Firstly, I believe that medical devices are one of the most worthwhile investment directions. The average annual consumption of medical devices in the United States is $347 per person, while in China it is currently $6 per person per year. Therefore, there is a significant gap in medical devices in China.
Secondly, I personally believe that our healthcare system is still in the stage of 'treating the head when it hurts, treating the foot when it hurts'. I think any drug that can block or target therapy upstream is a good investment direction.
Thirdly, I believe that our current implanted devices are still in a state of palliative care, and we should look further ahead in the future, such as with biomimetic materials. ”
Sometimes the death of a master may give birth to a new group of masters, because no one dared to challenge him while he was alive. In the second year after Andreas (the father of interventional cardiology) passed away, it was like 'there were no tigers in the mountains', and many' little monkeys' jumped out and said that the boss was not good because balloon dilation would cause occlusion of blood vessels and perforation of the heart. The following year, a stent was born, which is the heart stent we still use today
In 2010, I performed the first active valve implantation surgery in China. Ten years later, I needed to perform another surgery on this patient. He heard that I was the doctor who performed the surgery on him ten years ago, and immediately sat up and cried loudly. At this moment, I deeply felt the sense of honor as a doctor. Although being an investor is exciting, I think sometimes the sense of honor as a doctor is also very good
Our current treatment for hypertension, myocardial ischemia, and heart failure is mainly palliative care. We should consider whether it is possible to block the occurrence of diseases at a more fundamental level in the future... I think there will be a day when we can find upstream targets for certain diseases, so that we can truly achieve early intervention
"The hospitals in the future will not wait for patients to come to us for consultation as they do now. Now we have so many Internet hospitals, smart hospitals and third-party service institutions. The information sent back by these medical devices will be managed for you by someone, and will be integrated to feed back to good doctors."
These are the latest highlights shared by Ge Junbo, academician of the CAS Member, director of cardiology department of Zhongshan Hospital affiliated to Fudan University, president of CCI Innovation Institute, and Zi Zhenjun, CEO of Qiming Medical, in the dialogue at the 2021 Sequoia Global Health Industry Summit.
The topic of Academician Ge's lecture is "Where will innovative treatment of cardiovascular diseases in China go?" However, before starting, he first humorously narrates three milestone events in the history of world cardiovascular innovation:
From Werner Fosman, the inventor of the cardiac catheterization, to Andreas Grintzger, the father of interventional cardiology, to Alan Kribier, the first person to undergo active valve implantation surgery. Speaking of Andreas' unfortunate passing, Academician Ge not only expressed regret, but also pointed out that the death of a generation of masters can sometimes give birth to a new group of masters. His students innovatively proposed the heart stent in the second year of his death, and this technology is still in use today.
Academician Ge introduced active valve implantation surgery to China from Alan in 2010, but the lifespan of the artificial valve implanted in this surgery was 10 years. After 10 years, he once again performed the surgery for the first patient, deeply feeling the sense of honor of a doctor and the excitement experienced by investors in the market.
During the conversation, the speaker directly asked about the investment direction for future cardiovascular innovation and development. Academician Ge believed that there were three good investment directions, namely: (1) medical devices, (2) upstream blocking or targeted drugs, and (3) biomimetic materials.
Finally, when it comes to the intelligence of implantable medical devices, Academician Ge believes that this trend will completely change the future medical scene. Patients will no longer have to queue for medical consultations, but can scan QR codes to know their condition and the medication they should take. These data will provide great convenience for doctors and patients.
1、 Ge Junbo's keynote speech session
Thank you all. Dr. Yu Dechao just said that everyone present is a successful entrepreneur and investor. It seems that I am not yet, but I will work hard.
I am delighted to be invited to attend this medical summit today. I rarely have the opportunity to participate in such an event. I have been sitting here all morning today and I think it is worth it. I have learned a lot and started to think about how as a clinical doctor, I can do better in this industry and apply what I have learned.
1. China's medical device innovation is still in the process of "introduction digestion absorption". In 2019, the number of cardiovascular disease cases in China increased by 30 million more than the number of newborns
Today, I would like to talk about the innovation of cardiovascular medical devices in China from the perspective of the development of CCI (China Cardiovascular Doctors Innovation Club). CCI was established on September 11, 2015 at 9:11 am, and our original intention was to make some contributions to medical device innovation. The slogan we proposed at that time was' From the doctors, by the doctors, for the doctors'.
Because we just saw the guests here talking a lot about medical innovation, I was very touched. In fact, in the field of medical device innovation, China is still in the process of imitation - or "introduction, digestion, absorption". Several large medical device companies in China are mostly engineers who previously worked in international companies returning to China to start businesses, produce products, and then apply them to clinical practice to provide services for patients. Just now, Dr. Yu said that the past five years have been the best opportunities for pharmaceutical innovation in China.
First, let's take a look at the data. According to the 2020 Cardiovascular Report in China, there are currently 330 million patients with cardiovascular diseases, which is 40 million more than the 2018 figure of 290 million people released in 2019. The number of births during the same period was less than 10 million, while the number of people with cardiovascular diseases increased by 40 million in a year.
At that time, they asked: Academician Ge, is your number accurate?
Of course, there may be some overlap in the sampling process. For example, if a person has hypertension and heart failure, we may only record them twice. This is entirely possible, but regardless, the increase in the number of patients is definitely significant. There is a saying that out of 5 adults, only 1 has cardiovascular disease.
2. He was expelled from school after inserting a catheter from his right arm into his heart, and decades later he won the Nobel Prize for this and became the father of cardiac catheterization
Today, since I'm talking about medical innovation, let me tell three short stories——
The first story is about a young man named Werner Forssmann in Berlin, Germany in 1929. He wanted to know if there was a way to record the hemodynamic indicators of the heart, so he inserted a catheter from the brachial vein all the way to his right atrium (because the proposal for patient experiments was rejected).
The cardiac catheterization experiment conducted by Werner Fussman and the first cardiac catheterization X-ray captured, image sources: Research Gate, Science Direct
As a result, humans obtained the first X-ray image of a cardiac catheter, but because his action violated the regulations of the medical ethics committee at that time, he was expelled from school and was unable to complete his studies. Later, Fosman went to a small village on the border of Germany and Poland to become a urologist. We joked at the time that because he inserted a catheter into his heart, he had to become a urologist in the end.
He won the Nobel Prize in Medicine in 1956, but the committee couldn't find him at first. After finally contacting him, they asked if he was Werner Fussman, and he said yes. The staff told him that he had won the Nobel Prize, but he said you got the wrong person. The staff asked him again if he had conducted a catheter experiment in 1929, and he said yes. Then he said, 'That's you,' and that's how he won the Nobel Prize in Medicine in 1956.
3. The passing of a generation of masters can sometimes give birth to a new group of masters. The validity period of valve implantation surgery is only 10 years, and we must see the investment value in this field
The second story, also in Germany, was about a young man named Andreas Gruentzig (father of interventional cardiology) who thought to himself: Since we already know that myocardial ischemia and coronary heart disease are caused by narrowed blood vessels in the heart, can we find a solution?
He came up with many methods, one of which is to use a balloon. First, create a hole and then place the balloon inside to support it? It sounds simple, but at the time, a lot of effort was also made. Later on September 16, 1977, in Suez, Switzerland, he performed the first coronary balloon dilation surgery, which relieved the patient's ischemia.
It's a pity to say that sometimes the world envies talented people. He completed his first balloon dilation surgery in his forties and was introduced to Emory Hospital in Atlanta, Georgia as the director in 1980. He taught many students and was revered as a deity when he spoke on stage.
On October 27th, 1985, he made an appointment to perform surgery on a patient. He had his own plane, but the weather was bad that day. The pilot said, 'Boss, the weather is bad now. Let's wait and take off.'?
He said, 'Give me the key and I'll fly by myself.'. As a result, the plane flew up and fell down, crashing. Of course, the details were fabricated by me, and flying a plane may not require a key. Anyway, he flew the plane himself and it crashed.
I think Andreas' death is not entirely a bad thing from an objective perspective. Sometimes, the death of a master can give birth to a large number of masters, because no one dares to challenge him while he is alive.
In the second year of his death, it was like there were no tigers in the mountains anymore. Many "little monkeys" jumped out and said that the boss was not good because balloon dilation would cause blood vessel occlusion and heart perforation. In the second year, a stent was born, which is the stent we still use today. I won't go into detail about this story.
The third story is about a young man named Alain Kribier (the first person to undergo transcatheter aortic valve implantation surgery) who was in Denmark in 1987. He thought to himself, "Since so many patients are not suitable for the current surgery, can we place the valve on the balloon and directly implant it? But nobody is optimistic about this direction. This is also what Mr. Shen and Dr. Du Ying mentioned in their conversation just now, what to do with a technology when others are not optimistic about it. At that time, this article was submitted to Circulation but was rejected, and other core journals did not accept it. Finally, it was accepted for publication only when it was submitted to a journal with a score of only 1.9 at that time.
On April 16, 2002, Alan finally had the opportunity to undergo his first clinical surgery. The patient, who was in dire straits at the time, agreed and the surgery was successful, causing a sensation. Of course, it's too late to invest at this time. It should have been better to invest in the past few years. I met Alan in July 2002, and I said that Chinese people don't like surgery and prefer non-surgical treatment methods. He said why? I said that Chinese people say that surgery can damage one's vitality. What does he mean by vitality? I thought for a while and didn't know how to explain it. In the end, I said it's like when you were born with Energy, but if you bleed after surgery, your vitality will be lost. After listening, he said, 'Oh, it's very interesting.'.
I wanted to invite him to China for this surgery at that time, but I couldn't do it even after writing several reports. Later on September 29, 2010, I had a meeting in the United States and they said, 'Ge Junbo, we approve your report with conditions.'. At that time, I flipped over and quickly bought a plane ticket to return to my home country.
On October 3, 2010, we performed China's first active valve implantation. With so many investors present today, you must see this market because the validity period of this surgery is 10 years, and after 10 years, the implanted material will break down.
4. Being an investor is exciting, but being a doctor also brings a great sense of honor
The first patient mentioned above underwent surgery in October 2010, and 10 years later in 2020, the patient had heart failure again. Then we implanted a mid valve in him. Of course, when I went to see him, he was completely different from 10 years ago. He was 10 years older and heard that I was the doctor who performed the surgery on him 10 years ago. He sat up and cried loudly.
At times like this, I deeply feel the sense of honor as a doctor. Although being an investor is exciting, I think sometimes the sense of honor as a doctor is also very good.
5. My title cannot be written on two A4 sheets of paper, but I value the title of "President" of the Innovation College the most
I have summarized the three major regions for medical devices in China: the Pearl River Delta Greater Bay Area, the Yangtze River Delta represented by Suzhou, Hangzhou, and Shanghai, and the Beijing Tianjin Hebei region. The Beijing Tianjin Hebei region may have policy advantages, but in my opinion, the most active areas may still be the Pearl River Delta and Yangtze River Delta. What you may be more interested in is the current situation of our medical device investment in these products, their proportion, and patent conversion, etc. I couldn't see clearly without glasses today and forgot the data, so I'll skip it for now. Sorry.
I just mentioned the photo taken at 9:11 on September 11, 2015. I initiated the CCI (China Cardiovascular Doctors Innovation Club) and proposed the concept of 'from the doctors, by the doctors, for the doctors'. Our innovation college has trained many students. We have established a mature innovation system, from concept to materials, products, patent protection to transformation, and so on. We have established cooperative relationships with BIO DESIGN and ICI at Stanford, so the host just introduced me to many titles.
Actually, I don't even think I can write my title on two A4 sheets of paper, but the title that I am most concerned about is' principal '. Why? It's because I founded the Innovation Academy on September 11, 2015, which has produced over 100 patents in recent years. We now have 10 startups developing innovative products.
I personally believe that in order for our medical devices to move from imitation to innovation, we must first start with upstream policies. Company founders and entrepreneurs cannot lose their personal freedom due to innovation, so I think we should build the entire innovation chain well, so that China can go further and further on the road of innovation.
The rice bowl must be in one's own hands. Think carefully, almost all high-end medical equipment is purchased by us. I think there should be innovative products to emerge, so that we medical professionals can have weapons to overcome diseases. Okay, thank you all.
2、 Dialogue session
1. Medical devices, upstream blocking or targeted drugs, and biomimetic materials are the best investment directions for future cardiovascular medical innovation
Zu Zhenjun:
First of all, thank you to Mr. Shen for providing us with such a great opportunity for dialogue. From coronary heart disease to valve disease and so on, Academician Ge has always been at the forefront of technological innovation. I became acquainted with Academician Ge around 2000 because of heart bypass surgery. Due to time constraints, I won't share this story with you for now. Let me first ask some practical questions for the investors present here. Could you please list the innovative technologies in the cardiovascular field in the future, and which three directions are the most worth investing in?
Ge Junbo:
Because today my topic is medical devices, I think medical devices are one of the most worthwhile investment directions. The average annual consumption of medical devices in the United States is $347 per person, while in China it is currently $6 per person per year. Therefore, there is a significant gap in medical devices in China. At present, cancer and tumors are certainly important directions in our medical research, but cardiovascular disease is also very dangerous if not controlled. It currently accounts for about half of the current deaths from diseases, and one in every two people who die from diseases is cardiovascular disease. Look at how many neighbors around you do not have cardiovascular disease. The ratio of medical devices to drugs in developed countries is around 1:1, while in China it is only 1:3 to 1:4, so there is still a lot of room for growth in medical devices.
Secondly, I personally think that our medical treatment is still in the stage of "treating head pain and foot pain". I think that any drug that can block or target treatment in the upstream, such as small molecule drugs, to block the occurrence and development of atherosclerosis, is a good investment direction.
Thirdly, I believe that our current implanted devices are still in a state of palliative treatment. In the future, we should broaden our horizons and move towards more fundamental directions. For example, I am currently researching biodegradable stents, but I have not yet jumped out of the scope of stents. Can we look further upstream, such as biomimetic materials.
That day, I invited an American academician to my operating room. He said that you have operated on so much blood, and I said that our valve can be used once for 10 years. The material he researched has a lifespan of 2 billion times, and I calculated that it can be used for 40 years. I say to anyone, including myself, as long as they live to be 85 years old, their valve will definitely break, without exception. When the time comes, everyone will come to me and I will replace the valve for you. After replacing it, it will only last for 10 years. If the lifespan of the artificial valve is 50 years, after replacing it at 80 years old, it can last until 130 years old. After another replacement, it will be basically 200 years old. That's pretty good, right?
If you're over 200 years old, I'll help you switch and let you continue living. You may not be willing to do it anymore, so I think biomimetic materials should be the third good investment direction.
2. At present, the treatment of cardiovascular diseases is mostly palliative treatment, and in the future, we need to find targets to cut off lesions upstream
Zu Zhenjun:
Academician Ge made it very clear that two of these three are related to instruments, especially the third one about breakthroughs in biomimetic materials. In fact, we are also working on various polymer valves, biomimetic materials, and intelligent materials. I believe they will be used in clinical practice within 2-3 years.
The second question, there are many people here today who make medicine. I said that medicine and medical equipment play two very important roles in the development of cardiovascular disease. I have always had some questions and confusion. I have also asked Academician Ge this question before, which is about the medicine for hypertension. It seems like the sky is taking it, but it cannot be taken properly no matter what.
I think the cross-border development of technology is also very powerful now. Is it possible for a precise medical engineering treatment to solve chronic diseases such as hypertension in the future? Because the drugs we see are meant for you to take every day, or perhaps our drug manufacturers have already invented curative drugs and are unwilling to take them out.
Ge Junbo:
Our current treatment for hypertension, myocardial ischemia, and heart failure is mostly palliative care. I think the issue you just mentioned is worth considering, which is whether it is possible to block the occurrence of diseases at a more fundamental level in the future. Of course, cure is unlikely.
In the 1950s, there were not yet so many antihypertensive drugs available, and only one diuretic could potentially lower blood pressure. At that time, a doctor suggested that I simply cut open my stomach and cut off the sympathetic nervous system of the renal artery, and found that it could lower blood pressure. However, this is a major surgery that can easily lead to bleeding, infection, and other risks.
Later in 2004, something happened when a small company attempted to use radiofrequency ablation to destroy the sympathetic nervous system. The experimental results in the first few stages were satisfactory, but in 2014, it was finally found that the conclusion was invalid.
I personally believe that what they have encountered is a methodological error. When it comes to treating a disease, we should first discuss whether it is a conceptual error or a methodological error.
For example, the medicine we are currently taking has side effects, which is a methodological issue. If we really regulate the sympathetic nervous system upstream, no matter what means you use, the current methods may be relatively simple and crude, and better methods may emerge in the future.
Today, Professor Li Feifei mentioned that there are also people in her team who are collaborating with me to research AI for the diagnosis, treatment, and follow-up of cardiovascular diseases. I believe that with the changes in our algorithms, one day we will be able to find upstream targets for certain diseases, so as to truly achieve early intervention.
3. Medical devices have begun to evolve towards intelligence, and implanted devices can monitor data in real-time
Zu Zhenjun:
The last question, as we have been engineers for so many years, medical devices have gradually evolved from simple mechanical functional solutions to the development of new materials, new sensing technologies, and so on. Many years ago, I talked to a professor of vascular surgery about covered stents. I said that after the covered stent isolates the flow cavity, should we add some sensors to measure the pressure inside the flow cavity?
At that time, he told me not to do this. After I finally discharged the patient, he would message me every day. What if he came to me with any problems? This happened many years ago, but today we have started to make some attempts in this direction. For example, valves with sensors have been implanted into the cardiovascular system. With the development of information technology and advances in battery technology, it may be possible to continuously collect information.
I don't think drugs can achieve the so-called intelligence, but medical devices can, and the pace of implementation is getting closer and closer. What kind of changes may this technology bring to the treatment of cardiovascular diseases and patient management? What are your thoughts and insights?
Ge Junbo:
I think you are not only a successful entrepreneur or R&D personnel, but also many of your ideas are very forward thinking. I can responsibly say that the concerns mentioned by the professor you just mentioned no longer exist. Why? The hospitals in the future will not wait for patients to visit us as they do now. Now we have so many Internet hospitals, intelligent hospitals and third-party service institutions. The information sent back by these medical devices will be managed by someone for you, and will be integrated into a whole and fed back to good doctors.
What I once envisioned was that after each of us was discharged from the hospital, I would give you a QR code so that you could scan it and know how our condition was, what medication to take, when we should be followed up, and so on.
Zu Zhenjun:
Thank you very much for Academician Ge's wonderful speech, and also thank you to Mr. Shen for giving us the opportunity to have this "Fireside Dialogue" today. So we chatted freely without much lip syncing or looking at the teleprompter. I hope my chat with Academician Ge can be of some help to everyone.