness and care.
Zach:So Doctor. Douglas, thanks for being on the show.
Dr. Douglas:Thank you for some kind introduction .
Zach:Yes. Did this all get started? How did you get into the space? I'm kind of curious about, not the history of the dinosaurs exactly, but where did your interest in oculoplastic surgery and this convergence of medicine, science, and surgery start for you?
Dr. Douglas:Yeah. I was trained or did my training as a MD PhD, mostly in oncology. I saw a lot of patients go through oncology and spend a lot of my time trying to think of other therapies for oncology. And just kind of got interested intensely in ophthalmology and eventually into thyroid eye disease from the surgical aspect of A, being able to offer more than just a medical treatment, potentially a surgical treatment that sometimes can give you pretty substantial satisfaction almost immediately, improving vision, etcetera. And so it was that combination of research, potential medical therapies, and surgical therapies that really got me very interested in this field.
Dr. Douglas:And got very interested in thyroid eye disease, which was at that time very, very obscure. I think it's a little more well known now. But just seeing these patients who had this enormous physical disability or liability in their eyes, from bulging of their eyes, and that they just would not go out socially. This just impaired every aspect of what they did during the day. And just from an immunologic and research point of view, it just seemed like this is something we can potentially treat besides just surgically.
Dr. Douglas:It just became kind of a culmination of each of those three components focused upon this disease.
Zach:You spoke about starting an oncology and shifting and then noticing that you had the ability to impact people's quality of life. Curious what drives you to shift into that space. I don't know if there was a patient story or if there was a moment where you said, Oh, actually, this is a direction that feels right to me.
Dr. Douglas:Yeah. So part of it was I've always enjoyed surgery, but also another aspect was in oncology. I did several aspects of rotations, etcetera, And I saw the limitations that we had and there were some sadder stories I will not go into as far as some of the downtimes in medical oncology. That was really tough. But it was probably the times that I spent exploring a little bit more about ophthalmology, finally seeing a patient that came in with thyroid eye disease who pretty much was as devastated.
Dr. Douglas:Their entire appearance was altered. They couldn't see. They had profound double vision all the time, wearing a patch over one eye. Incredibly disabled from this. And it wasn't that they were just physically they would go out in public and they would tell me stories of little kids pulling on someone else's on their parents' coattails and saying, Hey, look at that person.
Dr. Douglas:What's wrong with them? And it was just kind of seeing at that point in time, and it started very much surgically of being able to come up with new techniques, of being able to move their eyes back, align them, and give them some sense of normalcy. None of my patients ever want to look like Beyonce. They just show me an old picture and say, Can you get me halfway there to resume a normal life? Going through that experience with that patient in particular showed that, Hey, there's an opportunity for surgical advancement, but we should also be able to do something medically here too, because it seems like an opportunity that was just not being fully utilized.
Dr. Douglas:So that was really the transition point for me was seeing what an unmet need that there was. And these patients quietly went away and just didn't cause a fuss because there just wasn't much treatment to be had. Opening those doors was the first step for me.
Zach:I think your thought process there is really interesting. You kind of look at these kind of challenges. You'll look at the challenge of someone who's going to surgery and you'll look at the space of ophthalmology and you'll kind of have a hunch like, Oh, there can be, science can do more here. It's not proven yet, but from a practitioner perspective, it's not always that common to think beyond the limitations, think about what research should be able to do, and then pursue it in your case, of being on the leading edge of driving the actual research to move forward. I don't see that a lot in investigators and physicians that I speak with where they'll have a drive toward, Oh, there's a better way to go about this.
Zach:Where do you think that comes from?
Dr. Douglas:Yeah, I think it comes from looking at a variety of fields and seeing their development. So I really do come back even to my oncology training and some of the research I did in immunology. Many of my mentors that I'm so grateful for made amazing discoveries. I often tell my wife I feel like Ploris Gump in many ways because I got to work with these amazing people who discovered hepatitis B and the vaccine, who discovered the molecular changes of cancer and actually of CML. And I actually worked in their labs.
Dr. Douglas:And so by comparison, I feel very lazy and not very profound because they had such vision. So you see what is possible in a field that is related but tangential. And then you look at your own problem and you're like, Well, it's kind of like looking at a fine Italian leather pair of shoes and then saying, I think I can put my shoelaces in straight. So I feel that I've been guided by people with incredible insight. I think one of the things I can do is learn lessons from someplace else and try to apply them in a field that probably needs a few lessons and is a little less developed.
Dr. Douglas:I think that I'm very fortunate in that way to have had amazing mentors who demanded a lot but achieved a lot.
Zach:It's quite entrepreneurial. If I reflect on my inflection moments of why did I go for leapcure ? And there's people in the past that have found a way to take you know, what's worked in kind of consumer tech and apply it to health tech in different ways. I think it's funny because, like, in some ways, you're doing something that, like, no one's ever done before. You're you're trailblazing for space.
Zach:But what it feels like on the inside is like, Oh, I'm doing kind of what these other people have shown is possible, and then kind of the drive. It's a hard thing for me to describe. I think you did a great job, but yeah, it's really interesting.
Dr. Douglas:I always think of it as there are never any new novel ideas. We just go back further in history and find out that someone else had that idea at some point in time. Or you apply it from another field application becomes very relevant and appears novel.
Zach:Yeah, that resonates. I want to jump next to where you've gone now. Beyond just mentoring other surgeons and being a leader in clinical research, you're opening up practices or have opened up practices in multiple locations across states, serving as chief scientific officer at Sling. You've put on these hats that are quite different than a lot of the work you've done before. Curious about what your experience has been as you shift into these other roles as well.
Zach:I think the
Dr. Douglas:shift has been a learning process for me too, because my ultimate goal is to hopefully make a contribution. When I'm gone, leave at least one more step for someone else to stand on and to move forward. Because that's what people have done for me. Looking back upon it, they haven't told me what to do or paved the path, but they gave me a step in which to learn and to stand and to move forward. I had NIH grants for many years and I saw that there was a limitation of how we could bring those relevant scientific achievements to patients.
Dr. Douglas:It was either barriers to access, as you're overcoming, to new trials and treatments or even the development of getting to that stage. Primarily in The US at least, that's been relegated for companies to take that. But it has to be done in an ethical way and it has to be done in a way that actually opens new opportunities for patients, but building upon those scientific foundations that are often garnered in the NIH and academic institutions, but then taking that next step to implementation to patients. And that's kind of where this last small part of my career has gone, is breaking down some of those barriers to getting not just national but international access for patients for clinical trials, for opportunities for new therapies, but then also trying to take the basic science that we already know and understand and how to translate that into the next step into a novel therapy, something that's new and that hopefully be quite beneficial to patients. So while it appears disparate, those are the two areas in which I feel that have been most blunted by innovation or where the roadblocks are most prevalent to overcome.
Zach:Yeah, I always think of building on success with both depth and breadth. I think it's a little bit of what you're kind of going where you're kind of like, How do I broaden the impact? How do I break down the barriers that are stopping patients from getting care? It starts with that kind of impact there. And then also the depth of saying, Well, how can we innovate to kind of take on the next generation treatments with what you're doing at Sling too?
Zach:So that you're doing it all is commendable. Usually, I have to pick between the two. I usually fall in the trap of trying to eightytwenty or do a bit of both, but you're finding enormous traction with both, and so it's a testament to how much you kind of care about the impact you're making, and I think that's fascinating and great to see that you're also thinking about the people that come behind you as you do it.
Dr. Douglas:There's great examples of community outreach and patient outreach that's already ongoing and people are excited to do. So the activation energy by me is actually probably relatively small because there's already this built up desire to want to bring this to patient by your group, by groups that you I know work with all the time. There's a lot of enthusiasm. It just has to be helped along. Hopefully I'm providing one match to some of the kindling to help move things along.
Dr. Douglas:It's probably an overstatement there. But hopefully if I can do something I really believe that there is already such a latent opportunity that just has to be harnessed and directed.
Zach:Well, yeah. I mean, on our side, because we've been able to partner together over the years, I found that you and your team are true collaborators to us, not just kind of helping make sure there's a great patient experience for everyone that comes through, like your team has always been exceptional at that, but kind of problem solving together when things come up, being kind of us against the problem, figuring out logistics for patients that are up against kind of barriers that they'd otherwise not be able to resolve. You definitely practice what you preach here from our experience to being able to kind of expand who we're able to bring in and also be thoughtful about each patient. So in terms of next frontier, you kind of spoke about it a little bit, but what are kind of the up and coming things in the space that excite you, whether it's in general ophthalmology or in thyroid eye disease at the moment?
Dr. Douglas:Thyroid eye disease, I probably know that space a little bit more intimately. We've just now started to actually understand the mechanism of disease, And I'd say that that applies to autoimmune diseases in general. We're just starting to understand them. And this doesn't just translate into treatment, etcetera, but it also translates into further understanding and that we're building bridges for biologic assessment, predictability as far as who is going to potentially get these autoimmune diseases, how are we going to control them, what is the difference between one person and another, why do some medicines only work 60 or 70% of the time, etcetera? So I think we're beginning now through joint collaborations of actually doing not just trials, but even biologic surveys.
Dr. Douglas:You have disease, you have a little blood drawn, or you have the clinical parameters plotted. You almost have these registries that can serve a lot more dynamic information and specific information to individual patients. I think that that in the next five years or so will make the individualization of treatment much more common, even more common than it is today. And certainly for thyroid eye disease, there's only one approved medication now, but we'll see a much larger expansion, improved side effects, improved efficacies, etcetera, going on. And then I think we'll see certainly that spreading around the world where that just isn't present at the moment, but spreading around the world.
Dr. Douglas:And as far as ophthalmic innovations, certainly less, but I admire the two areas that I think are probably most ripe for innovation and it feels like around the cusp. One is much more of a nuisance of needing reading glasses. This has been the holy grail of ophthalmologists for many years as far as developing either lenses or drops, etcetera, for not needing reading glasses. I think we've made a lot of incremental and some bigger steps, but I think that's not too far around the corner as far as having vision that doesn't change when you're 45. And while it's a new day, everyone who's that age and doing myself knows it's not as much fun not able to see up close.
Dr. Douglas:And the other thing is then finally chronic retinal diseases that are blinding to patients here in The US. And this goes beyond just diabetes, but also AMD and the various forms of retinal degenerations, including macular degeneration, I think that we're finally starting to get a handle of slowing the progress, but hopefully providing some reversibility of those by either cellular transfer or cellular reprogramming that can restore vision to patients, which is one of the most scariest things. You think about it and you think about the golden age of retirement, you want to be able to visualize that and you visualize it in your mind, but the scary proposition is not being able to see, to be able to really see that as you do get older. I think those two areas are the most promising in the next ten year projections.
Zach:Anything that you think isn't being spoken about enough in clinical research with your lens where you kind of see everything? I think you're starting to kind of take on international barriers, but any thoughts on that question?
Dr. Douglas:I'd be really interested to hear your side to In this clinical research, it still feels very segmental. It still feels like that we don't have an overarching platform in which to communicate clinical research ideas and to share data. The fact that it has been maintained a lot in companies limits the shareability of that. In the academic world, in the NIH, you publish findings, you publish raw data, it's out there and creates a level playing field very quickly. But that next step of when you go towards treatment, towards further development, it becomes more siloed.
Dr. Douglas:And I'm not sure that I have an answer to this because it comes part and parcel with innovation and protecting that innovation, but it also means that it does create barriers to the communication of those innovations across fields. And eventually it gets there, but certainly that appears to be a limitation. I know that you're working quite hard to help to overcome some of those barriers, so you probably have a lot more profound things to say than I about that.
Zach:Yeah. I think, as you're saying, AI comes to mind. I think the benefits of AI to knowledge share and change a lot of those structures that lead to silos. If you think how research is funded and kind of the incentives for a clin ops team to run something successfully and kind of have to report back to a leadership team and show like, Hey, this is what you paid us for. You did a great job investing in our team to go get this done.
Zach:I think that structure is probably going to get disrupted in some way by the benefits of having an AI type tool that can improve the outcomes based on sharing and collaborating. It's always been hard to have an incentive to collaborate because that kind of ROI has been difficult, and I think that will start to shift. I don't know when, but I hope it does, because I think then we'll be able to better parse, like, you know, when I'm working on one thyroid eye disease study versus another, what are the kind of practices that can be used to kind of make sure that we're kind of optimizing for the patient better and still kind of have an ROI to the person investing that looks good. That's been hard to do with our current structure, but I think AI can help. I don't know exactly how it'll look, I hope that's what comes.
Zach:Getting a sense of what really happens at the patient level. I think paired with AI, the conversation that I don't think is happening enough is really understanding and building trust with each of the patients. You know, I think like the way we've set up Leapcure and the way you set up your practice, we really give capacity to kind of understand patients and what's in their interest. And I think that's sometimes a little bit lost in how people think about clinical trial infrastructure. What comes with that is not just that we feel better about our work and it kind of feeds our impact, but we're also getting better information about what's working and what's not when we're able to create that better space.
Zach:I think it's actually a crucial part of innovating. And that's where, you know, I'm trying to kind of get our company to kind of step up more and more, because I think AI is going to shift the way that we kind of interact with patients in some way. But we're not going to be working with the same level of depth of information about what's actually helping people if we can't kind of solve that too. So that's my thought, but the world's changing a lot. You know, you spoke earlier about NIH and like the role NIH plays.
Zach:There's a lot of things that are, are changing. And so, you know, it's hard to know exactly how to predict the future, but that's what comes to mind for me. And then wanted to also get a sense of when you're kind of dealing with patients they're kind of, do they have an issue and it's, you know, their diagnosis is not thyroid eye disease? I'm interested in kind of your thoughts on the patients that are kind of needing support that are kind of outside of our specific realm for studies. I know that you often provide care, goes above and beyond, but interested in kind of where you think that's going because I see it in my business where if we try to find someone that's a fit for a study and they're not, we're doing our best to kind of equip them with resources.
Zach:On your end, I'm curious what happens for you.
Dr. Douglas:If they can't find or get into a trial or something like that?
Zach:Yeah, if they can't get into a trial or they were hoping they'd have a diagnosis maybe or be able to get clarity, but you kind of don't have the tools for that, how do you navigate that and kind of where that might be going?
Dr. Douglas:How we navigate it is usually understanding the network of resources that we have to help them. So if I can't provide a service and usually we're pretty good about not there are very few people that fall through our net as far as not being able to provide some help or improvement regardless of insurance or regardless of all the common practical things, but there are very few people that fall through that net to do that. I think one thing that we've relied upon is a network of family and friends, so to speak, And that is becoming harder and harder with the corporatization of practices. So many practices are being bought by PE or being bought and now are having pretty strict barriers to entry of providing care, of transfer of care, or providing solutions if I can't provide them something and then transferring them. A lot of that burden has been taken by larger institutions.
Dr. Douglas:I find myself relying more and more on larger institutions, at least in Los Angeles, of being able to provide that depth and breadth of care, regardless of any barriers that may be placed. And so I do see the private practice model diminishing significantly as far as the individual where you knew a bunch of people and they would just take care of you to more of that corporatization. And so I'm not sure if that's exactly what you're thinking and asking, but it has been what I've maybe I answered a different question, but
Zach:It's not something I think about a lot, which is Yeah, because there are these shifts in how private practices are built and PE jumping in and making a number of acquisitions, the autonomy that a private practice would generally offer you is not going to be what it used to be. And so the way that we think about the role of an academic institution shifting is fascinating. It's not something that a lot of people think about much.
Dr. Douglas:Yeah. And a lot of the academic institutions are also buying practices. So it is this rush to carve out your space. And we've seen this in the past before, and then there's usually a rush to sell those practices. So there's always a pendulum that swings back and forth, but certainly that's what I've seen much more recently that has created additional barriers for patients and has not actually made things easier, but has created additional barriers, frankly.
Dr. Douglas:I was going to ask you a question. A lot of people ask me about AI, especially in clinical trials, there are a lot of things I think that can be standardized, etcetera. But I was wondering, as far as when you think of the impact and the utilization both near and far of AI and thinking about your field, was just wondering how you feel that impact is going to be both short and longer term.
Zach:Yeah. And I can speak to it as a practitioner that helps people integrate AI, but not as the domain expert on AI, so I'll kind of qualify that. But I tend to be an AI optimist. And even if we kind of think about Facebook, for example, there's a lot of really you know, and there are issues with kind of like Facebook's practice as as a business, but I still think the good far outweighs the bad. Like right now, we're filling studies that otherwise wouldn't be done on time because we're able to run kind of Facebook ads, and Facebook is really good at kind of like getting in front of the people that'll, you will be able to help most.
Zach:And I think there's some parallels with AI where there's going to be some issues with how it's implemented. And I think that those are things that we kind of want to get our head around solving as quickly as we can. But I do think with AI, there will be so many more benefits at a high level to kind of speeding up research and providing better care that we otherwise wouldn't be able to do. You know, where we are right now, it's a little bit of the Wild West with how people understand their data, and there's not really a clear roadmap to data you should be kind of protecting in what ways, and how do you get the benefits of what you can learn utilizing your data versus protecting what is best for you to protect? Like, I think everyone's trying to kind of think for themselves on that.
Zach:Maybe they'll go to, like, a cybersecurity expert to to kind of, like, make sure that, like, you know, doomsday scenarios don't happen. But there is a little bit of, like, risk versus reward with how you utilize your data, and I think that's one of the key things that people are gonna have to kind of figure out for themselves. You know, another thing about AI is like, you you will see a lot of kind of like, I think you've probably seen this, service providers over the years, where people feel like they can kind of solve something big because they have an AI capability. The reality is integrating and making sure that everyone in the process of running a clinical trial is kind of aligned in together is kind of a bigger thing. Like when Leapcure first started, we kind of had this false thinking that if we could bring strong advocacy patients into clinical trials, suddenly we'd shave two years off of the timeline of getting something working.
Zach:It's like, that's an important part, but unless we understand what's going on on the site side, unless we understand how sponsors work and think and how they win, unless we can kind of tie everyone together, our impact is gonna be there, but it's not gonna be as big. And so I think, you know, I'd expect a lot of service providers to kind of come in and, you know, hopefully they're smarter at making promises with AI, but, you know, typically that's not, you know, how companies get invested by saying like, they don't kind of qualify their benefit. Yeah. That's, that's what kind of comes to mind for me, but I don't know if I answered your question well.
Dr. Douglas:That's Yeah.
Zach:Before we wrap, if this was kind of like your Oscar speech and you're being awarded, got plenty more to achieve in your career, but let's say it's a lifetime achievement award for what you've done up to this point. Who are you thanking? You mentioned some mentors, but maybe colleagues, friends, family members.
Dr. Douglas:Yeah. I think as anyone puts together a speaks like that or a Swan Song, etcetera, they thank all those people. It certainly started for me with parents who believed in me and I think that that's still hopefully something I tried to give back to my kids and my family and believing in them. And then progressing to mentors who also believed in you, but also walked the talk and then made you do the same and exposed me to fields that I just couldn't imagine. I think that exposure is priceless in so many ways.
Dr. Douglas:You almost are able to then find future mentors that way by seeking them out, by people who are enthusiastic, who are just unsatisfied with the status quo. You seek them out. And so those have been mentors throughout my life, both at UCLA and prior to that, my wife and family for putting up with the strange ideas and questions that it's like, Well, what do you think of this? That often happens in opportune times or long drives. I think the primary point is that it probably has less to do with me and more to do with the people that I've surrounded myself by over the years, and that's been something that's been very fortunate for me.
Zach:As someone who's been on the periphery and seen our collaboration do amazing things, you're just really grateful that you kind of think
Dr. Douglas:of others and how you approach your work. Thank you for all you do and really for our collaboration over the years and for my learning. I've actually learned a ton of I never thought about the whole process, and I know you've shared the story of how you've gotten into this, but of the whole process of clinical trials and doing this. And so I think that you've been instrumental in overcoming many of the barriers and those transition points that I spoke about earlier. Really thank you and your team for all the great work that you've done.
Dr. Douglas:And I know that certainly my patients have benefited and appreciate it.
Zach:Thanks, Doctor Douglas, much appreciated. And I think we'll wrap on that. Thanks.
Leapcure:That was Doctor Raymond Douglas, a true innovator in oculoplastic surgery and thyroid eye disease treatment, sharing his remarkable journey from lab bench to clinic and his groundbreaking work that's transforming lives worldwide. We hope this conversation shed light on the intersection of science, surgery, holistic care, and the power of persistence in driving medical breakthroughs. If you enjoyed today's episode, be sure to follow Leap Together for more conversations with leaders pushing the boundaries of modern medicine. Thanks for listening, and until next time, stay informed, stay engaged, and keep pushing for better health outcomes for all.