Session V

Medical Opportunities in Hawaii

Moderator:
Virginia Hinshaw
University of Hawaii at Manoa

Dr. Hinshaw, chancellor of the University of Hawaii, introduced the final session by noting the importance of health care in Hawaii, whose population “lives longer than any other in the United States.” She said that health care was an appropriate local emphasis, with the “health sciences increasing in strength at UH Manoa.” She cited the words of Thomas Jefferson, who said, “Public health is what we as a society do to ensure conditions in which people can be healthy. The care of human life and happiness, and not their destruction, is the first and only objective of good government. Without health, there is no happiness.”

She emphasized the collaborative work of the health sciences, in which Hawaii sought to integrate its particular strengths of basic sciences, nursing, medicine, social work, cancer research, and public health. “We envision this as a system-wide endeavor,” she said, “including pharmacy and allied health efforts across the university. For much of my career, I worked internationally on influenza viruses, and I learned early that countries need to work together to keep our local and global neighbors healthy.”

CLINICAL TRIALS IN HAWAII

Art Ushijima
Queen’s Health Systems/The Queen’s Medical Center

Mr. Ushijima, president and chief executive officer of the Queen’s Health Systems and the Queen’s Medical Center, noted that even after 37 years’ experience



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Session V Medical Opportunities in Hawaii Moderator: Virginia Hinshaw University of Hawaii at Mānoa Dr. Hinshaw, chancellor of the University of Hawaii, introduced the final session by noting the importance of health care in Hawaii, whose population “lives longer than any other in the United States.” She said that health care was an appropriate local emphasis, with the “health sciences increasing in strength at UH Mānoa.” She cited the words of Thomas Jefferson, who said, “Public health is what we as a society do to ensure conditions in which people can be healthy. The care of human life and happiness, and not their destruction, is the first and only objective of good government. Without health, there is no happiness.” She emphasized the collaborative work of the health sciences, in which Hawaii sought to integrate its particular strengths of basic sciences, nursing, medicine, social work, cancer research, and public health. “We envision this as a system-wide endeavor,” she said, “including pharmacy and allied health efforts across the university. For much of my career, I worked internationally on influ- enza viruses, and I learned early that countries need to work together to keep our local and global neighbors healthy.” CLINICAL TRIALS IN HAWAII Art Ushijima Queen’s Health Systems/The Queen’s Medical Center Mr. Ushijima, president and chief executive officer of the Queen’s Health Sys- tems and the Queen’s Medical Center, noted that even after 37 years’ experience 110

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111 SESSION V in hospital administration, he was newly excited by several innovative programs in Hawaii’s health care. One was a new partnership between the medical school, which does not have a hospital, and the hospitals in the community. A second was the hospitals’ growing experience with clinical trials. He noted that Hawaii’s uniquely diverse population made it an ideal location for clinical trials, and that true local expertise in the medical care of Asian Pacific populations was likely to draw patients not only from Hawaii but also from throughout the Pacific Rim region. He said that the Queen’s hospital was founded in 1859 by Queen Emma and King Kamehameha IV and has been in its current location since July 1860. Today it is a tertiary care teaching hospital affiliated with the John A. Burns School of Medicine of the University of Hawaii. The hospital admits over 22,000 inpatient cases a year and 350,000 outpatient visits. It employs about 3,500 people, includ- ing 1,100 physicians. Today, he said, a focus of Queen’s is to build a strategic framework around innovation. This was not easy to do in a large hospital, he noted, because so much of its activity is driven by tradition and a broad array of regulatory requirements, but he was seeing exciting improvements. Some of these improvements were in process, such as using clinical protocols to standardize medical care. Others came from program development, such as wider application of minimally inva - sive surgery, including a robotics surgical program. A third area is research and development, he said, primarily in the area of clinical trials. He saw three primary areas of value in the clinical trials work: (1) It brings novel therapies to patients, (2) it feeds an innovation framework by supporting researchers developing new therapies, and (3) it brings opportunities for commercialization of new drugs, devices, and applications. Mr. Ushijima described three successful clinical trial initiatives that have been developed. Three Successful Initiatives Queen’s Center for Biomedical Research This center, he said, is an outgrowth of recruiting Reinhold Penner, M.D., Ph.D., from the Max Planck Institute in Germany 13 years ago. Dr. Penner’s wife and professional collaborator, Andrea Fleig, Ph.D., earned her doctorate at the UH and wanted to return, and Queen’s worked with the university to recruit them. It built a laboratory and provided seed capital for his research program, while simultaneously strengthening the laboratory capacity on campus for him and for other researchers. It also increased the National Institutes of Health (NIH) indirect funding rate from 19 percent to about 75 percent today, developing a new funding model by sequestering indirect funds to support the investigators for special equipment and for times when they were needed. The funds were not used for operations, but to seed and support research.

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112 BUILDING HAWAII’S INNOVATION ECONOMY Much of Dr. Penner’s research had addressed cell signaling, signal trans- duction, and ion channels. At the same time, he had experimented with the drug clofazamine, known for treating Hansen’s disease, and was beginning to apply it to innovative treatment of autoimmune diseases, such as psoriasis, rheumatoid arthritis, multiple sclerosis, Type 1 diabetes, and Crohn’s disease. Such practical applications can extend the value of existing drugs and provide new treatments for patients. MRI Research Center Mr. Ushijima said that Queens’s has also worked closely with the medical school in developing novel solutions for known problems. One example grew out of the desire of a researcher, Linda Chang, M.D., to move from Brookhaven National Laboratory in New York State to Hawaii in the early 2000s. The focus of her research was the effects of methamphetamine on the brain and HIV on the brain. When she received a grant for a three-tesla MRI from the Office of National Drug Control Policy, Queen’s committed $2 million to building out new space and providing some ongoing laboratory support. Dr. Chang brought her team and more than $20 million in grants to the university. Her husband and professional collaborator, Thomas Ernst, Ph.D., is a researcher in digital imaging who is developing a technique to address a negative feature of MRIs. An MRI may take 45 to 60 minutes to complete, and if the patient moves, it may have to be repeated, which is costly, time consuming, and disruptive for the patient. Dr. Ernst and collaborators have developed a technology to provide real-time correction to an MRI image that might otherwise be blurred by motion. Mr. Ushijima said that he estimated that reducing the number of MRIs in the United States alone could save over $1 billion in repeat MRIs. PET Imaging Center A third initiative, Mr. Ushijima said, grew out of an agreement established in 1998 with Hamamatsu Photonics. The company, internationally known for photo- multiplier tubes used in satellites imaging and astronomy observatories, wanted to site a PET scanner prototype in the United States. They proposed a joint venture with Queen’s to build a $5 million cyclotron facility to manufacture the radio- pharmaceuticals for PET imaging while Hamamatsu Photonics provided the pro - totype PET scanner. The timing was good, because Medicare in 1998 recognized the value of PET and began to reimburse for procedures. Recently collaborators have developed a tracer that offers a solution to a detection problem with prostate cancer. The common tracer for prostate cancer, fluorodeoxyglucose, accumulates in the bladder and masks the prostate. The Queen’s researchers developed a tracer process for a choline compound that does not accumulate in the bladder, but goes to the prostate, where it is visible in a PET scan. The choline technique, able to

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113 SESSION V give better staging, avoid unnecessary biopsies, and track response to chemo - therapy, is now going through Food and Drug Administration (FDA) approval, and is also being tested on breast cancer, hepatoma, and brain cancers. Recruiting Senior Researchers Results from each of these centers feed directly into clinical trials, Mr. Ushijima said, and each of the projects has brought valuable lessons to Queen’s. First, he said, it is important to recruit established and funded researchers. “Having the expertise is critical.” Second, the institution must provide an adequate infrastructure to sup- port the researchers. Third, leading researchers must be able to pursue collabora- tions and strategic partnerships all over the world. And fourth, the institution must develop “path to market” expertise. This fourth ability, he said, had not yet been developed, but was a current focus at Queen’s. “One thing that Barry Weinman has imbedded in us,” he concluded, “is ROI, return on investment. Whatever you do, you have to include a plan for ROI and a way to sustain it.” Mr. Ushijima added in conclusion an essential fifth ingredient: the willing - ness to take some risk. “In all these initiatives,” he said, “our board at Queen’s was willing to assume a significant amount of risk. This is what has allowed these facilities and projects to happen, and we’ve had significant success as a result. But we still have a lot more to do.” 1234567891011 UNIVERSITY OF HAWAII MEDICAL INITIATIVES Jerris Hedges John A. Burns School of Medicine University of Hawaii at Mānoa Dr. Hedges, dean of the School of Medicine, began by placing the medical school in a developmental context. He said that the school had had “pockets of excellence that predated my arrival” and provided a “nucleus for our matrix.” The current strategy, he said, was to “start bringing clusters of knowledge generation together, and linking them with the community at large.” In the year 2015, he said, the school of medicine will celebrate its 50th anniversary as a medical school. It trains not only doctors, he said, but also public health officers, medical technologists, speech pathologists, and basic scientists. “We have probably the most diverse student body population and faculty of any medi- cal school in not only the United States, but in the world.” Of the current medical school class, 64 were chosen from 1,800 applications; 90 percent of the students are residents of Hawaii. He said that the school’s excellent Kaka’ako Campus had opened in 2005, made possible through the generosity of taxpayers; the cost of 1 2 3 4 5

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114 BUILDING HAWAII’S INNOVATION ECONOMY bonds issued to permit the construction came from the state’s share of the tobacco settlement agreement. On the same campus, construction is also under way for a new University of Hawaii Cancer Center. More Community Partnerships The current strategy for the medical school, he said, was to bring education and research together and to build a complete biotechnology enterprise, in part - nership with the community health care institutions. He said that an overarching goal was to move further into community partnerships. An example was the new biosafety research cluster within the basic science building that allows research on significant infectious diseases, such as dengue fever, avian flu, West Nile virus, and HIV/AIDS. Dr. Hedges praised the neuro-imaging group directed by Dr. Linda Chang and described by the previous speaker, as well as the Institute for Biogenesis Research, developed by Dr. Ryuzo Yanagimachi. This lab had developed some of the original techniques of in vitro fertilization, as well as techniques of trans - genesis, the placing of genes from one family of organisms into another, includ - ing the first demonstration of moving genes from one organism into the DNA of another. Some original cloning work had also come out of the Institute for Biogenesis Research, he said, helping us understand how birth defects evolve during cell multiplication. In a related program, the school participates in the National Children’s Study in which 1,000 Oahu children are to be carefully monitored from the pregnancy of the mother through their lifetime. At the other end of the age spectrum, he said, the school’s Department of Geriatric Medicine is nationally recognized, partly for its nationally ranked educational and research programs tailored to Hawaii’s diverse communities. The Kuakini Medical Center, for example, is known for its studies of the mechanisms and genetic basis of healthy aging. Another partner was the Department of Native Hawaiian Health, in which investigators have been addressing the role of social stressors on the health of indigenous peoples. Dr. Hedges closed with a “plug for my colleague Michele Carbone,” who was studying a disease caused by the mineral erionite in Turkey, where it is commonly used in the construction of churches and other structures. Dr. Carbone and col - leagues found that erionite, a mineral similar to asbestos, has a strong association with the lung and peritoneal disease mesothelioma in some families, but virtually no association in others. This had led to an international collaboration to discover the genetic basis of this difference. The Melding of Ethnicities and Cultures The medical school has strong NIH research programs, he said. These pro- grams are well suited to study the melding of ethnicities and cultural groups and

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115 SESSION V have allowed researchers to ask questions beyond simply what is the molecular basis of illness and to look into social and ethnic factors. “One Clinical Transla- tional Research award allows us to begin on multiple levels to start unraveling the issue of nature versus nurture,” he said. The school focuses on six key health areas to identify causes of health disparities amongst (ethnic, cultural, and geographic) groups: cardiovascular, respiratory, cancer, nutrition and metabolic, perinatal and growth, and aging/neurocognitive health. “We look at the community at large,” he said, “trying to identify factors that promote better health in our population. We also provide resources to young investigators to help prepare the next generation of investigators.” The medical school, like other academic institutions, is also trying to trans - late the results of its research into useful form. In the health sciences, this has to do with understanding how knowledge at the basic level is taken to the patient’s bedside, and from there to the community at large. One goal is to better under- stand existing disparities between groups. Is the difference simply due to access to early diagnostic studies and therapies? “Why do population subsets differ? We have a great opportunity to study that issue,” Dr. Hedges concluded. “In each of the six key health areas we are focused on documented disparities within Hawaii, and we have expertise in each of those areas. We will start to unravel those fac - tors and hope our multicultural, multiethnic population can serve as markers or bellwethers for health in the country as a whole.” One way to translate innovations to the community, he said, is through the embryonic thrust of personalized medicine, ethnically and culturally tailored. Another way is through new business models that are health focused, use alter- native delivery systems, and minimize redundancy in care delivery. “We need to know why some treatments work for some individuals and not for others,” he said. Changing the Medical Model The larger challenge, Dr. Hedges stated in closing, was to make fundamental transformations in the practice and delivery of health care. “Some 17 percent of GNP is now devoted to health care,” he said. “That has to decrease. We have to deliver medical care in a more healthy prospective manner. We have to introduce social impact factors and personal involvement in one’s own health care. This means a move away from an insurance-driven transactional model, an end to our process of waiting until someone becomes desperately ill and then rescuing them from that state. “We also have to change our definition of medicine from what the physician is doing to what the health care team is doing. It’s time for the medical school, nurses, and social workers to work closely with hospital partners to make that change. In our lifetimes, we’ve seen a lot of industries come and go, and I think our health care delivery system is going to change too. We need to move fast to be ready for it.”

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116 BUILDING HAWAII’S INNOVATION ECONOMY ADVANCING INNOVATION AND CONVERGENCE IN CANCER RESEARCH Jerry S. H. Lee Center for Strategic Scientific Initiatives National Cancer Institute National Institutes of Health Dr. Lee, deputy director of the National Cancer Institute (NCI) Center for Strategic Scientific Initiatives, noted that cancer is known to be not one but many diseases, and that many are “relatively manageable” when the disease is detected early and localized. But the thing that connects all of these many cancers is what happens when the disease spreads, or metastasizes, and contributes to more than 90 percent of cancer deaths. 12131415161718192021222324 Approximately half a million Americans died from cancer in 2010, and about 1.5 million will be diagnosed this year. “What’s startling to me is that, while we’ve made progress in other diseases since 1950, we’ve not done such a great job with cancer, which challenges us to think more innovatively about the disease. By 2020, the experts tell me that mortality will rise to about 10 million per year worldwide and incidence to about 16 million worldwide.” Citing recent publications by the World Health Organization (WHO), in some regions, he said, incidence and mortality have increased by 50 percent since 2002. However, he said, there has not been a more exciting time for research given the advancements in both information exchange via the internet and the many new technologies that are bringing deeper understandings of the human genome and variations that may relate to cancer at a unprecedented pace. For example, less than 10 years after celebrating the complete sequencing of the human genome, in 2010, the NIH announced the 1000 Genomes Project to establish the most detailed catalogue of human genetic variation among different ethnic groups. Dr. Lee said while considerable new data is being generated, the statistics he cited earlier clearly demonstrate that transforming the data into new knowledge to generate value to the patient has been more challenging than anticipated. One reason, he said, is the rising costs the pharmaceutical industry faces to develop each new drug—costs that are unsustainable by current models. How to Make a Large Difference Fast In 2003, when the NCI started the Center for Strategic Scientific Initiatives (CSSI), the primary objective was to help figure out a way to break out of this unsustainable high-cost paradigm. The goal was to identify steps that could make a large difference right away. The Center found that the pace of progress was slowed by “turning the crank thinking.” When the community of researchers 12 13 14 15 16 17

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117 SESSION V was asked directly what should be done to break the paradigm, he said, “We were a little shocked at the answers.” The survey of researchers said that faster progress depended on better standards, protocols, real-time public release of data, multi- disciplinary teams and thinking, and, more importantly, individual team members who themselves were trained in more than one discipline. “You can imagine that these are very tough tasks to deliver. But we figured that if it would give us the potential to transform cancer drug discovery and diagnostics, we should do it.” Dr. Lee stepped back to put the NCI in context. The NCI was created as part of the National Cancer Act, signed into law in 1971 by President Nixon. From a recent report generated for the National Cancer Advisory Board, currently about 50 percent of cancer research is conducted by private industry, and a quarter supported by NCI. “We have heard a lot today about partnerships, and this is one area where they are strong.” He said that the NCI Center for Strategic Scientific Initiatives had launched approximately seven programs since 2003, all of which “took key inputs from the research community” and recognized “that some of the things we’re doing will, in the next 5-10 years, yield real benefit, and some are already doing so.” Dr. Lee then gave an example from a nation-wide nanotechnology initiative, led by Dr. Piotr Grodzinski, that just the previous week launched its third clinical trial which uses not only a nano-based platform to stage the patients but also will give the patients the appropriate nano-enabled therapeutic. Dr. Lee said that the Center found after eight years of work that a good idea does not equal innovation. However, a good idea paired with some unique imple- mentation will significantly increase the potential for innovation. This pairing had already led to some unanticipated innovations. Launching a Cancer Genome Atlas “So our very first step,” Dr. Lee said, “was to go back to the drawing board and ask: Where did we miss some potential opportunities?” Cancer has always been thought of as a disease of the genes, but everyone had their own way to char- acterize these changes in small sample sets. He said we took the community’s first recommendation of standardization and decided to do a systemic identification of all genomic changes at a large-scale by multiple teams, repeat it for all cancers, make the data publicly available in real time, and test whether the data could be assembled in a format akin to a chemical engineering steam table.25 Efforts to accomplish this started in 2004, and in 2007 the Center launched The Cancer Genome Atlas (TCGA) program.26 It focused on three pilot diseases—brain, lung, and ovarian cancer—to see if the concept would be helpful. What the group first encountered when they tried to do this for hundreds of samples was that there 25 A steam table lists the properties of steam at varying temperatures and pressures. 26 .

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118 BUILDING HAWAII’S INNOVATION ECONOMY was a national shortage of highly annotated biospecimens for cancer research. “This was an unanticipated innovation on our part,” he said, that led to an ongoing effort, led by Dr. Carolyn Compton, to build a public resource called the cancer human biobank (caHUB) to provides such highly annotated biospecimens to the research community.27 Returning to TCGA, Dr. Lee noted that despite the cautions of many naysay- ers, state-of-the-art genomic characterization of more than 400 cases of glioblas- toma (GBM) by several expert teams working together, followed by a subsequent unprecedented multi-disciplinary analysis of the collected data and existing avail- able clinical data about the diseased tissue, revealed several unanticipated discov- eries. This was published in a landmark paper in a 2008 Nature article, not only because of the wealth of data, but also due to the fact that the manuscript had only one author, The Cancer Genome Atlas Network. And since the data were made publically available in real-time, prior to the publication, several scientists not supported by the program made their own unanticipated scientific discoveries and that led to new hypotheses. For example, clinicians had used the GBM reference cancer genome and “now are able to separate responders from non-responders.” In 2010, researchers identified a new subset of GBM that occurs in younger patients, and a technique to better predict outcomes. “So we’re really excited by the way this has enabled the entire research enterprise to innovate.” He said that at the same time when the Center was preparing for the TCGA program, the community had asked whether a similar atlas could be created for cancer proteins, which are encoded by genes being examined in the genome atlas. Unfortunately, as assessed by the National Academies, technologies used to detect protein changes were not yet mature enough as compared to those used by TCGA to examine genomic alterations. As such, the Center launched a pro - gram in 2006 to get proteomic technologies ready for clinical utility. Led by Dr. Henry Rodriguez, the program announced, in 2009, the first successful multi- site assessment of proteomics tools in the United States, including a public data resource for those who want to look at the raw data set. The program also began working with the FDA to develop a “mock FDA 510(k) document”28 to educate new developers on how to clinically prepare proteomic technologies for FDA approval to be used in clinics. Also, the Center established an antibody charac - terization laboratory that gives out highly characterized, high-quality antibodies and reagents at nominal costs. He said that CSSI would soon launch the second phase of this program, pairing genomic abnormalities found in TCGA with their associated changes in proteins. 27 . 28 FDA Section 510(k), or Premarket Notification, requires medical device manufacturers to submit premarket notifications if they intend to introduce a device into commercial distribution for the first time.

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119 SESSION V Enlisting the Perspective of Hard Science Dr. Lee noted to the audience that all of the programs he mentioned thus far seemed only to be contributing to the already extraordinary amount of data being generated by the research community. He said this was something the Center rec- ognized back in 2008 and knew that a new perspective was needed in order to sort and integrate these large and complex datasets. CSSI asked a group of 300 physi- cal scientists, engineers, mathematicians, and other “hard scientists” that were used to combining vast information to help think through whether basic principles and laws could be developed for cancer, like they were done for fields such as physics and engineering. Over a span of a year they asked “people who had never thought about the disease to think about it with us.” They responded with some valuable insights: for example that the cancer community was thinking of signal - ing pathways in two dimensions, when in fact they occur in three dimensions. “Proteins move around,” he said. “They don’t just sit next to each other.” He said that the physical scientists were fascinated by metastasis, and how rare, random, and inefficient the phenomenon is, and yet so deleterious. After several addi - tional workshops, the Center launched in 2009 the Physical Sciences-Oncology Centers (PS-OC) program that brought together life and physical scientists led by Dr. Larry Nagahara. “We gave them a charge not to just give us better science, but paradigm shifting science, and to build transdisciplinary teams to achieve this. We gave them some tools we’ve never before given to NCI grantees—such as the ability for individual PS-OCs to give out internal and external pilot funding to support what the grantees felt were important new innovations.” Dr. Lee closed by inviting members of the workshop to reach out to the 12 awarded PS-OCs and contribute their own expertise and form collaborations. “I think you have some interesting perspectives that these teams would love to hear about. Also, it helps that we gave them the mechanism to exchange personnel, and it’s probably not going to be a very hard sell to have one of these professors send a post-doc or graduate student to Hawaii to collaborate with your existing infrastructure.” He thanked the organizers for the opportunity to describe “what we see as the potential for the future of personalized health medicine.” BIOMEDICAL INNOVATION WITH GLOBAL IMPACT IN HAWAII Hank Wuh Skai Ventures Cellular Bioengineering, Inc. Dr. Wuh, who identified himself as “a proud product of the University of Hawaii,” said that he had such a “fabulous education” there that he managed to

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120 BUILDING HAWAII’S INNOVATION ECONOMY get into medical school after only two years. After doing his residency at the UH School of Medicine, he moved to orthopedic surgery at Stanford University where he also started his first company. He had moved back to Hawaii seven years ago to take care of his father and to run his company Skai Ventures. Why Start-ups are “Really Hard” He began by acknowledging that start-up companies “are really hard” and gave a brief personal reminiscence about the experience. “The truth is,” he said, “there’s nothing sexy or glamorous about start-ups. Resources are tight, it’s difficult to raise money, the risks are great, and outcomes are unpredictable. Adventurous entrepreneurs do it because they believe in a concept, an idea, and a dream. In a fair fight, the big guys will always win. They have the resources, the infrastructure, and the network. Start-up companies and entrepreneurs are always the underdog. So you have to be nimble and creative. At Skai, we are the champion of the underdog and like to give them a chance so one day their dream might grow up to become a giant. As you all know, it does happen. It doesn’t happen all the time, but if you don’t try, you will never succeed.” Dr. Wuh said that visitors to the Skai office would see three words on the wall: Invent, Disrupt, Inspire. “Invent is obvious,” he said, “but the world disrupt is there for a simple reason. We like to focus on working on the sort of technology that is truly transformational. Rather than things that are a little faster, smaller, or cheaper, we’d like to focus on technology that can fundamentally change the future. At the end of the day, it’s no more work or time or energy to do that versus doing something incremental. And finally, to inspire: That refers to our interns. This past summer we had 15 interns, all children from Hawaii. The youngest was a junior in high school and the oldest had just finished college. They spent the summer with us to learn about technology and entrepreneurship. It’s a fantastic group, because they’re young, smart, and energetic. Most importantly, they’re completely fearless, because they don’t understand what limitations are yet. They don’t have grown-ups’ fears about how things can be impossible.” Champion for the Underdog The Skai model is a very simple one, said Dr. Wuh. It scours the world for great ideas from really smart people, typically at major universities and national labs. “Our job is to help them, because we are the champion for the underdog. The trick is we bring these innovations back home to Hawaii, where we grow them into big enterprises.” Skai works with many partners, he said. In addition to private equity funding, Skai has put about $35 million into their portfolio of seven companies. They also work with government partners who advance the technology and help mitigate some of the R&D risk. To illustrate the excitement of new technologies and the

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121 SESSION V breadth of opportunities for a small venture firm, Dr. Wuh summarized the work of several Skai companies: • Eyegenix. This company grew out of a chance meeting between Dr. Wuh and a Japanese ophthalmologist. The eye doctor mentioned that Asians were often reluctant to donate organs, mostly because of cultural or religious beliefs. Worldwide, corneal transplants are the number one human transplant procedure and perhaps the most successful. But some 10 million people in the world are blind from cornea disease, and the world supply of donor cornea can only address 100,000 cases. So 99 percent of those needing corneal transplants, he said, will not have a chance to see. In the United States, there are almost enough donors, but the problem is severe in Asia. Skai decided to scour the world for a technol - ogy that could be used for an artificial cornea. He found one at the University of Ottawa, under development for 13 years, and got an exclusive license for the technology. At Sweden’s Karolinska Institute, Skai found the surgeon who had done the pre-clinical studies with this technology, and about 2.5 years ago took the first group of patients to him. The first procedure was done on a 75-year-old woman, blind from a genetic disorder, and when her cornea was replaced with the Eyegenix material, she regained her vision completely, as did a chef, a school bus driver, and the rest of the 10 patients. The data was published in 2010, approvals are being sought, and a manufacturing plant is being built on the site of an old Dole cannery in Hawaii. “It’s a big deal for us here in Hawaii,” he said. “We can manufacture enough supply for the world’s cornea transplantation in a facility less than 5,000 square feet in size.” He said his company is also building an international treatment center where eye surgeons have invested as partners, and entered into an agreement with Visionsure, the largest consortium of eye banks, to provide donor corneas. The eye clinic is planned to become the foundation for a broader program of medical tourism, taking advantage of the state’s experience in dealing with visitors and extra capacity of hotels during certain seasons. • CBI Polymers. In the process of developing artificial corneas, Skai built expertise in materials science—specifically in a binding property between the polymer and the surrounding environment. When the Air Force put out a re - quest for proposals for a polymer gel that could bind radioactive particles, Skai responded. “We knew nothing about airplanes, and nothing about radioactive particles,” he said, “but we knew a lot about a polymer’s specific binding proper- ties.” From that idea has evolved a series of products to remove many kinds of toxic materials, including nuclear contamination, to restore building surfaces, and to perform many other tasks. “There is opportunity to do something significant,” he said, “even though we’re in Hawaii.” CBI Polymers now has 50 customers around the globe. Dr. Wuh closed by saying that there are many opportunities to do something “really significant here in Hawaii. It’s about creating a way that we can allow

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122 BUILDING HAWAII’S INNOVATION ECONOMY entrepreneurs to flourish in our community. These are the young people that we really want to help and inspire. Innovation is by nature difficult, and start-up companies are challenging. We have to help them in every way we can.” DISCUSSION Dr. Greenwood asked what the university could do to help create and bring more innovative companies to Hawaii. Dr. Wuh said there are two components. One is the culture or belief system. “In order for people to take risks, they have to understand that it’s okay to take risks. Entrepreneurship means taking chances on early-stage ideas and concepts. But in order to implement that, you have to have resources. We don’t want to create great companies and smart entrepreneurs only to have them leave the islands. They need resources here to build and thrive and be successful right here in Hawaii. There are many ways to achieve that, but it takes an entire community to believe that is an important part of the future.” Dr. Hedges acknowledged the “wonderful example set by Dr. Wuh in cou- pling knowledge with business.” At the medical school and affiliated programs, he said, “we have been able to generate a lot of good ideas with commercial potential, but we need individuals with both motivation and know-how to couple with our business community.” He said that this process was a challenge for the health professions and that colleagues from the business school had been “ex- tremely active” in putting programs together for entrepreneurs. “We also have to change what we’re expecting of our faculty, whose thinking is still limited to traditional publishing, grants, and promotion, rather than how they can work with the business community and be part of the economy.” Elmer Ka’ai of the UH said that “this was probably one of the best events I’ve attended in the last 10 years,” and asked for advice on ways to pull the vari - ous communities together. He noted a Hawaiian proverb that says, “This banana tree is exceedingly strong only because everybody got together to produce this single fruit.” He noted an inability of the medical community “to really move into Hawaiian communities without scaring them away.” How might we produce an environment, he asked, that brings in the Hawaiian people, who have so many health needs? A Department of Native Hawaiian Health Dr. Hedges commented that “we are blessed with having a Department of Native Hawaiian Health, which, in large part, was generated by a grant from the Queen’s Medical Center. “We [at the School of Medicine] followed the lead from Queen’s in building programs around the involvement and needs of native Hawai- ians. We have native Hawaiian leaders who have ties with the community in a variety of areas. The leadership in the department has developed networks with health centers and practitioners across all the islands to participate in an outreach

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123 SESSION V program, and it’s through this network that we hope our research program will be community engaged. We have such a diverse culture here in Hawaii that it’s impossible to fully understand all the cultural issues that exist, but we’ve put a lot of effort into having our students culturally sensitized so they can appreciate that they have limitations and can reach out for appropriate consultation. I think any efforts from the school are driven more by what the community has asked of us, and one of our challenges is to share our knowledge so that what we know can be more useful for their needs.” Dr. Wessner asked Dr. Hedges, in regard to the traditional orientation of the medical school faculty, what might be done immediately to change incentives toward innovative behavior, such as giving tenure credit for work with start-ups or patents. For Dr. Lee, he asked what kinds of activities at the medical school might attract new investment by the NCI. New Incentives for Faculty Dr. Hedges replied that, in fact, within the past month, the process of pro - motion and tenure had been reviewed, and the institution had decided to shift its reward system toward teamwork and partnerships of various kinds. “We want to reinforce that the landscape has changed and we’re expecting a different level of performance on the part of our faculty.” A related incentive, he said, was to re - ward contributions to collaborative (U54) grants and accomplishments in the pri - vate sector, such as the generation of patents and work with start-up companies. Time to Invest in Data Analysis—For Medicine Dr. Lee responded to Dr. Wessner’s question by referring to a point made earlier about informatics and support of computer infrastructure. “I think that would be a very wise investment down the road because many of these postdocs and graduate students who are working with medical and clinical issues are look - ing at the data and beginning to use it for patient care.” Data analysis, he said, has the potential to find molecular signatures that can be “worth more than any new drug.” It is time to invest in that activity, he said, because the need is growing more quickly than the analytical or storage ability. NIH is running out of storage space, he said, and The Cancer Genome Atlas is having to send discs of data to other centers for processing. “I think there’s some real power to be investing both in the manpower and in the informatics and IT infrastructure.” Dr. Hedges added that a previous dean was a “champion of problem-based learning” who had changed the curriculum. While this was an extremely positive step, he said, it meant that much student teaching was based on the ability to ac - cess information online and to synthesize that information in solving problems. “Getting essential information to make a clinical decision will be more and more challenging,” he said. “We need to enjoin our colleagues from computer science

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124 BUILDING HAWAII’S INNOVATION ECONOMY and mathematics to help us do a better job in synthesis and integration of that information.” Mr. Goldin agreed that data challenges are imminent for Hawaii. He added that he had been asked to estimate the minimum data capacities for the state, and had answered that 100 megabits of capacity should be provided for every home in Hawaii, and 1-10 gigabits for scientific research and business research. “These are absolutely mandatory thresholds,” he said, “if you want to have a high-tech industry that’s stable and grows.” In addition, he said, the computer science ca - pacity and supportive technologies at UH are not sufficient. He suggested a war chest of at least $10 million to $20 million to hire the best people and upgrade the infrastructure.