Dr. Andy Moye, Paige AI, on exploring AI’s role in transforming cancer diagnostics

In the latest episode of the BULQ Podcast, co-host Sarah Meadow engages in a compelling conversation with Dr. Andy Moy, the CEO of PAGE, a groundbreaking digital pathology software company that leverages artificial intelligence to enhance cancer diagnostics. Founded in 2017, PAGE stands out as the only company with FDA approval for an AI-based product in this field, and it has recently partnered with tech giant Microsoft to develop the world's largest image-based AI cancer model. Dr. Moy, who has an impressive background that includes service as a flight officer in the U.S. Navy and leadership roles in various healthcare organizations, shares his journey from military service to the forefront of healthcare innovation. 

Listeners can expect to gain insights into the transformative potential of AI in healthcare, the importance of precision medicine, and the challenges faced by startups in navigating the complex healthcare landscape. Dr. Moy's expertise and passion for advancing cancer care through technology provide a thought-provoking look at the future of diagnostics and the role of AI in improving patient outcomes. This episode is not just for healthcare professionals; it’s a fascinating exploration for anyone interested in the intersection of technology and medicine.

INTERESTING FACTS

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Dr. Andy Moy was born in Frankfurt, Germany, and grew up as an army brat, moving around frequently due to his father’s military career.

Peptide Therapy's Growing Popularity

He initially aspired to be a soldier like his father, but after his father’s retirement, he was influenced by the idea of a different career path, which included playing golf with generals.

Peptide Therapy's Growing Popularity

Dr. Moy has a passion for serving and being part of something larger than himself, which he fulfilled through his military service as a flight officer in the U.S. Navy.

Peptide Therapy's Growing Popularity

He emphasizes that there is no straight line to career success, advocating for non-traditional paths and the importance of flexibility in career choices.

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Dr. Moy believes in the value of hiring veterans in startups, as they bring unique benefits and skills to the workplace.

Peptide Therapy's Growing Popularity

He has a strong interest in understanding customer needs and market dynamics, which he developed through his experiences in sales and marketing.

Peptide Therapy's Growing Popularity

Dr. Moy pursued further education by obtaining an MBA and a PhD in health economics, driven by a desire to enhance his skill set and knowledge in the healthcare industry.

Peptide Therapy's Growing Popularity

He has a fascination with the intersection of technology and healthcare, particularly in the areas of diagnostics, precision medicine, and AI.

Peptide Therapy's Growing Popularity

Dr. Moy has a collaborative approach, seeking to work closely with MDs and PhDs to deepen his knowledge and contribute to advancements in healthcare.

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He has been with PAGE for nearly three years and finds it exciting to be part of a startup that integrates his diverse experiences and knowledge in a rapidly evolving field.

Peptide Therapy's Growing Popularity

The guest frequently receives emails trying to sell denim, which they find amusing.

Peptide Therapy's Growing Popularity

They have experience leading a company that is a spin-out from a prestigious cancer center, Memorial Sloan Kettering Cancer Center (MSK).

Peptide Therapy's Growing Popularity

The guest emphasizes the importance of AI in distinguishing various elements in medical imaging, drawing a parallel to technology used in Mars rover missions.

Peptide Therapy's Growing Popularity

They highlight the “black box” period in cancer diagnostics, where patients are often unaware of the intricate processes that occur after their samples are sent for analysis.

Peptide Therapy's Growing Popularity

The guest discusses the challenges of navigating the transition from an academic provider to an entrepreneurial startup environment.

Peptide Therapy's Growing Popularity

They mention the importance of having a “ruthless focus” in startup ventures, particularly in the healthcare sector.

Peptide Therapy's Growing Popularity

The guest reflects on the impact of the COVID-19 pandemic and low-interest rates on fundraising dynamics in the startup ecosystem.

Peptide Therapy's Growing Popularity

They express a commitment to concentrating solely on cancer diagnostics, believing it is a significant enough area to warrant dedicated focus.

Peptide Therapy's Growing Popularity

The guest acknowledges the potential for human error in pathology and advocates for AI as a safety net to improve diagnostic accuracy.

Peptide Therapy's Growing Popularity

They are involved in building software tools aimed at enhancing the efficiency and accuracy of pathologists’ work in cancer diagnosis.

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The guest is involved in a health tech startup focused on providing tools for pathologists and healthcare systems.

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They emphasize the importance of understanding user needs to ensure return on investment for hospitals and health systems.

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The guest describes the journey of their startup as non-linear, highlighting the challenges faced in the health tech industry.

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They mention the rigorous process of obtaining FDA approval, which includes numerous discussions to ensure safety and efficacy.

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The guest points out the unique challenges of regulating AI in pathology, particularly the lack of a safety net if the AI makes a mistake.

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They highlight the significance of a diverse and robust dataset in training AI algorithms for accurate results across different populations.

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The guest notes that the majority of cancer pathology is conducted in community and rural settings, where generalist pathologists work.

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They express pride in their AI tool’s ability to enhance the diagnostic capabilities of generalist pathologists, allowing them to operate at a specialist level.

Peptide Therapy's Growing Popularity

The guest reflects on the fast pace of innovation in health tech and the challenges of keeping up with regulatory requirements.

Peptide Therapy's Growing Popularity

They mention the importance of collaboration and communication with regulatory bodies to navigate the complexities of health tech development.

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The guest is actively engaged in discussions with the FDA regarding the regulatory processes for AI models, particularly those that could be applicable to all tumor types (pan-cancer).

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They emphasize the importance of rigorous FDA approval for AI tools, highlighting a personal trust in the medical processes that involve family health issues, such as prostate biopsies.

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The guest has a strong belief that the FDA’s regulatory capabilities will keep their company ahead of competitors in the AI healthcare space.

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They have received breakthrough designation from the FDA for a product called Breast Lymph Node, which aids in detecting metastatic disease.

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The guest’s company collaborates with Microsoft, which they believe shares a similar vision for healthcare innovation and provides significant computing power for AI development.

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They are working with Nuance Communications, a company acquired by Microsoft, which has a history of providing tools to doctors during the radiology digitization era.

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The guest is involved in cutting-edge research, including a project that aims to develop the largest computer vision model ever built.

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They have published a model called Virchow, which was trained on a million slides and exhibited unexpected emergent properties.

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The guest finds the concept of emergent properties in AI fascinating, particularly how models can demonstrate knowledge beyond their training data, such as coding or language skills.

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They discuss the challenges of building AI models, mentioning the significant computational resources required, including the use of high-performance compute clusters with NVIDIA GPUs.

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The guest believes that healthcare technology lags behind other sectors by 10 to 15 years, highlighting the outdated tools still in use, such as fax machines.

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They emphasize that new generations of pathologists are digital natives, having grown up with technology like smartphones, and are not keen on traditional methods like using microscopes.

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The guest advocates for AI as a tool to enhance the capabilities of pathologists, allowing them to focus on complex problem-solving rather than mundane tasks.

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They express excitement about the potential of AI to revolutionize cancer treatment by predicting patient responses to drugs based on extensive data analysis.

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The guest acknowledges the skepticism surrounding AI in healthcare, particularly regarding trust in AI predictions and the need for validation of AI tools.

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They foresee a gradual adoption of AI in larger academic medical centers, while smaller hospitals may lag due to economic and change management challenges.

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The guest envisions a future where AI integrates various data sources (like electronic records, genomics, and radiology) to recommend personalized treatment plans for patients.

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They liken future AI capabilities in healthcare to a “Star Trek” scenario, where doctors can interact with AI to determine the best course of action for patients.

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The guest is currently involved in developing multimodal predictive algorithms that combine different medical data types to improve treatment outcomes.

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They highlight the importance of training and educating healthcare professionals about the applications of AI in medicine, suggesting that this is a critical aspect of integrating AI into healthcare practices.

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The guest emphasizes the importance of intuitive user design in healthcare technology, comparing it to the user-friendly interface of an iPhone.

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They mention a team member, Dr. Juan Retomero, who has extensive experience in digitizing medical labs and plays a significant role in training physicians on new technology.

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The guest highlights the challenge of physician burnout and suggests that AI can help alleviate this by automating administrative tasks.

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They discuss a specific AI tool, Dragon Ambient Experience, which captures patient conversations and generates clinical notes, significantly reducing the time physicians spend on paperwork.

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The guest points out that only 5% to 10% of patients participate in clinical trials, indicating a major area where AI could improve patient recruitment and outcomes.

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They acknowledge the slow pace of change in the healthcare system, which can hinder the adoption of new technologies.

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The guest expresses concerns about ethical considerations in AI, particularly regarding the quality of data used for training, which can reflect biases present in society.

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They note that the ethical implications of AI are currently a hot topic among regulators and policymakers, highlighting the need for transparency in AI applications.

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The guest believes that AI has the potential to address a wide range of healthcare challenges, but acknowledges that the system itself is complex and resistant to rapid change.

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They stress the importance of investing in training for healthcare professionals to effectively use new technologies, rather than assuming they will adapt without support.

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The guest emphasizes the importance of continuous learning in one’s career, particularly for those in the healthcare space.

Peptide Therapy's Growing Popularity

They believe that focusing solely on titles can detract from personal and professional growth.

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The guest suggests seeking feedback from supervisors about skill gaps to identify areas for improvement and development.

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They acknowledge the slow-moving nature of change in the healthcare sector, advising patience for those looking to make significant impacts.

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The guest admits to not being technically inclined, having only taken a basic coding course in high school.

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They value surrounding oneself with knowledgeable and skilled individuals to fill personal gaps in expertise.

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The guest highlights the significance of balancing technical proficiency with soft skills, such as effective communication and interpersonal abilities.

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They stress the importance of having a robust and knowledgeable technical team, especially in roles related to AI and engineering.

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The guest believes that having gaps in knowledge is acceptable and encourages individuals to embrace learning opportunities.

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They advocate for the need to adapt and prepare for long-term commitments in the health tech industry, as monumental changes can take decades.

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The guest emphasizes the importance of understanding various facets of a business beyond just technical skills.

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They believe that effective communication and customer interaction are crucial in many roles.

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The guest values the ability to absorb large amounts of information quickly and translate it into actionable insights.

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They acknowledge that different roles require different skill sets, from hardcore coding to strategic finance and business development.

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The guest expresses enthusiasm for the future of AI in healthcare.

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They highlight the significance of time management in professional roles.

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The guest seems to have a collaborative mindset, appreciating the contributions of others in a team setting.

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They are optimistic about the developments in their field and eager to see future innovations.

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The guest appears to have a forward-thinking perspective, focusing on the evolving landscape of technology and its impact on industries.

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They appreciate the opportunity to share their insights and engage in discussions about important topics.

HOW THEY GOT HERE?

Childhood Aspirations

Dr. Andy Moy grew up wanting to serve, inspired by his father who was a soldier in the army. Initially, he aspired to become a soldier himself.

Military Service

After expressing his desire to join the Army, Dr. Moy’s father discouraged him, leading him to serve as a flight officer in the U.S. Navy for eight years, fulfilling his desire to be part of something bigger.

Educational Advancement

Following his military career, Dr. Moy recognized the need to enhance his skill set in business and healthcare, prompting him to pursue an MBA from the University of Florida.

Entering Healthcare

Dr. Moy transitioned into the healthcare industry, specifically focusing on diagnostics and precision medicine, understanding its critical role in treatment decisions.

Career Development

He gained experience in sales and marketing within the healthcare sector, engaging with customers to understand their needs and the competitive landscape.

Leadership Roles

Throughout his career, Dr. Moy consistently sought and achieved leadership positions, driven by a desire to lead and innovate in the healthcare field.

Further Education

To deepen his expertise, he pursued a PhD in health economics, equipping himself with advanced knowledge relevant to his career.

Joining PAGE

Dr. Moy joined PAGE, a digital pathology software provider, where his diverse experiences in healthcare, diagnostics, and leadership converged.

PAGE's Innovations

Under his leadership, PAGE developed AI-driven solutions for cancer diagnostics, becoming the only company with FDA approval for an AI-based product in this field.

Strategic Collaborations

PAGE expanded its partnerships, including a collaboration with Microsoft to create the world’s largest image-based AI cancer model, further establishing its influence in digital pathology.

Foundation at MSK

PAGE originated as a spinout from Memorial Sloan Kettering Cancer Center (MSK), a leading cancer hospital with over 150 years of history, known for its exceptional cancer care.

Vision of the Founders

Dr. David Clemstra and Dr. Thomas Fuchs envisioned using AI technology, initially developed for NASA’s Mars rover missions, to enhance medical imaging and tissue pathology.

Development of AI Algorithms

The team leveraged extensive data from MSK to create AI algorithms aimed at improving the accuracy and efficiency of pathology, ultimately enhancing cancer diagnostics

Understanding Pathology Process

The process of diagnosing cancer involves sending tissue samples to a lab where pathologists analyze slides under a microscope, a process that can be prone to human error.

Integration of AI Tools

PAGE developed software tools that serve as a safety net for pathologists, reducing the likelihood of misdiagnoses and providing additional insights for cancer treatment.

Navigating Spinout Challenges

Transitioning from an academic provider like MSK to a startup involved navigating complexities related to product development, funding, and establishing a clear business model.

Healthcare Market Dynamics

PAGE faced unique challenges in the healthcare sector, where the relationship between product producers, users, and payers is complex, making market adoption difficult.

Focus on Product Market Fit

PAGE faced unique challenges in the healthcare sector, where the relationship between product producers, users, and payers is complex, making market adoption difficult.

Ruthless Focus on Cancer

Over the years, PAGE honed its focus to solely target cancer diagnostics, recognizing the significance and complexity of the disease as a worthy area of specialization.

Commitment to Transforming Diagnostics

PAGE continues to work towards transforming cancer diagnostics by providing innovative tools that empower pathologists and enhance patient care.

Foundational Focus on Clinical and Technological Tools

The journey began with a commitment to enhancing the clinical side of healthcare through innovative technology, aimed at aiding pathologists and understanding user needs.

Identifying Market Needs and ROI

The team recognized the critical challenge of demonstrating return on investment (ROI) for hospitals and health systems, particularly in securing reimbursement from payers.

Navigating the Complexity of Health Tech

Acknowledging that the path to success in health tech is not linear, the company embraced its startup status while gaining traction in a competitive market.

Understanding Regulatory Landscape

The discussion highlighted the unique challenges in healthcare regulation, contrasting it with other sectors like AI, where products can launch without regulatory approval.

Engaging with the FDA

The company engaged in extensive dialogue with the FDA, undertaking approximately 95 discussions to clarify what was needed for approval, especially for their AI algorithms in pathology.

Achieving Breakthrough Status

They successfully obtained FDA breakthrough status, which expedited their product’s approval process and allowed for direct communication with the FDA regarding necessary studies.

Ensuring Robust Data Set

A significant focus was placed on ensuring their AI’s training data was diverse and comprehensive, capable of performing well across different populations and settings.

Demonstrating Efficacy in Studies

Clinical studies showed that pathologists using the AI tool improved cancer detection sensitivity by 8-10% and reduced diagnostic errors by 70%.

Empowering Generalist Pathologists

The AI tool enabled generalist pathologists in rural settings to perform at the level of specialists, addressing a significant gap in cancer care accessibility.

Pioneering a Unique Approval Path

After two years of rigorous study and validation, the company achieved a de novo approval from the FDA, setting a precedent that others have yet to replicate, showcasing the strength of their data and methodology.

Executive Order on AI

Joe Biden issues an executive order addressing AI regulations, prompting Health and Human Services (HHS) to implement transparency rules, alongside the FDA’s various frameworks for AI tools.

Regulatory Landscape

The company recognizes the challenge of fitting diverse AI tools into existing regulatory frameworks and emphasizes the importance of rigorous FDA approval for clinical-grade AI applications.

Emergence of AI Startups

The speaker notes that the barrier to entry for AI startups is low, with small teams able to create AI models using publicly available datasets, but stresses that without FDA approval, these models may not be trustworthy for clinical use.

Breakthrough Designation

The company achieves breakthrough status from the FDA for their product, Breast Lymph Node, which aids in identifying metastatic disease in breast cancer patients, showcasing their commitment to high-quality, validated AI tools.

Pan-Cancer Model Development

The company engages in discussions with the FDA regarding the development of a pan-cancer AI model, aiming to create a solution that addresses all tumor types, thereby pushing the boundaries of regulatory conversations.

Partnership with Microsof

The company partners with Microsoft, driven by the need for substantial computing power to train large AI models, recognizing Microsoft’s investment in AI technology and its similar vision for healthcare innovation.

Investment in Compute Power

The company reflects on its early days, where they built a high-performance compute cluster with NVIDIA GPUs to support AI model training, highlighting the computational demands of developing advanced AI applications.

Collaboration with Nuance Communications

The partnership extends to Nuance Communications, which was acquired by Microsoft, leveraging their expertise in radiology and digital tools for doctors, enhancing the company’s capabilities in the healthcare sector.

Cutting-Edge Research with Microsoft

The collaboration with Microsoft Research focuses on developing potentially the largest computer vision model, exploring emergent properties that arise during training, which could lead to unexpected and innovative outcomes.

Excitement for Future Discoveries

The company expresses enthusiasm about the unknown possibilities that may arise from their research and development efforts, particularly in the realm of emergent properties in AI, reminiscent of breakthroughs seen in large language models.

Emergence of AI in Healthcare

The conversation begins with the introduction of computer vision models aimed at understanding cancer architecture to predict patient outcomes, showcasing the intersection of technology and healthcare.

Initial Studies and Research

Early studies are published on the effectiveness of AI in predicting cancer recurrence and treatment responses, sparking interest from pharmaceutical and life sciences sectors.

Technological Lag in Healthcare

Acknowledgment that healthcare technology lags behind other industries by 10-15 years, with outdated practices like fax machines still in use in medical offices.

Generational Shift in Pathology

Newer generations of pathologists, trained in a digital age, express a desire to leverage AI tools instead of relying solely on traditional microscopy.

Role of AI as a Tool

AI is framed as a supportive tool for pathologists to enhance their diagnostic capabilities and improve patient treatment plans, rather than replacing human expertise.

Trust and Adoption Challenges

Emphasis on the need for pathologists to build trust in AI tools, which involves overcoming skepticism and adapting to new digital workflows.

Gradual Integration in Large Institutions

Predictions indicate that large academic medical centers will lead AI adoption, while smaller community hospitals may lag behind due to economic and change management challenges.

Vision for Multimodal AI

A future scenario is envisioned where AI integrates various data sources (genomics, pathology, radiology) to provide comprehensive treatment recommendations for patients.

Star Trek-like Future

The discussion culminates in a futuristic vision where AI assists doctors in making informed treatment decisions, akin to a science fiction scenario where technology seamlessly aids medical professionals.

Importance of Training and Education

The conversation highlights the necessity for Paige to engage in the training of healthcare professionals, ensuring they are educated on AI applications and integration within their practice.

Entrepreneurial Aspirations

The journey begins with an MBA graduate aspiring to launch a health tech company, recognizing the need for effective training for healthcare professionals using their product.

Understanding User Experience

The realization that healthcare technology isn’t as intuitive as consumer tech (like the iPhone), prompting a focus on user design to simplify the interface for medical professionals.

Expert Collaboration

The inclusion of Dr. Juan Retomero, a pioneer in digitizing labs, who plays a crucial role in training physicians on how to use the product effectively through various communication methods.

Investment in Training

Acknowledgment that introducing new technology in healthcare requires time and resources for training, emphasizing that this is an essential investment rather than an optional step.

Identifying Healthcare Problems

Recognition of the vast array of challenges within healthcare, leading many startups to enter the space with the intention of solving specific issues.

AI’s Role in Reducing Burnout

Introduction of AI tools like Nuance’s Dragon Ambient Experience, which helps alleviate physician burnout by automating administrative tasks and streamlining the documentation process.

Focus on Diagnostics

Highlighting the potential of AI in medical imaging and cancer diagnostics as an area ripe for innovation and improvement.

Enhancing Clinical Trials

Discussion on the low patient accrual rates in clinical trials and how AI can assist in matching patients to trials, thereby improving survival rates, particularly for rare cancers.

Ethical Considerations

Addressing the ethical implications of AI in healthcare, particularly the importance of the quality of data used in training AI systems and the potential biases that can arise from it.

Regulatory Landscape

Mention of ongoing regulatory efforts, such as executive orders and the EU’s stance on AI, indicating that ethical considerations are becoming a priority in the development and implementation of AI in healthcare.

Emergence of AI in Healthcare

The conversation begins with the recognition of AI, particularly in healthcare, as a transformative force, prompting organizations like OpenAI to refine AI’s capabilities while addressing ethical concerns.

Understanding Hallucinations

Sam Altman discusses the concept of “hallucinations” in AI, drawing parallels to human problem-solving, where imaginative scenarios can enhance reasoning but also pose risks when they introduce inaccuracies in clinical records.

Ethical Implications

The dialogue emphasizes the need to mitigate harmful hallucinations in AI, particularly in sensitive areas like healthcare, where incorrect data can have serious consequences for patient records.

Focus on Robust Data Sets

The importance of developing AI models that are robust and generalizable across diverse populations is highlighted, stressing the need for representative data to reduce bias in AI applications.

Career Advice for MBAs

The speaker advises MBA graduates to focus on continuous learning and skill development rather than merely chasing titles, emphasizing the significance of understanding personal gaps in experience.

Navigating Healthcare's Slow Pace

The discussion acknowledges that healthcare is a slow-moving sector, cautioning aspiring professionals to be patient and prepared for a long-term commitment to see substantial change.

Identifying Skill Gaps

Practical advice is given on how to identify and address skill gaps, encouraging individuals to seek feedback from supervisors and pursue diverse experiences to enhance their qualifications.

The Value of Team Dynamics

The speaker stresses the importance of surrounding oneself with knowledgeable individuals and mentors, recognizing that no one can be an expert in every area.

Hiring Criteria at Page

When hiring, Page looks for a balance between technical proficiency and soft skills, highlighting the importance of effective communication and interpersonal abilities in customer-facing roles.

Continual Evolution

The conversation concludes with a reminder that as AI and healthcare continue to evolve, professionals must remain adaptable and committed to lifelong learning in this dynamic field.

Understanding the Role

The discussion begins with recognizing that different roles within tech have varying requirements, from hardcore coding to strategic business functions.

Skill Diversification

Emphasis is placed on the importance of skill diversification, particularly for roles in strategic finance and business development, highlighting the need for effective communication and customer interaction.

Learning to Absorb Information

The conversation touches on the necessity of quickly absorbing large amounts of information and translating it into actionable insights, which is critical for success in any business role.

Role-Specific Skills

The dialogue underscores that the skills required can differ dramatically depending on the specific role one is pursuing within the tech industry.

Future of AI in Healthcare

The podcast hints at the exciting developments on the horizon for AI in the healthcare sector, suggesting a transformative impact on the industry.

Networking and Collaboration

The importance of networking and collaboration is implied, as roles often require working with various departments and understanding their functions.

Continuous Learning

A theme of continuous learning and adaptation emerges, emphasizing that professionals must stay updated with industry trends and technologies.

Closing Remarks

The conversation wraps up with gratitude for the insights shared and anticipation for future developments, particularly in AI and healthcare.

Invitation for Further Discussion

The host expresses eagerness to continue the dialogue in the future, showcasing the ongoing nature of learning in the tech landscape.

Encouragement for Future Engagement

The closing encourages listeners to remain engaged with the evolving world of technology and its implications for various industries, especially healthcare.