Is the current clinical trial system fundamentally broken? With an estimated 95% of cancer patients unable to participate in clinical research, a new model is urgently needed. This episode dives deep into the world of Decentralized Clinical Trials (DCTs), a revolutionary approach that brings research directly to patients, breaking down long-standing barriers of geography, cost, and convenience. We explore how this model could fix a system that often fails the very people it's meant to serve.
Joined by our special guest, Dr. Jonathan Cotliar, Chief Medical Officer of Science 37, we uncover how technology is making research more accessible and equitable. We dissect the immense challenges of traditional trials, discussing the incredible burden placed on patients and how this leads to a staggering lack of clinical trial diversity. You'll learn about the innovative solutions that are changing the game, from remote data collection using wearable sensors to virtual study visits. We trace the fascinating journey of Science 37, a pioneer in the DCT space, from its founding in 2014, through its meteoric rise during the pandemic and a $1.3 billion SPAC merger, to its current operations. The discussion also tackles the significant hurdles to adoption, including industry inertia and the critical role of evolving FDA guidance on clinical trials. Dr. Cotliar shares his firsthand experience navigating regulatory skepticism and convincing multi-billion dollar pharma companies to embrace this new frontier. A key focus of our conversation is the transformation of clinical trial patient recruitment, moving from a site-centric model to direct-to-patient outreach through digital channels and patient advocacy groups, especially for rare diseases. Discover the key benefits of decentralized trials and what the future holds for drug development and patient care.
Introduction
Dr. Tim Showalter: Hey Paul, what are you up to?
Dr. Paul Gerrard: Work and shoveling snow.
Dr. Tim Showalter: It's no better here in Virginia. Should we just get into it?
Dr. Paul Gerrard: Let's boogie.
Dr. Tim Showalter: Are we doing that really?
Dr. Trevor Royce: Welcome to Health Tech Remedy, the show where three physician leaders in health technology tell the stories of new and established companies and interview leaders from the industry. I'm Trevor Royce, radiation oncologist and researcher with experience in real-world evidence, informatics, and AI diagnostics.
Dr. Paul Gerrard: I'm Paul Gerrard. I started off as a physical medicine and rehabilitation physician before focusing on reimbursement policy, molecular diagnostics, and market access for AI products.
Dr. Tim Showalter: And I'm Dr. Tim Showalter, a radiation oncologist and prior medical device entrepreneur who is now focused on bringing AI advances to cancer patients.
Dr. Trevor Royce: This week, we're talking about Science 37, a company that focuses on decentralized clinical trials.
Dr. Paul Gerrard: Then we'll speak with Dr. Jonathan Cotliar, chief medical officer at Science 37.
Dr. Tim Showalter: Well, great. Let's hop in, guys. I'm excited to talk to you about Science 37. For our listeners who are not familiar with Science 37, it's a company that's based in Raleigh, North Carolina, and it's focused on decentralized clinical trials. If you're not familiar with decentralized clinical trials, maybe you missed the pandemic because this was an area that really emerged to save clinical research and progress for clinical trials.
Just for context, the definition of a decentralized clinical trial is when some or all of the clinical trial activities occur at locations other than a traditional clinical trial site. This could be at home, a local healthcare facility or nearby laboratory, and collecting data points from non-traditional locations for clinical trials. And there's some real major access benefits to this.
If you've ever enrolled a patient on a trial, you know that the assessment schedule can be cumbersome. We make the participants on the clinical trials come to the cancer center for every single data collection point for a traditional clinical trial. A decentralized clinical trial upends that. And as we've seen all the advent of digital health technologies.
Dr. Tim Showalter: Activity trackers, I'm wearing one right now. I don't know if you guys are, but I've got my WHOOP glucose monitors. I'm wearing a continuous glucose monitor right now, so I'm the perfect candidate for these. But essentially, as all these sensors are available, this technology and related ones really make it much more possible. It's obviously much needed to help improve participation in clinical trials and help speed the conduct of research.
Understanding the Barriers to Clinical Trial Participation
Dr. Trevor Royce: Real quick before we dive into Science 37, let's flesh out this problem a little bit more. You talked about the assessments being cumbersome for clinical trials. What does that actually mean for the patient? How often are you having to come in to get blood work? What kind of assessments are we talking about? I just feel people don't appreciate the incredible burden that clinical trials can be beyond them already being sick, beyond their care that they're already getting during the routine course of things.
Dr. Tim Showalter: That's a great point. Just to use an example, think about a typical phase two or phase three pharma study. A lot of the initial screening would happen at one of the sites that has that trial. For example, if you're a recently diagnosed cancer patient and you're interested in participating in a clinical trial, you might need to get sent over to a different medical center that has that trial open because you could only be enrolled at that site.
And then each study visit, a screening visit, treatment visit would have to be done at that site. And then for the long term, you're committed to ongoing follow-up at that treatment location. If you can imagine you're going to a clinic or a hospital that is 45 minutes away from your house, there's a tremendous burden. And we ask the patients to show up to the actual location. The assessment schedule is built around isolating the effect of the drug and around the schedule of the hospital and their location, but it's not patient-centered in that way.
Even finding the right match of a clinic that has a trial of interest open that's applicable to the patient involves a lot of work if you're a willing and able clinical trial participant. And then over time, it's costly in terms of the time of patients and the amount of money even for driving back and forth in parking.
Dr. Tim Showalter: As we all know, clinical trial enrollment is a massive problem. The estimates can vary. I always hear the number of 5% of cancer patients or less participate in clinical trials. And many trials never get done due to poor accrual or take years and years to happen because of it. There's real promise for making the whole process easier.
Increasing Diversity and Overcoming Disparities in Clinical Trials
Dr. Trevor Royce: In the big picture, there's a general acknowledgement that there's a lot broken about the clinical trial infrastructure and the history of clinical trials. And how, just like so many parts of healthcare that we touched on this show, are outdated and haven't taken advantage of modern technology and infrastructure. You can imagine if you are a rural cancer patient living far away from a tertiary care center and you have a rare cancer diagnosis, the number of clinical trials that may be available may be pretty small for that specific diagnosis. And if you want to be involved in a trial, you're traveling far distances, and to your point, that costs money, that costs time, and you may not comply with that experimental therapy or that trial because of all those barriers.
This is a way to try to address that, and we'll talk specifics about it. But it becomes a setting where only certain types of patients have the best access to trials because they have the most resources. You're starting to bake in some of these disparities that we've been hearing about for decades within the clinical trial infrastructure. And because these trials establish the standard of care, you have an experimental arm and a control arm. If the experimental arm wins, you have this new standard of care.
If you don't have a diverse cohort or all sorts of patients contributing to developing that evidence, then how do you know it's going to work in that population? You really see how these disparities can get baked into the system and how tough it is. That's a reflection of only 5% or so of patients enrolling in clinical trials. And a lot of these professional organizations say the standard of care is to be on a clinical trial. So another way to look at that is only 5% of patients are getting the standard of care. And boy, maybe we could do something about that. Paul, do you have anything to reflect on before we dive into the solution?
Dr. Paul Gerrard: No, but I was just thinking of, I think it's an NCCN guidelines. It says their position is the optimal treatment for all patients with cancer is in the setting of a clinical trial.
Dr. Tim Showalter: Trevor, as you were going through that, I was just thinking, preach. I'm totally on the same page with you.
Dr. Trevor Royce: As investigators too, we really acutely feel this pain because it's so hard to get patients on these trials and you spent billions of dollars going to developing these trials and executing them. And then you can't get the patients to enroll, even though it's a common cancer and a common problem. This is the cutting edge question that your research should answer. And then, boom, you can't get enough patients to complete your trial closes early due to poor accrual. All these resources have been flushed down the drain. And boy, it's tough.
The Science 37 Story: From Founding to SPAC and Beyond
Dr. Trevor Royce: There is a lot to comment on about this company. I'm really excited to speak with Dr. Jonathan Cotliar later this month about this and hear his personal experience. But a couple of things catch my eye about science. There's seven. Number one, they're based in Raleigh, North Carolina, which I have extreme bias towards. So I was pretty excited about that. They really had a time in the sun during the pandemic where everything was moving remote and it really energized a lot of these efforts to decentralize clinical trials. Is there a way to get these therapies to execute these trials for patients so that they don't have to come to an actual clinic and the whole world was shut down during COVID?
Dr. Tim Showalter: Literally no other trials were happening.
Dr. Trevor Royce: Yeah, yeah.
Dr. Tim Showalter: You could enroll a patient.
Dr. Trevor Royce: Totally. That's basically where Science 37 really became quite well known, but they've been around for a while. They were founded in 2014 by Noah Craft and Belinda Tan, both MD, PhDs from UCLA. And they have since left the company, but it's been around now for over 10 years, which is great.
They had all sorts of different fundraising rounds, subsequent raises from 2015 on. They peaked in 2021 when they went public through a SPAC, a special acquisition company merger with a valuation of $1.3 billion. There was a ton of interest in this. I'm not an investment banker. There's all sorts of interesting nuances that maybe we could touch on a little bit with SPACs. But this was a great example of a health technology company being available to the public market through the SPAC mechanism right at the peak of a frothy market around 2021.
Dr. Trevor Royce: That's pretty much their story. The latest was they went private in, I think a year ago, 2024, when a telehealth and diagnostics company called eMed, I'm not familiar with them, so I won't speak on it, but the articles that I read said it went private for around $38 million in January of 2024. We can talk a little bit more about the people involved. We'll hear a lot about that from Jonathan when we interview him. So I may defer some of that in terms of that conversation, but I will say on a personal level, I became quite familiar with Science 37, or at least aware of what they were doing, as I mentioned, because of their presence locally in North Carolina, which is where I'm from, but also a good friend, Shalon Begg, who was a vice president there and has now gone on to work at the NIH and NCI. He was one of their vice presidents. They just had this great post-pandemic story.
The Case for Decentralization: Precision Medicine, Diversity, and Regulation
Dr. Paul Gerrard: As you guys mentioned pretty extensively, the approach to clinical trial participation and enrollment is really still rooted in the days before we had computers and the internet. And that is the underlying fundamental issue. But why does that matter? One of the big things is clinical trials are slow and costly. And if you are an innovator, like a drug company, you have a certain patent duration, you have a certain exclusivity arrangement.
For your product. The longer that trial takes, the less time you have with the drug on market, on patent. That can impact the lifetime value of the drug. Also, as you guys alluded to previously, if you're a patient living outside of where a big academic center is or a place that routinely engages in clinical trials, it's tough to get access. And there is a lot of infrastructure required to run a clinical trial. So it's not like a community healthcare practice can just say, oh, I'm going to enroll my one cancer patient who's eligible for a trial into this trial.
The final thing here is really when we start to think about the world of precision medicine, where we are looking at more and more refined populations, the potential patient selection pools can get narrower and narrower. When you start to look at uncommon or rare mutations, and you want to enroll patients with these rare mutations for a drug trial, that is increasingly difficult to do with a small number of people. You really need to start to think about how you can expand the pool of patients you're drawing from.
The other important thing to note here that I think you alluded to earlier, Trevor, was diversity. Diversity has been a back burner topic for a long time in medical research. But in the past few years, I've seen the FDA take increasing attention to diversity within clinical trials for data that's going to the FDA for clearance or approval.
Dr. Paul Gerrard: So, a big question is, how could we start to enroll more diverse populations. This has been something that's been going on for a long time, but it remains a challenge, so new tools are needed. The regulatory changes, I think, are also worth mentioning here, just the history of what's happened over time in this space. People have known about needing to let the public know about clinical trials for a long time. We can go all the way back to the 1980s when the Health Omnibus Programs Extension Act of 1988 created the AIDS Clinical Trial Information Services, which was intended to let people know about potential clinical trials for AIDS treatment they could be involved in. Now, of course, it wasn't on the internet at the time, but even back then, we recognized that this was a problem.
And then in 1997, the Food and Drug Modernization Act was the starting point of what we now know as clinicaltrials.gov. I'm sure you guys are very familiar with clinicaltrials.gov.
Dr. Tim Showalter: I'm always updating and releasing records and all the things.
Dr. Paul Gerrard: It's an important source of information now. If you want to look and say, I see a study published today, what was the design of the study that they initially publicized? The way it really started was as an information source that patients could be aware of potential trials they could get involved in. Now, of course, this just told patients where the trials are. It didn't actually help them get involved in the trials beyond just making them aware that trials were ongoing and telling them where they were. I see this as, we're almost 30 years late here. That was 1997 that we had the law to establish clinicaltrials.gov, and here we are in the mid-2020s. But it sounds like we're really getting some technology that can not just tell us where clinical trials are, but decentralize the clinical trials and bring the clinical trials to people to really help them get involved in clinical trials.
Dr. Trevor Royce: The timing was right for Science 37 to tackle this problem. We mentioned the pandemic and everything moving remotely. But concomitantly with that, obviously, were the technical advances and the comfort of some of these remote devices in our life. Tim, you mentioned you've got these smart monitors that people carry with them. And all of a sudden that became an amazing way to capture data. I can get my O2 sats from my watch now, which is pretty incredible. That just wasn't possible 10 years ago. So there's this social component where people are comfortable with this ability to be monitored remotely and sharing data and sharing their health data. And obviously the pandemic supercharged all of that.
Dr. Tim Showalter: The arc of technology is bent in this direction finally. And we're at this point where everyone's got a smartphone, not that they're all experts at using it. I'm still learning things from my teenagers. People are accessible in this way. Thinking back during the pandemic, you and I were both at that time deeply engaged in the real world evidence space. And the pandemic and the clinical barriers and lack of in-person visits also affected real-world evidence. So we think about clinical trials, but also the data that we could glean to move products forward for regulatory applications was really paused. And that's a time when decentralized trials really shined so that we were having actual collection of data at home.
The Science 37 Platform: How Metasite™ Powers Decentralized Trials
Dr. Tim Showalter: That's something that is pretty unique about this overall approach. They essentially have an end-to-end technology platform that is called Metasite™. The idea is that it can help with all of the aspects of clinical trials. For example, even in terms of patient recruitment, some of the idea here is you're not just dependent if you're a sponsor on identifying patients from participating clinics, but there's a direct to patient aspect where there can be a campaign where patients can be screened and an expression of interest can be gained from that?
Dr. Tim Showalter: And then in terms of the consenting and enrolling on a trial, that can also happen through support with this platform. And then, of course, a lot of that could still happen at the site level as well. If you think about all the stakeholders involved and take it from that perspective, of course, clinical trial participants, our patients, the most important stakeholder are potentially, you would think, happy because they can have the better access to trials and without so much cost to themselves for transportation and time loss. And if they're not near a major academic center, maybe it can help them get access. For the investigators, if you're trying to run a clinical trial program.
Dr. Tim Showalter: You've invested a lot of time and you want the trials to work and you want to have access to patients to make the trial happen. It's a win for them. And then, of course, for sponsors, what shows value for them is that they're getting their trials enrolled on and completed quickly and they're not missing data elements. I think from all that perspective, it's pretty helpful. Thinking back to the diversity expression that you talked about before, I think that it's a real advantage to have access to patients who don't just represent those who could afford to live near and travel to an academic medical center. Trevor, a question for you since I think you're more familiar with this space is, I know they've got a end-to-end platform, read about that, but I'm curious how you see Science 37's particular technological advantages or right to win and where they fit in overall with this space.
Dr. Trevor Royce: A couple of things, and we should definitely ask Jonathan about this. An important concept is that the way we think about clinical trials in terms of measuring endpoints has changed over the last decade or two, like things like patient reported outcomes. Some of these endpoints are much more amenable to decentralized collecting. If you're a patient and you're giving patient reported outcomes, meaning I'm a patient and I'm filling out a survey about my symptoms and so forth, that kind of thing can be collected quite easily in a decentralized way, through a smartphone and stuff.
Science 37 has clearly been one of the pioneers in this approach. From a regulatory perspective, as Paul mentioned, there's an increasing acceptance for this type of concept for trial designs. They've gone to things like pragmatic trials, decentralized trials, things to try to lower the burden to execute trials. The timing, hopefully, is right for that, for Science 37. And then we'll have to hear from Jonathan what he thinks their special sauce is in terms of their tech and how they plan to execute that. We've painted a pretty rosy picture of what they're trying to do and why it's a problem. And why it should be addressed.
Navigating the Challenges: Risks and Industry Inertia in DCT Adoption
Dr. Trevor Royce: But why hasn't this happened overnight? What are the trade-offs? What are the risks of going totally decentralized with trials? What are we afraid of? What are the threats to that? What would set this back?
Dr. Paul Gerrard: The first thing is that clinical trials are still a critical component of the medical industry, and the medical industry is slow to adapt to things. You have the way of doing things, and you have certain business arrangements.
Dr. Paul Gerrard: A big thing that we have to think about is if you're doing trials for, say, drug companies or for medical device companies. They have to do trials that will produce data that is acceptable to the FDA. These trials are big financial risks. New product launches are risks. So if you introduce some new technology that sounds great, but it doesn't have a track record, that's just increasing your risk, not decreasing your risk.
The way that Science 37 is making money is through contractual arrangements to enable and enhance these clinical trial services. But part of this is it takes time and comfort within the industry for this to gain traction. Some things that might help are, well, the FDA is right now updating its guidance for good clinical practice for trials. In October of 2024, they published new guidance on decentralized clinical trials, which hopefully is adding clarity and increasing the willingness of companies to adopt decentralized clinical trial approaches. And in 2023, they also published guidance on the use of digital health technologies for remote data acquisition. I'm hoping that these things will help. There's still some issues. You have to get a commercial footprint, record of success, and inertia is important in every industry, particularly healthcare.
Dr. Tim Showalter: Completely agree. As I'm thinking about this space, it's something that society needs and that the industry needs. And I'm just picturing being a, let's say you're, a medical director on the clinical development team for a pharma company. Although the FDA has written a lot about supporting decentralized trials and that this is an area that we're evolving, we've seen that before where there's been a lot of publications about AI and ML and there's been guidance given for real world evidence. But still, after years and years in these spaces, there still are a limited number of real success stories broadly within the space.
I just picture that medical director of clinical development choosing whether or not to use this platform, understanding that that would require a different trial design to take advantage of this approach and that the endpoints and the collection methods would be different. It just requires so much courage, both on that medical director's part and then on the FDA review panel's part, and just openness to change. And to your starting point, Paul, the life sciences, biopharma space just is not one to embrace change very quickly. And there's a lot of money and a lot of risk involved. That's what I worry most about, despite the enthusiasm about the general idea.
Dr. Trevor Royce: I think all three of us have tried in various settings to work with Big Pharma as a collaborator and so forth. And it'll be really interesting to hear from Jonathan how they have, how willing they have been to engage and how they are really willing to put their money where their mouth is for decentralizing some of their processes.
A couple of things that we should reflect on. I don't think you can overstate how fundamentally different executing a trial is if it's decentralized in the way that's envisioned versus the traditional method. There are all sorts of things that we touched on, but we haven't said explicitly that would be fundamentally different. How do you do a patient consent if they're doing it remotely? How do you capture their data and treat it with the proper controls and privacy protections and so forth? How do you onboard staff at a site that's remote for collection and execution of the trial? What about looking for things like side effects, toxicities? We take all this stuff for granted when we're the ones that run the trial and we have it all done at our home site. But when you start outsourcing that or removing where that's all done, the risk for the trial could truly increase. Compliance, adherence, how do you know patients are responding to their assessments correctly or taking their experimental drugs and so forth? So there's just a lot, a lot of layers to the onion here that complicate this. It sounds like it's simple, but it's really complicated.
From the Clinic to the C-Suite: A Conversation with Dr. Jonathan Cotliar
Dr. Trevor Royce: We've got Dr. Jonathan Cotliar with Science 37. He's the chief medical officer here. And we have a great discussion lined up. You'll probably hear from myself, Trevor, Paul, and Tim. We've all spent some time thinking about the great work that Science 37 has been doing and have questions for Jonathan. To kick things off, we'd love to hear from Jonathan his story, how he came to Science 37, how he was in the clinic and got introduced to this career path. We'll touch on all these themes. And without further ado, I'll turn it over to Jonathan to hear from you a little bit.
Dr. Jonathan Cotliar: Thanks, Trevor. Thanks, Tim and Paul, for having me on. Really excited to chat with you all. My journey with Science 37 was rather serendipitous. I'd been a lifetime academic clinician, ignorantly happy, I suppose, mentoring and writing grants and doing clinical care full time and felt very fulfilled. But a couple of my friends co-founded Science 37. We had all trained together at UCLA, and I really was in tune with the mission and the culture.
Once they introduced me to the concept of Science 37, where we are allowing basically anybody interested in a clinical trial who's otherwise eligible to participate in research, eliminating geography as the principal barrier to research participation, it was all in at that point. It's been an interesting but very fulfilling journey from that, it was 2016, from that time point. And I'm excited to discuss that with you all today.
Dr. Trevor Royce: So you joined before the pandemic. We could probably talk a little bit about that, how the pandemic really changed the work environment from the physician perspective and industry. But just to go back to something you mentioned earlier, you talked about serendipity and how that led you to Science 37. And I definitely believe in the power of serendipity, but I also think in some ways we make our own serendipity just by how we go about our professional lives. I'm curious, could you speak a little bit about how you made your own serendipity happen to lead you to this amazing company doing all sorts of incredible innovations and clinical trials and how your experience as a clinician really set you up for success as you transitioned away from the clinic into this different role?
Dr. Jonathan Cotliar: That's a good point, Trevor. You're right. Probably serendipity may be overstating it quite a bit. I've been in academia for 15, almost 20 years. And at a certain point, even if you're fulfilled in any endeavor that you've partaken in, as you get older, you start to question, alright, if this is going to be my life from now until whenever it is I retire, I'm going to be completely cool with that. But it'd also be interesting to see if there's anything else out there that I can supplement my day-to-day life with. As you all know, seeing patients in the hospital, seeing patients in the clinic, coming home, having a little bit of time to spend with your family, eat dinner, and then you're starting your chart work, that can be a cycle of sometimes some numbing of the mind as it were.
For me, there was a point where I was thinking, well, maybe there's some cool stuff out there where I can combine some of my clinical experience with something a little bit more entrepreneurial. You're right, it wasn't pure serendipity. It was a little bit of intellectual curiosity combined with a network of friends that were doing some interesting things tangentially or more than tangentially related to clinical care. So that's where I started to think about a life where I can incorporate, again, something a little bit more entrepreneurial.
Dr. Jonathan Cotliar: For me, uniquely so, I was trained as an internist and a dermatologist. The spectrum of my day-to-day clinical work and my research interest was pretty broad. That unique training background allowed me to have some flexibility when I did join Science 37 to have a little bit of broader domain expertise as it relates to evaluating clinical trials and protocols and patient populations across a pretty broad swath of clinical indications spanning from rare disease, certainly dermatology, but even more so in the oncology space and other medical subspecialties for which I was pretty comfortable in understanding patient journeys and unmet needs related to a variety of different indications. I suppose that background really ended up benefiting my own positioning in a company that was, at the time I joined, 15 or 20 people deep, just passed our A series of funding with a huge growth potential.
But certainly, I was rather naive in terms of understanding not just what true entrepreneurship was, but for a physician who had never really done anything outside full-time clinical care, what my expectations would be as we sought to grow and, basically eliminate barriers for patients in drug development.
Defining the Chief Medical Officer's Role in a Health Tech Startup
Dr. Tim Showalter: I love your story and I can relate to so much of it, like being in academic practice and then even the story of having your friends start something and then you want to be a part of it. I'm also in an chief medical officer role and it sounds like you've been able to really use your position as an experienced clinician across a lot of domains to make an impact at Science 37. I'm wondering if you can comment a little bit on how you view the chief medical officer position within a startup like that? And just curious to hear your thoughts for how you view the potential impact.
Dr. Jonathan Cotliar: Well, when I joined, I joined as a vice president of medical affairs, but honestly, we had three full-time physicians at the time I joined, including the two co-founders. We were all wearing multiple hats. The titles, as you guys know, almost are irrelevant at that early stage of growth. I'm doing everything from serving as a medical executive to cold calling patients and hopping on early discovery calls with biotech and big pharma partners, you quickly learn more about imposter syndrome than you ever could have imagined being in that role.
And particularly for me, I had done a lot of investigator-initiated trials and was quite comfortable with writing my own protocols and getting IRB approval at the institutional level. But I'd never really been in the room discussing at the ground floor clinical programs where those protocols hadn't even been baked, much less anything more than one or two page synopsis.
Dr. Jonathan Cotliar: Even though it was not in my comfort zone, I loved the fact that I was going from a place of my days were very predictable from the time I got up to the time I went to sleep to a place where not only were the days unpredictable at Science 37 in those early periods, but every hour brought a new level of chaos and problem solving that I found quite stimulating.
For me, I'm guessing that if you did a PET CT of my brain before and after my first foray at Science 37, there'd be a lot more metabolic activity a week or two into my full-time role there than there had been probably for the previous 10 or 15 years in academia. I don't mean that as a pejorative. I just mean that it really triggered in me a curiosity that I didn't know had existed prior to becoming part of a startup organization. And I found that super addictive, and I really enjoyed it.
Dr. Tim Showalter: Jonathan, that tracks so much with my perception. I have this hypothesis, it's not very tightly held, but let me throw it at you and see if you believe in it too. I think for early phase startups, there's something about being a practicing physician that gives you a lot of the ability to step in. You mentioned imposter syndrome, but as physicians, you're in a sense helping run a business unit and you're serving patients and you're interfacing with stakeholders and you're concerned about billing and all the other considerations. In a sense, you represent one small example of the healthcare system. It just seems like you're really well poised to be that T-shaped individual in a startup company where you can have really broad impact despite having a pretty narrow major expertise.
Dr. Jonathan Cotliar: The folks around me in the company, most of whom weren't physicians, many of whom had never really been in industry either, were surprised to see a physician just jump in and do everything from playing the role of an executive to mopping the floors or putting away the snacks. A lot of my coworkers had viewed doctors in this hierarchical way in the same way we as trainees viewed our attending physicians. For them, as consumers of healthcare, there'd always been that firewall between themselves and the doctors that they were interacting with because it was a much more professional patient-doctor relationship.
Here, when you're coworkers and you let down your guard and you basically are relating to your coworkers in a different way, it was just a different scenario altogether. I think people appreciated the fact that a physician was doing cold calls or pitching in for things outside of my domain expertise. I think it was super rewarding. And you build relationships really quickly with co-workers in ways that maybe if you're perched on your own loft as a physician is not possible in traditional settings.
Dr. Paul Gerrard: Were there things that you felt like you brought to the organization from that work you had done as a physician in the past and with a physician with a clinical research experience?
Dr. Jonathan Cotliar: Given my unique training background, there wasn't a single protocol that I couldn't at least evaluate and have a reasonably good understanding as to whether we as an organization could support a particular trial in a decentralized manner. And in those early days, and even to some extent now, there was so much skepticism about a decentralized model being created to help support patient access for clinical research. This is long before the FDA had come up with the draft guidance or even their formal guidance on decentralized clinical trial conduct.
This was before the pandemic when a lot of the telemedicine laws and rules in individual states were loosened to allow for telemedicine-based interactions between patients and physicians, in some cases across state lines, whether that was for the prescribing of controlled substances or even just for routine clinical care. It was a different era. And I remember, there were times when I would hop on a phone call or a video call with a potential client and just not just the amount of skepticism, but the cynicism and to the point where I don't know what the virtual equivalent of somebody hanging up a phone would be, but you can tell within two minutes of doing telemedicine-based physical exams and shipping investigational drugs across state lines to participants in clinical trial and doing electronic consent in a virtual fashion and all the things that our model is so dependent on operationally were so far outside of the realm of consciousness for a lot of our potential clients at that time.
I think more than anything, having a physician on that call outside of whatever clinical expertise they brought to bear during those conversations, but just having a physician on some of those calls maybe provided a little bit of credibility to an otherwise maybe crazy concept that we were discussing on those calls. I think that was probably the biggest utility that I brought is the MD after my name more so than anything that I can bring in terms of expertise. But joking aside, it was a crazy time. Sometimes I look back and I think to myself, and I'm sure you guys do as you're involved in your own respective startups is conceptually, you're like, okay, does this make sense? How am I going to gender the confidence to take on this call and project, a level of assurance that we're going to be able to support their programs. We're talking to these multi-billion dollar companies whose programs have a lot to do with the a lot of money and a lot of risk involved. That's what I worry most about, despite the enthusiasm about the general idea.
Dr. Trevor Royce: I think all three of us have tried in various settings to work with Big Pharma as a collaborator and so forth. And it'll be really interesting to hear from Jonathan how they have, how willing they have been to engage and how they are really willing to put their money where their mouth is for decentralizing some of their processes.
A couple of things that we should reflect on. I don't think you can overstate how fundamentally different executing a trial is if it's decentralized in the way that's envisioned versus the traditional method. There are all sorts of things that we touched on, but we haven't said explicitly that would be fundamentally different. How do you do a patient consent if they're doing it remotely? How do you capture their data and treat it with the proper controls and privacy protections and so forth? How do you onboard staff at a site that's remote for collection and execution of the trial? What about looking for things like side effects, toxicities? We take all this stuff for granted when we're the ones that run the trial and we have it all done at our home site. But when you start outsourcing that or removing where that's all done, the risk for the trial could truly increase. Compliance, adherence, how do you know patients are responding to their assessments correctly or taking their experimental drugs and so forth? So there's just a lot, a lot of layers to the onion here that complicate this. It sounds like it's simple, but it's really complicated.
From the Clinic to the C-Suite: A Conversation with Dr. Jonathan Cotliar
Dr. Trevor Royce: We've got Dr. Jonathan Cotliar with Science 37. He's the chief medical officer here. And we have a great discussion lined up. You'll probably hear from myself, Trevor, Paul, and Tim. We've all spent some time thinking about the great work that Science 37 has been doing and have questions for Jonathan. To kick things off, we'd love to hear from Jonathan his story, how he came to Science 37, how he was in the clinic and got introduced to this career path. We'll touch on all these themes. And without further ado, I'll turn it over to Jonathan to hear from you a little bit.
Dr. Jonathan Cotliar: Thanks, Trevor. Thanks, Tim and Paul, for having me on. Really excited to chat with you all. My journey with Science 37 was rather serendipitous. I'd been a lifetime academic clinician, ignorantly happy, I suppose, mentoring and writing grants and doing clinical care full time and felt very fulfilled. But a couple of my friends co-founded Science 37. We had all trained together at UCLA, and I really was in tune with the mission and the culture.
Once they introduced me to the concept of Science 37, where we are allowing basically anybody interested in a clinical trial who's otherwise eligible to participate in research, eliminating geography as the principal barrier to research participation, it was all in at that point. It's been an interesting but very fulfilling journey from that, it was 2016, from that time point. And I'm excited to discuss that with you all today.
Dr. Trevor Royce: So you joined before the pandemic. We could probably talk a little bit about that, how the pandemic really changed the work environment from the physician perspective and industry. But just to go back to something you mentioned earlier, you talked about serendipity and how that led you to Science 37. And I definitely believe in the power of serendipity, but I also think in some ways we make our own serendipity just by how we go about our professional lives. I'm curious, could you speak a little bit about how you made your own serendipity happen to lead you to this amazing company doing all sorts of incredible innovations and clinical trials and how your experience as a clinician really set you up for success as you transitioned away from the clinic into this different role?
Dr. Jonathan Cotliar: That's a good point, Trevor. You're right. Probably serendipity may be overstating it quite a bit. I've been in academia for 15, almost 20 years. And at a certain point, even if you're fulfilled in any endeavor that you've partaken in, as you get older, you start to question, alright, if this is going to be my life from now until whenever it is I retire, I'm going to be completely cool with that. But it'd also be interesting to see if there's anything else out there that I can supplement my day-to-day life with. As you all know, seeing patients in the hospital, seeing patients in the clinic, coming home, having a little bit of time to spend with your family, eat dinner, and then you're starting your chart work, that can be a cycle of sometimes some numbing of the mind as it were.
For me, there was a point where I was thinking, well, maybe there's some cool stuff out there where I can combine some of my clinical experience with something a little bit more entrepreneurial. You're right, it wasn't pure serendipity. It was a little bit of intellectual curiosity combined with a network of friends that were doing some interesting things tangentially or more than tangentially related to clinical care. So that's where I started to think about a life where I can incorporate, again, something a little bit more entrepreneurial.
Dr. Jonathan Cotliar: For me, uniquely so, I was trained as an internist and a dermatologist. The spectrum of my day-to-day clinical work and my research interest was pretty broad. That unique training background allowed me to have some flexibility when I did join Science 37 to have a little bit of broader domain expertise as it relates to evaluating clinical trials and protocols and patient populations across a pretty broad swath of clinical indications spanning from rare disease, certainly dermatology, but even more so in the oncology space and other medical subspecialties for which I was pretty comfortable in understanding patient journeys and unmet needs related to a variety of different indications. I suppose that background really ended up benefiting my own positioning in a company that was, at the time I joined, 15 or 20 people deep, just passed our A series of funding with a huge growth potential.
But certainly, I was rather naive in terms of understanding not just what true entrepreneurship was, but for a physician who had never really done anything outside full-time clinical care, what my expectations would be as we sought to grow and, basically eliminate barriers for patients in drug development.
Defining the Chief Medical Officer's Role in a Health Tech Startup
Dr. Tim Showalter: I love your story and I can relate to so much of it, like being in academic practice and then even the story of having your friends start something and then you want to be a part of it. I'm also in an chief medical officer role and it sounds like you've been able to really use your position as an experienced clinician across a lot of domains to make an impact at Science 37. I'm wondering if you can comment a little bit on how you view the chief medical officer position within a startup like that? And just curious to hear your thoughts for how you view the potential impact.
Dr. Jonathan Cotliar: Well, when I joined, I joined as a vice president of medical affairs, but honestly, we had three full-time physicians at the time I joined, including the two co-founders. We were all wearing multiple hats. The titles, as you guys know, almost are irrelevant at that early stage of growth. I'm doing everything from serving as a medical executive to cold calling patients and hopping on early discovery calls with biotech and big pharma partners, you quickly learn more about imposter syndrome than you ever could have imagined being in that role.
And particularly for me, I had done a lot of investigator-initiated trials and was quite comfortable with writing my own protocols and getting IRB approval at the institutional level. But I'd never really been in the room discussing at the ground floor clinical programs where those protocols hadn't even been baked, much less anything more than one or two page synopsis.
Dr. Jonathan Cotliar: Even though it was not in my comfort zone, I loved the fact that I was going from a place of my days were very predictable from the time I got up to the time I went to sleep to a place where not only were the days unpredictable at Science 37 in those early periods, but every hour brought a new level of chaos and problem solving that I found quite stimulating.
For me, I'm guessing that if you did a PET CT of my brain before and after my first foray at Science 37, there'd be a lot more metabolic activity a week or two into my full-time role there than there had been probably for the previous 10 or 15 years in academia. I don't mean that as a pejorative. I just mean that it really triggered in me a curiosity that I didn't know had existed prior to becoming part of a startup organization. And I found that super addictive, and I really enjoyed it.
Dr. Tim Showalter: Jonathan, that tracks so much with my perception. I have this hypothesis, it's not very tightly held, but let me throw it at you and see if you believe in it too. I think for early phase startups, there's something about being a practicing physician that gives you a lot of the ability to step in. You mentioned imposter syndrome, but as physicians, you're in a sense helping run a business unit and you're serving patients and you're interfacing with stakeholders and you're concerned about billing and all the other considerations. In a sense, you represent one small example of the healthcare system. It just seems like you're really well poised to be that T-shaped individual in a startup company where you can have really broad impact despite having a pretty narrow major expertise.
Dr. Jonathan Cotliar: The folks around me in the company, most of whom weren't physicians, many of whom had never really been in industry either, were surprised to see a physician just jump in and do everything from playing the role of an executive to mopping the floors or putting away the snacks. A lot of my coworkers had viewed doctors in this hierarchical way in the same way we as trainees viewed our attending physicians. For them, as consumers of healthcare, there'd always been that firewall between themselves and the doctors that they were interacting with because it was a much more professional patient-doctor relationship.
Here, when you're coworkers and you let down your guard and you basically are relating to your coworkers in a different way, it was just a different scenario altogether. I think people appreciated the fact that a physician was doing cold calls or pitching in for things outside of my domain expertise. I think it was super rewarding. And you build relationships really quickly with co-workers in ways that maybe if you're perched on your own loft as a physician is not possible in traditional settings.
Dr. Paul Gerrard: Were there things that you felt like you brought to the organization from that work you had done as a physician in the past and with a physician with a clinical research experience?
Dr. Jonathan Cotliar: Given my unique training background, there wasn't a single protocol that I couldn't at least evaluate and have a reasonably good understanding as to whether we as an organization could support a particular trial in a decentralized manner. And in those early days, and even to some extent now, there was so much skepticism about a decentralized model being created to help support patient access for clinical research. This is long before the FDA had come up with the draft guidance or even their formal guidance on decentralized clinical trial conduct.
This was before the pandemic when a lot of the telemedicine laws and rules in individual states were loosened to allow for telemedicine-based interactions between patients and physicians, in some cases across state lines, whether that was for the prescribing of controlled substances or even just for routine clinical care. It was a different era. And I remember, there were times when I would hop on a phone call or a video call with a potential client and just not just the amount of skepticism, but the cynicism and to the point where I don't know what the virtual equivalent of somebody hanging up a phone would be, but you can tell within two minutes of doing telemedicine-based physical exams and shipping investigational drugs across state lines to participants in clinical trial and doing electronic consent in a virtual fashion and all the things that our model is so dependent on operationally were so far outside of the realm of consciousness for a lot of our potential clients at that time.
I think more than anything, having a physician on that call outside of whatever clinical expertise they brought to bear during those conversations, but just having a physician on some of those calls maybe provided a little bit of credibility to an otherwise maybe crazy concept that we were discussing on those calls. I think that was probably the biggest utility that I brought is the MD after my name more so than anything that I can bring in terms of expertise. But joking aside, it was a crazy time. Sometimes I look back and I think to myself, and I'm sure you guys do as you're involved in your own respective startups is conceptually, you're like, okay, does this make sense? How am I going to gender the confidence to take on this call and project, a level of assurance that we're going to be able to support their programs. We're talking to these multi-billion dollar companies whose programs have a lot to do with the overall success of these large organizations. I'm standing in front of them saying, reassuring them that our model is sound, even though we've never been in front of the FDA and we've never had a trial filed with using any of our safety or efficacy data to get a label, but you project that confidence. And maybe that was the single greatest attribute I brought during those times.
Overcoming Industry Skepticism and Navigating FDA Guidance
Dr. Tim Showalter: Where do you think the regulatory agencies are right now with respect to considering decentralized trial data?
Dr. Jonathan Cotliar: The FDA has always been well ahead, I think, of the sponsors in terms of their willingness to accept data from a decentralized clinical trial construct. I think that, and justifiably so, they've always been deliberate, I would say, about accepting data. If you read the draft guidance and ultimately the final guidance, there's a little bit of nuance to the language that they provide regarding non-inferiority in clinical trials as it relates to decentralized clinical trials and accepting historical data as the basis for comparator populations when you're looking at decentralized clinical trial patient populations.
To them, they've always thought for sponsors, whether those are smaller biotechs or larger pharma companies, to at least have a component of their cohort in a decentralized model so they can compare and contrast the safety and efficacy data that's ultimately generated from these trials. They were, even in our early days, and we were lucky enough to get in front of the FDA, at the policy level, we were always lucky to have their support, even if it wasn't as overt as a guidance that invokes Science 37 or any of us in the industry. But they were always trying to get us to work with sponsors to have DCTs set up to really understand what the data was saying relative to the same data that might be generated in trials where there was brick and mortar counterparts or traditional sites within trials that we were supporting.
The irony, of course, is whenever we were having some of those early calls with sponsors or potential sponsors, as it was, they would always blame like, oh, the FDA will never go for this. They would be quite skeptical of a design where you would have somebody for a cardiometabolic study participate completely from home. And they say, no, actually, they're asking us if our sponsors would get on board with that concept and you won't get any pushback from the FDA. Obviously, there has to be a sound design and there's going to have to be a type B or a type C meeting to flesh out whether this is fit for purpose with respect to a DCT design, but they are not going to be the ones holding us back if this is scientifically sound and ultimately safe for patients.
In those early days, we didn't have historical trials to point to where we could say, these are trials that Science37 supported in a completely decentralized fashion that have been granted a label based on the data that was filed from the cohort we supported. But slowly and surely, we got to that point because sponsors were more and more convinced that what we were doing was safe and ultimately scientifically sound. And then, of course, by the time the FDA's guidance document on DCT came out, we'd already been involved with like 10 or 15 pivotal studies at that point. I think it certainly solidified where we were as an organization, but it would have been welcomed five years earlier, I suppose, in terms of getting potential sponsors over the line and working with us.
Dr. Paul Gerrard: That's someone's always got to be the first to get the FDA to come along.
Dr. Jonathan Cotliar: Yeah, 100 percent. And that's fine. It was exciting to be at that point.
Dr. Trevor Royce: There's so many really important themes to touch on there that you really pulled out. One is obviously the innovative work that you guys are doing and just clear industry leader in this really amazing approach to clinical trials. But to the idea that the FDA may actually be more open than their reputation precedes them. I think that's really critical. And I don't know that I've ever heard it quite put as eloquently as you put it right there. I think that's an amazing thing for our listeners.
How Decentralized Trials Work: Technology and Trial Design in Practice
Dr. Trevor Royce: Going back to being involved in some of those earlier trials, I'd love to hear some specifics. If you can talk a little bit in however much detail you're willing to provide on a trial that is a good example of this, but also in terms of your product and the technology that you guys are doing, can you give us an example of something that really demonstrates what a decentralized clinical trial is and how technology can enable it and how sponsors and even regulators are open to it?
Dr. Jonathan Cotliar: I would say it certainly was a challenge historically, and it probably still is to some extent, is that people throw around the term DCT and you don't necessarily know what they mean by that because DCT can be a single point of technology supporting a single element of a clinical trial or in our case, it could mean every participant that we are touching in a clinical trial is participating completely remotely from the comfort of their own home.
In that context, we do rely on technology to help facilitate all the types of procedures and assessments that we take for granted when they're occurring in the clinic or the hospital space. That could be everything from the informed consent to the demography where you're filling out all the demographic baseline characteristics of an individual participant, doing the vital signs, doing the physical exam, and all of those things we all know historically take place in the same geographic space where a participant is in a clinical room, an exam room, a hospital bed, and all the delegated study team members are coming into the room to do their thing.
Dr. Jonathan Cotliar: In our model, TableStakes is having a technology that can do everything from providing telemedicine or video medicine support to real-time data capture where you're taking annotated case report forms, you're digitizing them, you're building them in a technology platform that allows for contemporaneous documentation as you're doing your part of that visit within the schedule of assessment. At the time we started, our company was launched in 2014. There was nothing off the shelf that you could use to support all the order of operations that are required for a proper study visit in a highly regulated space, such as drug development.
It's different than a simple FaceTime call where you're just having a one-on-one with a patient like you might during a check-in to see how they're doing with a new medication or certainly, an interaction that everybody got used to during the pandemic where it was a FaceTime call or a Zoom call. But you were using your historical technologies, whether those are EHRs or other mechanisms of capturing clinical data, but it wasn't all integrated in a way that allowed for you and others to do that in real time. And some of that was asynchronous, and some of it was contemporaneous, but not in a HIPAA compliant, but also FDA 21 CFR Part 11 compliant way, which is a completely different level of security.
Dr. Jonathan Cotliar: We had to build all that and it would have been great it would have been much easier if there was something off the shelf that you could pay a monthly subscription for and it would allow you to do all this. We spent a lot of time and human power and money building technology that ultimately allowed us to do that. It's all baked into one platform and so it allows for every delegated study team member to access in real time wherever they are. It allows medical monitors, FDA inspectors and sponsors to view data in a de-identified way. Those are the types of things that are painstaking to build. But are ultimately necessary just to get you off the ground floor.
Then once you're at that point, you get into the, well, what constitutes a good fit for decentralized clinical trial conduct? I can give you a litany of things that check the box from objective endpoints, blood-based endpoints where you're not relying on heavily nuanced assessments.
Dr. Jonathan Cotliar: I'll give you an example. For Parkinson's disease, there's something called the UPDRS, which has three different parts to it. There are some parts of that assessment that require a very experienced clinician to assess motor activity rigidity. And the difference between one physician using that assessment and another, there's a lot of nuance there. You may have a lot rate or disagreement in terms of how one patient is viewed by one experienced clinician and another. A blood-based endpoint, like a hemoglobin A1C or any number of biomarkers, if you're collecting them in the clinic or the hospital or you're collecting them in the home, as long as you're using the same method of collection and processing and ultimately the assays being done by the same central lab, you're probably not going to have too much of a difference between where that venipuncture is originating. Those are the types of trials that tend to be a really good fit for DCT.
In our early days, and to be honest with you, even to some extent, 10 plus years later, in most cases in those early days, we were getting protocols that were nearly impossible to execute at the site level.
Dr. Jonathan Cotliar: Beggars can't be choosers, I suppose. In the early days of any startup, you're happy to get any work, even if it's way more difficult than you bargained for. So we were getting rare disease trials. We were getting rare oncology trials. Or even in cases where you had a common indication, eligibility criteria that ultimately made these indications rare diseases because of the exclusionary medications or some of the parameters within those eligibility criteria.
Dr. Jonathan Cotliar: And the types of trials, we were getting everything from autoimmune blistering skin disease trials, to diabetes trials, to rare endocrine trials, rare neurology trials. And honestly, we had a lot of smart people, and more importantly, a lot of hardworking people. But I think we got lucky early on. And as you all know, even a little bit of luck early on can trigger explosive growth. We like to fancy ourselves as experts, and we can recruit these patients, needle in a haystack patients from anywhere. And, oh, look at us. We're going to puff out our chest. But the truth is, is that sometimes a little bit of luck goes a long way. And we did really well in our early days, even though we were commissioned to support pilot trials where maybe our enrollment numbers were 10, 20, 5, or 10. But we did well. And that got the attention of a lot of potential partners in the space. And it led to getting more opportunities for things that were still challenging, but maybe a little less so, only slightly less so, and gave us an opportunity to shine. We just took advantage of some of those early opportunities.
Revolutionizing Patient Recruitment for Rare and Complex Diseases
Dr. Tim Showalter: Clearly, decentralized trials is a huge win for patients. I'm so interested to think through how your patient recruitment strategies can be different in that platform. And particularly for rare diseases where reaching patients directly might be more successful than going through more traditional health center-based routes. Can you give us some ideas for the tactics that Science 37 or maybe the DCT field was able to leverage to accelerate recruitment to trials like that?
Dr. Jonathan Cotliar: That's a great question. One of the things that really is freeing is if you're doing a telemedicine-based trial and you have broadly licensed nurses and broadly licensed physicians in all 50 states, the total denominator of potential participants who are interested and otherwise eligible for a trial is exponentially greater than what you might be able to encounter within a traditional site. Historically, when you're doing site feasibility for a traditional site, you can draw a 30 to 50 mile radius around that brick and mortar site and assume that 95 plus percent of your enrollment is going to originate within that radius. That's not to say there's anything wrong with that. That's the way things have historically been done. But it's ignoring a large swath of the population that can't get to the site.
Dr. Jonathan Cotliar: Either they're not proximate to the site or they have lives that preclude their ability to travel back and forth over the life cycle of the trial. If you're starting from a point of everybody is potentially eligible for a trial, when you eliminate geography, it gives you the ability to do pretty unique outreach. For all of our trials, I would say there are a variety of channels that we typically tap into and they're not mutually exclusive. In some cases, we're just going direct to patient through a variety of digital channels. That could be social media, that could be search engine optimization or search words. In a lot of cases, particularly for the rare disease trials you mentioned, Tim.
We work with patient advocacy or registries or even Facebook and other social media patient advocacy closed groups who may publicize within those closed groups a particular trial opportunity for a group of patients. In some cases, you may not have any approved therapies for the diseases that they are affected with. Or in some cases, if there are approved therapies, individuals with those conditions may have already tried them and had either side effects or a lack of efficacy, and it gives them opportunities to hear about new trials within that same space with newer investigational drugs. Digital outreach, where you can publicize trials for patients and give them the option of participating either at a brick-and-mortar site close to them and in cases where they can't get to that brick-and-mortar site, giving additional optionality to participate in a decentralized clinical trial is super synergistic with any brick-and-mortar footprint that a sponsor may have for a clinical trial, and that goes a long way.
Dr. Jonathan Cotliar: The other thing is we can partner with referring physicians or health systems, and they can mine their electronic medical records to find patients who may be interested in clinical trials, particularly in cases where that clinic or a brick-and-mortar site or even health system is not engaging themselves in that clinical trial but can at least make available to their patients opportunities for participation outside of the health system. And all of those typically constitute different buckets that we tap into.
The other large one, I would say, is diagnostic labs. This went a long way during COVID when testing for COVID was happening at some of the larger networks across the country, and there were no trial opportunities. But we can partner with a large diagnostic entity. And if they're doing broad testing for patients, and then if they're testing positive for COVID, let's say, you can offer up a clinical trial as they're getting their results. And the ability to participate from home based on that outreach from a diagnostic lab is really huge in terms of potential as a mechanism to help find patients. All of those things work collectively. In some cases, a particular trial, one channel might work a lot better than the other. It's always hard to predict how that's going to play out. But being able to turn the knobs up and down based on what you're seeing in real time as the funnel is being built for a particular trial and the enrollment for that trial is really effective.
Final Thoughts: Advice for Clinicians Eyeing a Career in Health Tech
Dr. Trevor Royce: That's fantastic. Well, we really appreciate you spending some time with us today and sharing those examples and your story and your experience. It's such innovative work that you have. You've created a whole new area, a new field of clinical trials, and I think it really benefits the patients at the end of the day. So we're glad you could join us and press with your work. As a final thought, would you like to leave any words of advice for clinicians thinking about this type of career path and any final reflections on that?
Dr. Jonathan Cotliar: For me, the lesson was opening up my mind to the possibility of diversifying my work day or work life. Even in cases where you're super fulfilled or where you think you have your dream job, it's always good to keep your eyes open and look for other opportunities and figure out if other opportunities provide additional satisfaction in terms of your work life. For me, it certainly did. And now, I'm just glad I was open to the possibility of doing something a little bit different.
Dr. Trevor Royce: Amazing. It's been a great path and appreciate the conversation today. Dr. Jonathan Cotliar, Chief Medical Officer of Science 37. Thanks for spending some time with us.
Dr. Jonathan Cotliar: Thanks so much.
