Charles Cho, MD, Han Choi, MD, LLM, and Doug Yoon, MD, PhD, MPH, MBA

Charles Cho

Charles Cho, MD

Managing Director, Palo Alto investors Clinical Professor, Neurology & Neurological Sciences, Stanford Medicine

Charles Cho, MD, joined Palo Alto Investors in 2008 and specializes in the healthcare sector. Dr. Cho is a practicing board certified neuromuscular specialist and serves on the Charles Cho, MD Managing Director, Palo Alto Investors Clinical Professor, Neurology & Neurological Sciences, Stanford Medicine faculty at the Stanford Medical Center where he is the Director of the Amyotrophic Lateral Sclerosis Clinic. Previously, Dr. Cho was a Clinical Instructor at the Harvard Medical School. Dr. Cho received his bachelor of science from Brown University and his doctor of medicine from Georgetown University School of Medicine. He completed his residency at Stanford and did a post-graduate fellowship at Massachusetts General Hospital.

Han Choi. MD, LLM

Principal, Oracle Investment Management

Han Choi, MD, LLM is currently a Principal at Oracle Investment Management, a healthcare hedge fund based in Greenwich, Connecticut. Prior to joining Oracle, he held positions of increasing responsibility in licensing and business development at Pharmacia Han Choi, MD, LLM Principal, Oracle Investment Management Corporation and Bristol Myers-Squibb Company. Dr. Choi received his M.D. from the Mount Sinai School of Medicine and trained in General Surgery at New York University Medical Center. He also holds law degrees from Oxford University and Harvard Law School and is admitted to the New York State Bar, Third Judicial Department.

Doug Yoon, MD, PhD, MPH, MBA

Chief Scientist, Washington Scientific

Doug Yoon, MD, PhD, MPH, MBA is the Chief Scientist of Washington Scientific, a health science consulting firm based in the Washington metropolitan area. Dr. Yoon Doug Yoon, MD, PhD, MPH, MBA Chief Scientist, Washington Scientific specializes in the application of scientific principles and evidencebased risk management strategies to medical, environmental health, and pharmaceutical issues. Dr. Yoon is a strong advocate for humanitarian actions. He worked as the United Nations Peace Keeping Officer in 1997. He has participated and led medical relief actions responding to various disasters including the 2005 tsunami and the 2006 earthquake. In November 2014, the Korean government selected Dr. Yoon as a physician member of the Korean Disaster Response Team (KDRT) to fight against the Ebola outbreak in West

“physician” or “medical doctor” is a professional who practices medicine, which is concerned with promoting, maintaining, or restoring human health. Nonetheless, there are a growing number of physicians who are leveraging their clinical backgrounds to roles beyond direct patient care. As the Cover Story of the April edition, WKMJ interviewed three such physicians who are actively engaged beyond clinical medicine

What was your major reason for attending medical school? Why did you want to become a physician?

Dr. Choi caught in action during a meeting.

[HAN] As with many other Korean families, my parents played a big role in my going to medical school. My mother was one of the first women to have a faculty position at a major teaching hospital in Korea in the 1950s right after the Korean War. She was very dedicated to her academic practice, even putting off starting a family until she was in her mid-forties. Her influence was so strong that she convinced me to do a six-year accelerated B.S.-M.D. program, which led to my becoming a doctor when I was 22 years old. My age ended up being a problem when I started my general surgery residency because patients would take one look at me and say, “you’re just a kid, there’s no way you’re operating on me.” So after getting my medical license, I decided to take some time off from my residency and became a public health officer at the U.S. Centers for Disease Control and Prevention. While at CDC, I ran public health and health policy programs both in the U.S. and in Africa, which is where I first developed an interest in the non-clinical side of healthcare. From there, I decided to go back to school and became an attorney with the intention of doing health policy work at the federal or international level afterwards. However, I ended up joining and eventually leading the licensing and business development functions for two multi-national pharmaceutical companies where my medical and legal backgrounds were useful in structuring and negotiating licensing deals and company acquisitions. Then 13 years ago, I was recruited by a hedge fund to manage their pharmaceutical and biotechnology investments, which is where I am today.

[CHARLIE] As a young child (a very long time ago), I enjoyed the excitement of looking for then discovering something interesting and seeking new experiences. This manifested in many ways during my young life, but also over my educational and career choices. I studied and majored in History, Geology, and Literature during my undergraduate education; then, went on to seek a more basic science post-graduate schooling. After starting a career in Investment Banking, I applied to and attended Medical School, Residency, and Fellowship subspecializing in increasingly more specific desperate diseases. With each differentiating step, there was a growing awareness of need, not just medical care delivery, but also for diagnostic and therapeutic solutions for diseases without adequate cures. Each patient was a mystery needing a solution, and these investigations led to diagnosis and cures.

[DOUG] I lost my ability to walk due to a rare bone disease when I attended elementary school as a second grader. My mother had to carry me on her back to and from the school every day for three years. It was a difficult situation for anybody. One bright aspect of it was, however, that it forced the young boy in a small fishing village to think about the future path relatively early. One day, when I was left alone in the classroom during a physical education class while other friends were playing outside, I gave up the idea of becoming a fisherman because I was not sure that I could walk again. Instead, I made up my mind - “I will do something to fix this kind of embarrassing disease.” I guess that was the beginning of processes that led me to a medical school eventually.

Please introduce your current profession in the clinical and/or nonclinical setting. What experiences have motivated you to pursue your current profession? What are the long-range career goals with your profession?

[HAN] I am currently a Principal at Oracle Investment Management, which was the first sector-specific healthcare hedge fund in the U.S. Although we invest across all subsectors of healthcare, my primary responsibility is to manage our investments in pharmaceutical and biotechnology companies. The last few years have been a great time to be a biotech investor. The pace of clinical research has been staggering, and I consider myself fortunate to have seen many small research-focused companies we invested in mature and grow to become very profitable multi-billion dollar commercial-stage companies. What is even more encouraging is that I am seeing more and more Korean biotech companies attract interest from both the big multinational pharmaceutical companies as well as from U.S. and European institutional investors. There is a lot of cutting-edge research being done by Korean universities and companies that I think will lead to tremendous growth of the Korean biotech sector in the coming years.

[CHARLIE] As a clinician, I am a Professor at the Stanford University School of Medicine Department of Neurology. As a Neuromuscular specialist and Director of the ALS Clinic, I see a focus of patients with truly devastating and life-threatening diseases. I used to also run large multi-center clinical trials to seek curative therapies for these diseases, but have stopped this part of my practice a decade ago, primarily due to my desire to seek more creative solutions and invest in a broader range, and hopefully have a bigger impact in healthcare.

My other professional focus is as a portfolio manager at a Hedge Fund, investing our collective funds into promising healthcare companies in the US, EU, and Korea. The areas of interest include drugs, biologics, devices, and diagnostics. Over the last 9 years, we have deployed over $3 billion into public companies in these three regions. This mission is similar to my clinical activities in that they both are investigating the basic and clinical science technology and seeking treatments and cures to extremely serious diseases.

Dr. Yoon pictured while attending a CDC Ebola training in 2014

[DOUG] I currently work as the Chief Scientist at Washington Scientific, a health science consulting firm that I established in the Washington metropolitan area after working for five years at a large NASDAQ-listed science consulting company. Washington Scientific works on the intersection of medicine and epidemiologic principles. We often are involved in controversial issues such as unwanted effects of drugs or chemical compounds, association vs. causation, and cancer cluster claims.

Before working in the non-clinical setting, I practiced medicine for 18 years in a large academic hospital system in Korea. Evaluation of the epidemiologic evidence behind the clinical decisions was one of the tasks during that era. That’s when I developed further interests on systemic reviews and evidencebased medicine. I decided to earn a degree in public health focused on those areas during my sabbatical year. When I finished my degree in epidemiology, I decided to take a job that might present more opportunities in which I could utilize both of my clinical and epidemiologic training.

As a founder of Washington Scientific, I want to see my company grow from a mere consulting firm into a think tank that helps society navigate into the future. As a society, we are facing many issues currently overarching scientific principles and clinical practices. Health insurance system issues, discrepancies between scientific evidence and real-world clinical practice, and misuse of societal assets in healthcare areas are just a few of them. I dream that Washington Scientific will provide critical guides to the society in overcoming those issues.

Especially for your non-clinical career experience, have you identified any advantages and/or disadvantages of being a physician?

Dr. Choi photographed in his office

[HAN] Being a physician is an advantage anywhere within the healthcare industry because doctors will always make the majority of diagnostic and treatment decisions for their patients. That said, there are an increasing number of dual-disciplined physicians these days including M.D., Ph.D.s, M.D., M.B.A.s, and M.D., J.D.s., including on Wall Street. In the investment management field, being a physician is an advantage because a significant part of our due diligence on companies involves speaking with thought leaders across all specialties about ongoing clinical trials, practice trends, and reimbursement models. Being able to engage thought leaders as peers is often useful in these discussions and having first-hand clinical experience is also helpful in determining whether a healthcare company’s business model is sound or flawed.

Dr. Cho photographed in his office

[CHARLIE] It is during times of extreme change and distress that the measure of someone’s true character becomes apparent. Personally, I’ve witnessed dramatic changes for the worse sweep over my field of Neurology over my 20 year medical career. For example, programs in Alzheimer’s disease taking a decade to develop continue to fail, not even in curing, but in even slightly helping memory and function. Dozens of studies in ALS fail, leaving absolutely no curative treatment for this fatal disease. Not to mention hundreds of Neurological diseases in children and adults that also remain untreatable despite advances in science. Then, there are the logistic changes in medicine that are unfunded mandates of reimbursement hurdles, litigation risk, documentation requirements, service practice laws, etc. As a physician, we live these tectonic shifts to the field of medicine that an average (or even extraordinary) investor may not be able to appreciate, let alone understand in any detail. My most recent appreciation of the medical background in the investing world was during FDA discussions about a cancer drug’s potential black-box warning. There are nuances to the story, but basically, Wall Street discounted the drug’s possible approval or eventual adoption into doctor’s treatment algorithm due to the potential black-box. My understanding of the existing treatments, and the exceedingly dire need of the patient’s with this type of cancer suggested that a black-box would have no bearing on patients or doctors’ decision to use the drug. This is a classic mismatch of non-medical investors and doctors. Eventually, my thesis proved true and the drug was both approved and became the standard of care with widespread use throughout the world.

[DOUG] Understanding science behind the disease and hands-on experience in clinical settings are critical assets in my work. People often overlook scientific evidence and epidemiologic principles behind the clinical practice. Being a physician with extensive clinical experience provides a unique perspective when you examine the situations overarching scientific principles and society, especially on controversial and sensitive issues.

Currently, many doctors are demonstrating their knowledge and skills around the world beyond clinical fields. Do you think this can evolve into a trend? How do you foresee the landscape of the healthcare professions in the future?

Dr. Choi served as a lieutenant of the U.S. Public Health Service at CDC in 1993

[HAN] Healthcare is very different from all other industries because there are so many stakeholders involved. In most industries, supply is generated by a provider of a good or service and demand is generated by the consumer of that good or service. In the healthcare industry, although the patient is the one receiving the good or service, they are not empowered to decide when and which good or service they will get, which is decided by their doctor. Furthermore, that good or service is usually paid for by an insurance company or a government program whose incentives are often misaligned with the patient as well as the doctor. On top of all this, healthcare is a highly regulated industry because it involves public safety. With so many different stakeholders involved, there are multiple segments of the healthcare industry that go beyond direct patient care. I think more physicians will continue to become leaders in these non-clinical segments, which is a positive trend that will benefit both physicians and their patients.

[CHARLIE] Medicine requires a lot of time and dedication, perhaps 10+ years after college to just finish training, then more time and effort to acquire experience and domain knowledge to become a great doctor. Some would argue it is a lifelong pursuit of a singular skill. For these and other personal intangible reasons, most doctors choose to dedicate their professional skills to the clinical fields. However, with these shifts in external factors that affect medicine, such as reimbursement and litigation risks, our skill sets may allow more individuals (rather than huge trends) to deploy their skills in other ways that also contribute to society. This article’s other featured doctors and myself are just a few examples of alternative professions that benefit from the medical background, but there are certainly many other possibilities.

[DOUG] I think that more and more doctors will work on the issues beyond the clinical area. This is a trend that is only getting stronger regardless of the region.

Dr. Yoon and fellow healthcare workers at a CDC Ebola training in 2014

Two trends are evident in the healthcare system. First, the modern healthcare system is getting more complex. Working in the healthcare system now requires more skill sets and broad understanding of the healthcare system than ever before. Some people say that artificial intelligence will replace doctors fairly soon. The people who think such thoughts don’t understand the complex processes and interpersonal skills that doctors are using in a seemingly simple patient encounter. The doctor’s role in the healthcare system and outside of clinical practice will increase and be more diverse.

Second, there is a growing trend of seeking efficiency as the modern health insurance system expands. That, in turn, often poses restrictions on clinicians. Insurance companies love efficiency and directing patients to the cheapest facility available. That means healthcare will be more fragmented and less humanistic unless we, as a society, step in. Finding a right balance between efficiency and humanistic medical care will be a new trend. In that trend, doctors will have more roles in leading society than merely seeing patients.

Do you have any comments or advice for current medical students as well as those who aspire to become a doctor?

[HAN] I think becoming a doctor involves such a substantial commitment of time, resources, and effort that it only makes sense for those who want to treat patients. That said, many physicians split their time between seeing patients and other administrative or executive roles usually in some business-related aspect of healthcare. The one constant in the rapidly evolving healthcare industry is that physicians will never be rendered obsolete in the clinical setting so the opportunities in adjacent segments can only grow.

[CHARLIE] These are very exciting times for young doctors and doctors-in-training. Science and technology are evolving at an accelerated pace and we may witness amazing new treatment options for our patients. Future doctors will have the great honor of treating the terrible diseases that is not possible today, eradicate cancers, reverse dementia, cure aging. In addition, there will be so many options for clinician-scientists and entrepreneurial endeavors to start companies, join industries and assist in healthcare legal activities including patent law, healthcare IT, services, regulatory sciences, sales/marketing. Also, the investment side that I participate will always be available, either at the earlier venture stage or later public stages.

[DOUG] Congratulations. You are among the selected group of people or those about to be selected. However, do not stop thinking about the future and your potential. Only you can set your full potentia

WKMJ has readers from over 10 countries globally. Please share your final words or thoughts with our readers.

Dr. Choi pictured with his wife and two daughters

[HAN] The other unique aspect of healthcare is that although basic human anatomy and physiology are universal, the delivery of healthcare services varies tremendously between counties and sometimes within different parts of the same country. There is no one country who has the best healthcare system, and I have always found it fascinating to see how differently healthcare works across the globe. As physicians around the world continue to share advances in cutting edge research for the benefit of their patients, I think it’s also incumbent on physicians to share best practices for the nonclinical aspects of healthcare as well to improve the overall delivery of healthcare in each country.

Dr. Cho pictured with his father, one of the founders of Korean Air/Hanjin Group and his son

[CHARLIE] My focus has been the translation of basic science to important clinical therapies, hopefully in diseases that currently have no other treatment, or perhaps diseases that only have symptomatic medicines. This focus was both through the practice of medicine but also by investing and providing capital to companies that I felt would have the highest impact and chance of succeeding. This approach carries many scientific, trial, regulatory, and marketing risks. Instead, for many other countries, a medical background may be better focused on transfer of existing technologies/drugs, and perhaps either generics or biosimilar therapies that lower costs to society. There will always be alternative career choices with a medical background, but the specific opportunities may not be the same from country-to-country. I believe by treating patients, teaching (leveraging your knowledge by spreading it to the next generation), investing (multiplying the leverage by using knowledge to potentially treat thousands-millions of patients) scientists and doctors can contribute to society and make a huge difference to the future of healthcare.

[DOUG] Regardless of the region in the world, the healthcare system is a big issue that everybody has something to say. Whatever the issue, in the end, I believe the scientific principles and humanity should prevail. I encourage the readers to look beyond the issue you are looking at.

APRIL 4, 2016