What is a Data Hippie?

Brian Urban:
Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today we're going academia and beyond. We're so thankful to have Dr. Chris Boone join our conversation today to talk about healthcare economics, behavioral economics, real world data, and many more subjects. Dr. Boone, thank you for joining our show.

Dr. Chris Boone:
No, thank you for inviting me. It's a pleasure.

Brian Urban:
This is going to be a lot of fun. You're donning the NYU purple beautiful colors today, so we're definitely going to talk about that side of your world, but every guest we have on our little show here, Dr. Boone, we like to get to know on the personal level first and talk about who's Dr. Boone before the PhD.
Let's go back to getting to know Chris a little bit more and what led you into becoming known as the Data Hippie, which I'm really excited to talk about as well. Take us back through it. How did you get to where you are?

Dr. Chris Boone:
Honestly, I'll say this, I'm from Dallas originally. I grew up and Dallas Proper, the city. I grew up, I wasn't very... I'll just say we weren't very rich. We didn't have very much, but as everybody says, a lot of love in the family. I knew that I really had a dream and a dream of doing something and make an impact and leaving my mark on the world.
For me, that was in the healthcare space. I had done internships in other industries, I'd tried other things out. I just didn't get that same fulfillment that I was seeking as I got with healthcare. I sought that I was going to get into the world of healthcare administration, I was going to be this big time CEO of some big nonprofit public hospital that was going to treat all people around the world.
It's funny that when I look back at it, to think that that was the dream. Honestly, I'm still doing all the things that I really set out to do, it's just in a different modality. It's not through the hospital administration world. Honestly, I think that even at that time, I was very local in my thinking. I was thinking I wanted to impact Dallas. That's what I want to do, I want to change the world for people in Dallas and not even thinking that you can really just make an impact on the world globally. That's pretty cool, man.
I've been in the healthcare industry my entire professional career. All of my degrees or boards and committees and all these things link back to the healthcare space, so you can see that I'm very, very passionate about it, it's not a passive interest. I started off in hospitals and now you fast-forward into pharmaceutical companies, and I've worked everywhere in between from nonprofits, to consulting firms, to serving on federal advisory committees, to serving on different boards and doing a whole host of other things. Obviously the NYU activities I have going on, too. That's my career in a nutshell,

Brian Urban:
You're being very modest. Chris, we'll definitely get into the depths of some of your leading projects, especially your view on the emerging space of I'll say alternative or non-clinical data being used in research for advancing clinical outcomes or access improving health equity and a number of measures across the industry.
What fascinates me about your background is it seems like you're never satisfied. You keep doing more and you keep giving as well, not just professionally, but in your academic setting. As I hope some of the young minds, maturing minds that you are teaching and helping lead at NYU will not only enjoy this podcast here, but also is going to take away a different flavor of yourself here too as a leader.
With that, I want to go into some of the projects that you've been a part of. A lot of them seem to stem back into the life science, pharmaceutical manufacturing space, and a lot of what you touched was health economics and outcome research data at large. We're going to go into the real world data sets, SDH data and things like that, but your work at the time, I think it was even going back into maybe your Pfizer days, what was your curiosity path in looking at healthcare from an economic perspective?
That's almost like a supply chain view of services, drugs, putting out to the market and how it's deployed and how it's used and how people are serviced. Where did that curiosity come from because very almost engineering side of your brain perhaps. Where'd that come from?

Dr. Chris Boone:
I think that's a fair thing. It's funny because I think if I look at my career, the constant pull through is this focus on access to care. If you tie that into why that matters from an economics perspective, you're really talking about feasibility or affordability for patients to get certain drugs. You're also talking about this whole issue of value, which has certainly been one of the topics du jour across the US and just globally, where people are really trying to reap value from the therapies or the interventions they're putting in place for patients.
All of that has been driven by much of the work that's happening in health economics and outcomes research, where at the heart of it, it's really showing and demonstrating not only just the economic value, but the clinical value, the humanistic value.
I always like to tell people that... Can you really place a value or cost truly on the vaccine from COVID? It sort of restarted the world. I think that people want to place a price tag on it, but the reality is we were in a global pandemic that literally shut down the global economy, the world as we knew it at that time. I don't know if you can really place a value on that, but I think that we do our best in trying to capture the essence or quantify the value in a meaningful way so that many of these decision makers can make the best decisions they can.

Brian Urban:
A very thoughtful response there. I'm curious, Chris, aside from a price tag on a vaccine, the economic effect locally, household, street to street wise, there was a lot of work done across a lot of retail suppliers, if you will.
Walgreens had a health equity vaccine program. They were literally deploying vaccinations in a lot of vulnerable neighborhoods from a socioeconomic standpoint, offering the vaccines through mobile units. Very difficult to do if you've never done that, you just think you can flip a switch and automatically get trust in a lot of these communities. There was some good penetration in terms of people adopting it.
I don't know what the outlook looks like for those programs in the future, but I'm curious on your perspective of... And we're going to get into clinical trial diversity maybe from this, but I'm curious from your perspective, did you see a lot of communities reaching out for help to these large box retailers or other outlets, or did you find it becoming even more of a barrier, the pandemic that we just experienced, for people to get access to vaccines? Or did you see it as this is a new opportunity, people really started to change their trust and their perspectives on healthcare.
I'm curious of what you saw from your research perspective and what you've strung across your career. Any insights there you could share?

Dr. Chris Boone:
I think that generally that sort of catastrophic event changed all of the cultural and humanistic norms that we knew prior to the pandemic. An example I would give is that people weren't really into telehealth for example, prior to the pandemic, but you actually saw the pandemic there was great, to use your term, market penetration of that technology and a new norm being established that allow people to connect with their physicians or whomever via telehealth. Now you've got people that just prefer to do it. That was the deal.
Going back to your core question, I have a tremendous amount of respect for many of the big box retailers stepping up and filling that gap because when we talk about this core issue of access, they are literally... I've heard this stat thrown out by many folks from all the different big box retailers that they have what they say, 95% of the US is within five miles of one of their facilities or locations.
That's a tremendous amount of coverage, especially in many of the rural and some of the underserved urban communities that are out there that wouldn't have access otherwise. You have those more fluent neighborhoods who have an abundance of access, but you also got a significant part of the population that unfortunately does not have.
I think that their role and stepping up to the plate and creating those capabilities that allow them to serve these different populations was I think critical to getting this whole pandemic under control because at one point it did feel... At the very beginning, it felt like the people who had the means were the ones who were getting first dibs on vaccines and treatments, and for the others they were left to their own vices and they were dying, as we saw so many individuals that lost their lives.
I think that mean if we were to call them out, the Walgreens, the CVS, the Walmarts, Rite Aids, all these organizations who stepped up and provided that care when it was really needed, I just don't know where we would've been without it. Shout out to them

Brian Urban:
Rightfully so. It's refreshing to hear your perspective on that because I feel like no matter what, everyone has some sort of critique, but they did their job and they did feel a very big-

Dr. Chris Boone:
They have all the critiques, but the reality is we've never been through anything like that before. Of course we could all look in hindsight and say there were certain aspects of that could have been done better, that should have been done differently.
The beautiful thing about if there was a silver lining, and there's not very many, but if there was a silver lining from the pandemic just to see the level of cohesion, collaboration, collegiality amongst all the different sectors, it was almost like it was a pre-competitive exercise. We all were in it for the betterment of society and humanity. For once, you really got to see I think the good side of people, you got to see the bad side of some people.
I think overall, it was great to see everyone saying no, we're all in this together and we're going to address this challenge, this pandemic head on. We can all poke holes in how we should have done things, and I think we will put things in place such as active surveillance for these types of breakouts or diseases in hopes that we can address them better the next time. I hope that many of the things that we put in place during that time are sustained because it only makes the system better.

Brian Urban:
Yeah, that's a very an interesting take too in terms of surveillance comment that you made. Hopefully there's more surveillance models put in place, community health, statewide, across the globe, and different virology labs as well everywhere across the world. That's one of my hopes as well.
I am curious too, because we're going down this track of improving access. Health equity obviously comes to mind and a lot of your work in your past here has touched clinical trials. We're now still going through this new age of clinical trial diversity.
The FDA has regulation out there for new drugs entering the market must have a diverse cohort. Some of the parameters underneath that detail out the types of race, ethnicity, gender that has to be considered in the cohort for improving drug effectiveness, improving access. CVS had backed out of this, Walgreen is going into this and there's a lot of other pharmacies in terms of retail, but then also drug manufacturers being a part of this.
I'm curious of your take on this because it's got to be very difficult to recruit a diverse cohort to really be heroes in advancing drug effectiveness. I think you look back the last 10 years, most cohorts that are being tested for drug effectiveness, 75% white, I think maybe even more than that male. This has been needed for a long time, even going back more than 10 years.
What's your take on the challenges of maybe recruitment, of having this adopted within different race ethnicity populations to want to trust different pharmacies to be a part of programs like this? I'm curious of what your take is on that and anything else that you find very fascinating about clinical trial diversity?

Dr. Chris Boone:
I feel like that's a loaded question, but so much, I think the bigger challenge that many of the big box retailers had is not in their lack of ability to deliver. I think that what you're doing is you're trying to change the system at the core. Anytime you want to change how you do it, it's difficult.
The challenge they had in front of them is around addressing this structural issue of trial availability and accessibility to these populations that otherwise would not have access to them. They said within five miles, 95% of the population, we can do this. They put a tremendous amount of investment into propping up this infrastructure that would allow them to do it.
Here's the challenge though, when it comes to clinical trial, one of the fundamental challenges that we have that often is not talked about, everyone wants to talk about trust because I guess that's more of a sexier topic to feel like you're addressing.
The reality is most people are not even aware of trials, that trials are even out there that they can participate in. Oftentimes, it's because most people, the majority of folks rely on their primary care doc or their doc in order to be made aware of that information. That is where the trust lives. The trust lies in between that physician and their patient.
Now you got physicians, now that sort of brings us to our next sort of challenge to overcome, who may or may not be aware of certain clinical trials that are out there especially if they're in the community space, they're not heavy into the research world. If they are aware, then they have their own biases as to why they would push it or not.
First you got the structural issue of trial availability being made to people who are not going to the world renowned academic medical centers that we know of that are generally on the coast of the US, they're not in the community hospitals.
Then you've got, the second challenge you've got to overcome is the sort of physician relationship aspects of it, but even if the physician is aware of it, then you have a third challenge, which is more clinical around being eligible for that trial. You have very, like folks like to say, narrow and strict eligibility criteria that many of the patients have to meet and that's really starts to get into some challenging times.
For me, for example, I have hypertension. It's a post-COVID thing that I've been wrestling with. That would probably limit my abilities to be part of... Otherwise, I'm healthy, but that would limit my ability to be part of a trial. I think then the fourth element is that even if we have the trial availability in place, even if we have that physician awareness and their support in pushing and educating about the trial, then even if once that patient is even eligible, meaning they meet those criteria, then you have the fourth aspect of it, which the decision resting with the patient. Now we're getting into the trust issue.
That's where the trust issue comes into play, and there's a number of reasons as to why patients... They may have historical biases that exist or things that they've heard that have been passed down from generation to generation. There may be sort of fear of side effects. You saw a lot of people who got the vaccine and they were saying, and they were experiencing some complications after receiving the vaccine. I'm not there. I don't know if that's true or not, but that's what some people claim, so you have the fear of the side effects issue.
I also think you have the... What we've seen is the logistical challenges, just the burden of being part of a trial. Even if you can recruit people, it's even more challenging to retain them because whether it's the burden of time and the commitment of being part of the trial, whether it's the burden of cost, which is why certain people are seeking some sort of compensation for being part of a trial, or it could be some of the normal things that we all have.
There's transportation challenges, there's childcare challenges, there's missing work challenges, there's all these things that all contribute to the patient deciding if they really want to be part of that trial. What you're seeing is that a multi-layered issue that is being, I think diluted or simplified to being a single aspect or attribute of a much larger problem.
I don't think that that is going to be resolved by just focusing on an issue such as trust, because there are still so many other structural issues that are part of it.

Brian Urban:
I'm truly thankful we got to have you on our podcast just for a little bit of time here today. I feel a follow-up coming on. There's so many crazy things that you're dipping your hands into. You're quite an innovator. Thank you again for joining our little show here today.

Dr. Chris Boone:
It's my pleasure. Thank you.

Brian Urban:
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