Hi, Steve Adams here and we're continuing with the Future of Precision Medicine Summit and today we have a guest, Bob Mitchell, that I'm excited to share with you. He's the CEO of Genesis Health. Among many other things, Bob's dedicated his career to exploring new horizons as an executive director and investor, building teams and pursuing innovation with an ey on projects that address unmet needs while promoting societal progress. For more than three decades, Bob has led high tech medical device companies working closely with clinical thought leaders the world over. He's witnessed and helped influence the evolution of several endovascular solutions.

In 2018, he retired from operating companies until recently to focus on a few disruptive and related projects. Mr. Mitchell is an active board member for companies based in Europe, the Middle East, Canada and the USA where he currently serves as chairman for three. He has helped fund more than 20 innovative companies including the successful Exit2 venture back startups. In the endovascular space, Bob is known as a mentor and change agent and has been invited as an invited lecturer in more than a dozen countries.

Bob Mitchell, welcome to the summit. Thank you for being with us. Well, thank you Steve. It's an honor to be here. Oh great.

So Bob, walk us through just your, I mean I read your bio, but walk us through a little more in depth, your own history and kind of how you arrived at this point where you're involved in medicine at this level as a thought leader. Yeah, well, thank you for that bio. That overview. I think as you can see from the reading of that, that my journey is, is a bit unique in that my 30 plus year career is, is focused primarily on less invasive medical devices. And through this journey I've been very fortunate to not only be part of some really innovative companies, but also I've been able to rub shoulders and lock arms with some of the really interesting thought leaders, clinical thought leaders in the space of vascular and interventional medicine.

And so over this history I've been able to see not only an evolution but also kind of a revolution in where medicine was to where it is today. So. So yeah, it touches a few different companies. I won't bore you with the details of each of those companies, but some are very well known and some of them are early stage, some of them are venture backed, some are, you know, NASDAQ companies. So I've kind of touched, touched a few things in my career.

Were you involved in aortic stents or. Stents in some way? Yeah, in fact the aorta has been a particular passion of mine from the Beginning, because it can be. Once you have an aneurysm, they call it kind of the, a silent killer. They call it a time bomb because most people don't know if they have an aneurysm in the largest vessel of their body and it can rupture without much knowledge.

And so it's been a passion of mine as to how to, number one, detect those aneurysms more effectively but also how to treat them with a less invasive approach. So several companies I was involved right from the beginning introduced, you know, in fact we took some technology from Australia early on and we brought it to the United States. It became a huge multi billion dollar market in the United States. And then fast forward in my career I worked on a company in Palo Alto that kind of addressed some of the unmet needs that were first innovated in some of the products that I initially introduced to the market. So yeah, that in particular has been one of my passions and an ongoing passion.

I sit on the board of a couple of companies and are looking at how to treat aneurysms more effectively. Yeah, that became personally interesting to me because I recently I went through a scan that's not a scan, it's a test called an mcg. It's kind of the latest, greatest, it's not very well known, not well distributed. And the person that the doctor who I saw wants me to have an echocardiogram because he said there's some things he wants cleared up regarding my aorta. Yeah Yeah.

He said don't worry, it's not some big emergency, it's just something I want you to look at. So I like the words less invasive because when I hear that large vessel, usually it means cracking the chest open to do something. Yeah, they can do it. You know, it's always a challenge of morbidity and mortality and fortunately they've been able to find seizures like this Steve, in a much less invasive technique. So you benefit both from morbidity and mortality.

So your time to recover, doing a much less invasive approach will be much beneficial for you. If we need to get to that direction, it's fortunate you have a friend in the space. Yes, I know, I know. That's what I'm excited about. Well Bob, you know you're a thought leader.

When I first met you, you were going to Hawaii to speak at a big conference on vascular health. You know, what do you see that's out there that's emerging that helps people proactively address vascular related disease. Things like cardiovascular disease, diabetes, hypertension, kidney failure, you know, and relating to this idea of precision, proactive, personalized medicine. Yeah, you know, that's a really good question, Steve. And it's because personalized medicine in a huge respect is kind of become a cliche tagline that a lot of people use, I think specific to vascular disease with an understanding that I've been studying the vascular anatomy and for several decades now, and I really thought that I understood it, but the reality is I've been focusing my career in understanding less than 1% of the vascular systems.

You know, when you think about all the vessels that I've been trying to help innovate in are all either the large, the aorta to the coronary vecular vasculature to the peripheral vascular system, even the neurovascular system, that in itself is just a fraction of the overall makeup of the vascular system. So I think some of the most exciting things that I'm seeing is the merger of two worlds. Those that much like myself, that have studied the macrovascular system combined with those that are studying the microvascular system. And a lot I've discovered in recent years that those two communities haven't talked very effectively. And so some of the exciting I think I see is on the diagnostic side instead of, you know, cat scans and MRIs and Angios, one of the most interesting and compelling things is some new, new techniques that you can look at the microvascular system using high powered microscopes, even under the tongue, to see real time the flow of blood and even red blood cells going through the capillary vessels.

And the reason that's, that's interesting to me is because what you find in the microvascular system is indicative of what you might see in the macrovascular system. So example, for example, if you see disease or profuse disease in the microvascular system, it's usually an indication that you have problems in your macrovascular system. Right. And that's the company you and I are both involved in, Genesis Health Sciences. Do you want to maybe talk a little bit about the device and what we do?

I mean, I'm full disclosure here on this one. I want to make sure everybody understands I'm involved in that company. But it doesn't negate the value of knowing about the science and how you could address some things proactively. Yeah. And it's, it's been a really great honor to work with you, Steve, on this, this very interesting project, because Genesis Health is looking at it from both a diagnostic and A therapeutic perspective.

And the diagnostic is really a simple tool that they use using these high powered microscopes and they literally place it under your tongue and it's through that they can analyze the microvascular system and understand the health because again, that will show you this. The capillary system under your tongue can show you how the rest of your vascular system works. And so once you have a good reading, what this U Genesis Health company has done is using AI and various algorithms, they've been able to triangulate the data to show a score, when it comes down to a score. And it basically scores the health of your. Your microvascular system.

And based on that score, they can then apply different therapeutics to help improve. Not only improve the score is the goal of this, but also to improve the overall health of your vascular system. So that in a nutshell is what Genesis Health is, is the diagnosis of the microvascular system and then the treatment of the microvascular system. That makes sense. And you know, I'm going.

I'm gonna. I don't normally do this in these things, but I'm gonna share a little bit more about my story about this because it's indicative of what can happen. I have a family history of cardiovascular disease and cancer because I own my own, you know, virtual kind of executive health program. We look at things like genetics and things like that. And something everyone should know is their MTHFR gene status.

It's about 50 to 55% of the population. It puts you at a higher risk of cancer. There's a lot of clinical reasons for that, but the problem is, is that there are chemicals in a chain of events that ultimately create serotonin, dopamine, melatonin, norepinephrine, other very beneficial neurotransmitters that you basically start to lose at 25 and by 50 that are gone. And so what happens is your immune system takes over and floods the body with adrenaline to make up for it. And that's setting you up for cancer.

That's before we introduce any bad lifestyle, like a lot of stress and a lot of sugar intake and a lot of carb intake and things like that, which fuel the cancer.

Like I was telling you with this test, the catalyzing moment that caused me to even go look for that, Bob, was the fact that I had scanned and done every 1% of the vascular system test you can do. I did the clearly scan, which I think is. It's a CT scan with AI of your heart. It's three dimensional, it's definitive in terms of large vessel blockage. I did a calcium score.

I had all of the advanced lipid marker test. All of them showed I was in good shape. The tests we do, the glycocheck test of the microvasculature was low, showed that I had a lot of damage to my glycocalyx, to the microvasculature. And so really what it did was it was a canary in the coal mine. Me, really.

And because if I had not done that, I thought, I'm just moving along just fine and I don't have anything to worry about. And what this test did was it helped me realize that there are additional lifestyle factors that need to change. There's some very simple supplementation that can replace the missing chemical to start to restore that problem, which then drives really poor mitochondrial health and also led to the discovery that, hey, maybe I should have my aorta valve checked. And so that's the power in something like this is the early warning system gives you many years in advance to go to work on something. Yeah.

You know what excites me about that story, Steve? I mean, that's such a. That defines the future of personalized medicine when. When I said, you know, it's kind of used as a cliche now, precision medicine and personalized medicine, a lot of times it uses a tagline just to sell more products. Yeah, right.

The experience that you just went through exactly defines how personalized medicine should be conducted. The triangulation of multiple points of diagnostics like you mentioned, which then lead to a very precise analysis of the patient. Your comorbidities, your predispositions, your genetics previous positions, your environmental factors. Once you have an understanding of that, it's that that point is when you start applying personalized and precision medicine. Unfortunately, sometimes we get ahead of ourselves and just assume all of us are the same and all the same conditions.

And so we apply some of these therapeutics generally and universally. So I love your story. And you keed on another factor, which is, you know, and maybe some of your audience doesn't understand what a glycocalyx is. I know myself. I've been in vascular, you know, research and my whole career.

And when I was told that, you know, what this glycocheck that you mentioned analyzes is the health of the glycocalyx, I had no idea what that was because a lot of the work that I do is done through other modalities of imaging. Ct, mri, angiograms, X ray, all of these are used in order to visualize the vascular system. What they do is they inject a dye into your vascular system so they can visualize the vessel and it can show if there are anomalies, if there's obstructions, if there's atherosclerosis, for example, what you defined on there is the help of the glycocalyx. What the glycocalyx is, just so your audience has an understanding of it, is if you cross sectionally cut a vessel, you look at the layers of the vessel and the innermost layer of that vessel is called the endothelium. And always, as my macrovascular scientist, they're always looking at the health of the endothelium.

But the glycocalyx is the substance that can, that protects the end of y. And this is what. That's why when you look at the score that you and I are talking about and your score was low, even though traditional medicine would tell you you're relatively healthy, there was something to show you that you, you know, there were may be some concerns and that is the help of look Glco Caly. So. So it's a fascinating story, Steve.

And I think, like I said, I think, I think it perfectly defines where personalized medicine should take us. Well, the lesson too here is you can do something about it. So this physician is kind of a world class expert, he's the first physician in the world that proved you could reverse blockage in your arteries. He said to me that a year from now provides you don't have any events or get sick. He said this will be completely reversed.

Your mitochondrial health will be completely turned around, Your microcapillary blockage will be largely eliminated and you'll go back to a below, significantly below average risk factor for these two things. Despite your genetics. The message is your genetics aren't your destiny. But they're helpful to know what to go look for. And so I think that's important to know about.

There was one other point that'll come to me later. Can't think of it. Did you want to jump on anything more on that before we move on? No. I think you and I could spend all day talking about the subject, so it's probably wise to move on.

Y. Yeah, right. Yeah. So I think one of the things that showed up in the materials that I have on you is about radiation free imaging and talk about that a little bit, Bob. And like, what are some of the downsides of doing so many of these traditional Tests.

Yeah. This is yet another one of my passions because I've had, given that I've been in the space for coming up on four decades through that I've had a lot of not only personal exposure to radiation, but also some friends that have been directly affected from radiation. In fact, I have a half dozen at least close friends that have passed away because of the research done with radiation exposure. Because you think about it now, MRI is not, it doesn't emit radiation, but CAT scans, CTs. Yeah, CTs and you know, angiograms.

You know, most of the less invasive technologies are done using image guided technologies. What that means is they use X rays called angiography to help guide a catheter through the vascular system. And not only is the patient being exposed to radiation, but the clinician who's the operator who's advancing these catheters and all the staff that's supporting him or her are affected by this radiation. And so I've done quite a bit of research on that. Not only how to protect the operator and the patient from this by, by using different qualities of lead and how you protect that and how you improve the imaging so it's less radiation, but also been involved with the University of Toronto with a program that is looking at DNA breakage and they found a way literally how to prevent DNA breakage by using a prophylactic treatment in advance of these.

And the beautiful thing about it is it's really a nutraceutical, so it's not a pharmaceutical. They take this in advance of the procedure and they show that post the procedure, both the operator as well as the patient have much less, if not almost minimal DNA breakage due to radiation exposure. So yeah, huge, huge part of my career and a passion, one of my passion statements is to help continue to advance in radiation protection. You've been, you bridge that you divide between preventative medicine and traditional medicine. You just made a point about there can be effective nutraceutical solutions as opposed to always having a prescription drug.

And at Genesis we have a product called Rvasca, which is a nutraceutical targeted specifically to repair what you find in the glycocheck test, to kind of restore that glycocalyx, that coating, that protectant of the endothelial lining. What is your view about that? Do you feel that, you know, people can, you know, properly sourced and manufactured, can they trust nutraceuticals to do a really good job for them and not only look at a pharmacological solution? Ye, that's an Excellent question, Steve. And I think, you know, in order to appreciate my answer, maybe I'll take a couple steps back because, you know, through my career, I've traveled the world and I've been able to witness firsthand medicine, how it is practice, how it is utilized across multiple geographies.

And sometimes as Americans, we suffer from a. I guess I'd call it a superiority complex where we believe that our way is the only way. And early on in my career, as I traveled to these areas, I felt it my mission to teach western medicine. But it was through this experience, primarily when I traveled through Asia, I found that they were. I'm using nutraceutical as a very broad natural definition.

And what I saw over there is that where we were using toxic agents to, for example, anesthetize the patient, they were using natural products to anesthetize the patient. And when I was first exposed to this, I thought, how barbaric. You know, that's just, you know, they don't understand the benefits of pharmaceuticals. But as my career advanced and as I witnessed this more firsthand, I saw how advanced, how much further advanced they were than we were. And so that was kind of the.

One of those moments in life where I had a chance to kind of challenge my preconceived notions. It. And it opened up the world of nutraceuticals. Leading now to your question. Now, you know, the pendulum can always swing one way or another.

Yeah. The problem sometimes when you use a broad category of nutraceuticals, if it's not controlled, the benefits of pharmaceuticals are its control. The FDA is monitoring it, they're approving it, they're analyzing the effectiveness of it. So you have this where with nutraceuticals, it can sometimes be considered the wild west, because there isn't that, you know, that FDA mandated control. However, what we're discovering is the population makes this shift more to a nutraceutical approach to it.

The sourcing to your question is critical. Right. You got to make sure you have the purest of sources and also with an acknowledgement that plants are medicine that, you know, if not handled with respect, understanding the formulations and the combinations can be just as toxic as a pharmaceutical. And so we've got to make sure is. I'm not suggesting that the FDA mandate this by any ways, but I'm suggesting that we become more educated on the nutraceuticals that we're using to make sure that they are controlled, make sure that we understand not only the formulations, but the, the cross analysis of when combining multiple nutraceuticals together, what the true effective is because right now we're seeing a few companies, I think Amazon is under quite a bit of scrutiny right now because not only because of their sourcing, but also because of sometimes the overuse of different nutraceuticals leading to kidney failure and other things.

So when I say the pendulum can kind of swing back and forth, we always got to try to find that equilibrium to make sure we're doing it the right way. And that's where when you mentioned Revasca and some other products on the nutraceutical side, they've gone through the scrutiny of clinically validating, you know, what is combined within their formulas. Well, there's some guardrails too. You know, the FDA does have rules for manufacturing. There's nsf, there's gmp, which is guaranteed minimum potency.

So like I owned an organic health food store with a big supplement department and we only stop things that have those guardrails on the label. And then the other thing we always tell people, it's like if you start taking a bunch of supplements, you really should have a physician look at what you're taking and making sure there's no, you know, contraindications with any pharmacy, any prescription drugs you're taking, you know, things like that. So there's ways to protect yourself. There's always ways. But not everyone looks at it the way you look at it.

And that's my point is we've got to make sure that the general population is educated as much as you are on these subjects. So you're right. So Bob, to finish up here, talk about when I saw you last. You have a pretty big vision of what's possible for human beings in the next 20 years in terms of the integration of what we're talking about here, this precision personalized medicine, being proactive about it with wearable devices and monitoring, you know what, you know, just given your almost four decades in the medical field, what do you think people can expect to see or look for in the next 10 years in terms of advances that they can participate in proactively themselves? And you weren't just in fairness to Bob, he was not prepared for that question.

I'm doing it extemporaneously. Yeah, most of your questions have been that way. So credit to you, Steve, keeping me on my toes. I like.

Well, I think, in my opinion, what I think the world needs and how I believe we can differentiate from some of the concerns of this, you know, this pendulum swinging and making sure, you know, patient education, make sure you have traceability. The approach that I believe should be embraced is really a three pronged approach to medicine. And what that entails is you have as we mentioned, the precision of diagnostics. Upn. Yep.

How and that can be multiple components of that. You can look at blood chemistry, you can look at genetics as you mentioned, you, you can look at, you know, glycocheck, you can look at, you know, external opportunities there where you, you really have a clear understanding of what the baseline of the patient is. That's number one in this three prong approach. The second one is based off of the interpretation of that triangulated data is you provide, provide a very precise therapeutic to what that represents, you know. But the third component is what most of the world is missing on and that is the follow up, that is the review, that is the assessment, that is the validation of the therapy that's been applied.

So what's interesting about you know, our common thread of genesis is by having diagnostic tools that can be used as both bookends of this equation, we can understand, we can track, we can apply and then we can track progress. And if the progress is lacking, you can go back to alter the therapeutic side. So to me it is to simplify a very complicated question and I could have given you a very complicated answer. I think if you take it down to that third three prong approach to it of diagnosis, therapeutic follow up review, I think that's fantastic. And there's a lot of innovation happening in all three of those areas.

Right. So that's what's exciting about the next 10 years. Yeah, and that's quite frankly that's again my objective is not to beat up the nutraceutical business just because I come from this world. That is not my objective. It'it's just to understand, you know, placebo is a huge tool that we use in medicine and it's something we don't want to underplay and we want to totally embrace.

But we can't just simply have subjective information by saying take this pill because my aunt did and she had this resolution, yah, take this because my husband did it, he grew hair. You know, you can't do objective analysis. It's got to be therapeutic validation and clinical validation by everything we're doing. Yeah, well I think if you're watching this summit, this is a really good rubric through which you evaluate anybody you work with, any decision you make going forward is, can they provide me a baseline? Can they provide me a precise therapeutic process?

And can they then validate what they're doing? And do they have the ability to adjust and have dynamic treatment planning based on the validation results? Well said, Steve. Well said. Well, thank you, Bob, for being on the summit.

Thank you so much for the invitation and look forward to continue to work with you, Steve.