Simple medical education can empower patients in clinical trials.
In this episode of Bite the Orange, David Grew, a board-certified radiation oncologist and founder of PRIMR, talks about how his company focuses on providing patient education for clinical trials. As a practicing radiation oncologist, he is passionate about patient education and uses simple drawings and videos to explain complex medical concepts to patients and caregivers. Therefore, he created PRIMR with the mission to provide engaging and concise patient education videos for clinical trials to improve patient recruitment and retention while building trust through transparent communication. Dr. Grew envisions PRIMR becoming the leading patient education company for clinical trials globally, catering to diverse language and cultural needs, and accelerating medical innovation through effective education.
Tune in to learn how PRIMR is redefining patient education for medical trials!
FULL EPISODE
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Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen. Welcome to another episode of Bite to Orange. And today, we have a very special guest who is doing something very unique in the field of medicine, especially around oncology .... Today, if you know him, then you probably know a lot about him, but if you don't, get to know him today. This is none other than Dr. David Grew. Welcome to the show, David.
David Grew:
Thanks! Thanks, Manny. Thanks so much for having me. I'm excited.
Emmanuel Fombu:
Alright, David, so I know you are a founder of a great company called PRIMR Med, but before we get into what PRIMR Med does, and we'll get to there, who is David, Dr. David Grew? Who are you? What's your background?
David Grew:
Yeah, sure. So I'm actually a practicing radiation oncologist. I work at a Yale affiliate cancer center in Connecticut. And really, prior to med school, I've always had a passion for teaching. So I taught undergrad students who were studying for the MCAT, the entrance exam to med school, for about, I would say, about 1000 hours. Over the course, between leading up to med school and then through med school, for a little extra money on the side, just to teach them how to prepare for that test. So a lot of time just learning how to explain things, distill them down to the simple first principles, and converting these complex concepts into simple visuals with a whiteboard. And really took that practice of knowledge transfer with visuals through med school right into my residency, and then as an attending radiation oncologist. It's just the audience changed over time, right? So it used to be med students, and now it's my own patients, to make sure that they understand their disease, the treatment options, the side effects, and all that kind of stuff.
Emmanuel Fombu:
Which is quite interesting. My background, I had ... at some point in their lives, teachers, and I also taught like ... kind of services. And it's very interesting because a lot of times when we teach, not only do you, you know, just teaching someone that has to learn, you also learn yourself while you teach as well, right? So I think that's one of the beauties of teaching. Like you actually, if somebody could explain something to me in layman's terms and laywoman's terms, then it makes me feel like, wow, they actually know what they're talking about, right? So I think you have that strong teaching background. Is that the reason why you like teaching?
David Grew:
Yeah, good question. My mom is a teacher, and that was actually my first job after college was working at a school where she worked teaching, so it's definitely in my blood. But I think what I love about it is, kind of getting at what you just mentioned, where if you can explain it in simple terms at a fifth-grade level, you really understand it. So I get some gratification out of just knowing that I've really mastered the subject matter. If you can teach it, you really know it. But then, you also get some secondary gain from seeing that light bulb go off and the patient sitting across from you, and I really love that feeling that, they were scared, my patients all have cancer, they're face to face with their mortality for, in many cases, for the very first time. They're often terrified, actually, but if you can explain something and really demystify not just the diagnosis, but also the treatments that they're about to embark on and really empower them and recruit their participation to really be jacked up and ready to start with these cancer treatments, that's a really powerful moment, and I really get a lot out of that. So that's what charges me up to work on, both with my patients as well as on this business.
Emmanuel Fombu:
It's quite interesting. When I went on your website, which is PRIMR Med, we'll put out the link in the show notes for anyone to go on, I liked how simple and straightforward it is. So when I get on there as a simple cancer, the most straightforward exploring, latest cancer research, and treatments, just very complicated in general. If you open most textbooks, then, the terms that you use are very confusing, the animations are very confusing, but I like the kind of animated kind of view of how you actually brought this to life on your website. So with that being said, we know that patient education is very important and especially around cancers, right? You have these fancy names like Glioblastomas and all these different names that come in, that is, it's advanced medical education, medical terminology, advanced medical terminology, right? And so someone got diagnosed, and then you walk that person through that and explain things to them, and I noticed on your platform you actually call ..., I think, anatomy and physiology or pathophysiology questions, right, about the disease itself. You have things around clinical trials to educate patients about clinical trials, figure to match them to clinical trials. So what was the big problem that you saw, first of all, and how did you see your company actually filling this need?
David Grew:
Sure, so it really started in early COVID, because I was seeing patients in our oncology clinic for their first visit with an oncologist, and there's a no-visitor policy, so they're coming in alone to have to absorb all this information about, you know, what stage they have and what these complex treatments are going to be, and it was just totally overwhelming for them. So I took to this practice of drawing it out on the paper for them every single time, and after I repeated those explanations 10 or 15 times, it started to get pretty tight, that explanation. And I'm sure all physicians go through this process over time, over the arc of your career, you really hone in on your explanation. It's just that I was doing it with, deliberately with this simple drawing. What ended up happening was patients were asking me to keep the drawings, which I think happens to a lot of other docs who draw right there on the exam table paper. But I had this idea to do it at scale and to, because of COVID, be able to send a digital version of these drawings and the narration off to the family members. So that's how it got started. I converted these pen and paper drawings into digital versions with just my narration, and it took off from there because it was very well received by the patients and their family. It was asynchronous education, so they could go back to it and learn from it later. They could email it around to all the family members wherever they were located, either internationally or across the other side of the country or whatever, and they really liked it, they got a lot of value out of it. But then a friend of mine who's a PI on several clinical trials saw what I was doing, because I was just putting these little videos on social media. Our trial is super complex; it's really hard to explain to patients consistently across all the disease sites or all the enrolling sites, so, could you make us a video for our clinical trial? And that's when it converted from being just this thing I was doing as a service for my own patients and as a free service on social media into an actual business. So it really had taken off from there, and now we've done, I believe, we've submitted our 24th and 25th IRB submissions for videos for clinical trials, and we just started doing this in June of 2022. So we're not even into a year of doing clinical trials, but it's really, obviously, we hit on a really serious need for trial education.
Emmanuel Fombu:
Which is quite interesting. For anyone listening, I like to think that a lot of our audience members are clinician entrepreneurs, right? Were you thinking about doing a business as opposed to your career, or doing something that just started? Because I think this is very opportunistic and I'm very happy to see that, right? The opposite, just something you're thinking about starting, or the opportunity, just jumped in it?
David Grew:
I'd say I always have had a bit of an entrepreneurial spirit, but never quite like during residency. I had different ideas, kooky ideas about medical devices for radiation therapy, and things like that. And I looked into partnering with where I did my residency at NYU, there were some grants that were available, but residency is, you're busy, it's hard, and then, plus, wherever you work, you're going to split the IP with them. And part of what drives me is the idea of autonomy being fully autonomous, and I wasn't excited about working in tandem with a large, a massive academic institution. I wanted the freedom to make the decisions completely on my own. The idea of doing something entrepreneurial was always there, it's just the constraints of the pandemic forced me into this kind of a solution. And it turned out I wasn't just solving a problem I had for myself and my own patients, this was a problem that was occurring, obviously at scale. And so we're building a solution to solve that problem at scale.
Emmanuel Fombu:
Which is, I find it quite amazing, actually. What I've actually found more interesting is how simple you made the videos, right? I just watched your videos on ..., for example, and I think look at the different ... and the different colors. It actually makes it warm and welcome. It's not scary when I look at it. I'm not an oncologist. When I look at it, it goes, it is very warm, welcoming, and this is something that patients can use to get educated, other clinicians could use to get educated, caregivers could use also getting educated about a particular condition, but that warmness of it makes it not scary, and so I think it's quite fascinating when you educate people about the disease and what clinical trials are out there. But with that being said, how do you go about making money on your platform, right? So the different business models, I noticed, I don't see ads popping at me when I'm on the website, right? So I don't know what ... something yet, I don't know how, where you going, but I know it's been a short journey, but where are you at on that journey from a business perspective? Where do you see yourself growing?
David Grew:
Yeah, sure. So yeah, at the very beginning, we actually had started off as, not a content or media company, but as a software company, because my thesis was that this is super easy to make these videos. Any doctor would, I'm sure, want to convert their common explanations into content, and we just don't have a great way to distribute it. You could use Instagram and YouTube and stuff, that's pretty unprofessional. No one's really excited about sharing their Instagram or YouTube channel with patients, it doesn't feel quite right. So I built a software platform, or I hired some software developers to build a software platform that would allow doctors who wanted to create content, distribute it in a HIPAA-compliant way as a text message. They would just, patients would just click the text messages and pop ups the video, but there are all kinds of issues selling that sort of a product because every healthcare institution has really strict rules around integrating software platforms into their system. And so it was good to try that because I learned a lot, I basically learned how difficult it was and the massive constraints around selling to an enterprise, especially healthcare enterprises, and in this environment, there's so many capital constraints that I just basically learned that was not going to be a viable business for me and probably would require some venture capital. I was pretty committed to doing this in a bootstrapped way. So instead, when we pivoted to doing clinical trial education, there was a variety of ways that you can be reimbursed for creating custom content for clinical trials. So, sometimes the PI has a grant, and they can pay you through the grant. Sometimes there's an industry sponsor, and that's a source of funding for this kind of custom content. Sometimes the institution itself supports promotional materials too, for investigator-initiated trials. So we really, we've been able to get reimbursed for our content products for clinical trials through each of those mechanisms. We're really now looking into kind of going upstream and working on an enterprise level with sponsors who have trial portfolios, for example, like Bayer may be supporting clinical trials that are like 5 or 10 clinical trials, all dealing with prostate cancer, for instance. And we're looking to partner with a pharmaceutical or a device company that wants a solution that's standard, branded, scalable way to provide IRB-approved patient education across their trial portfolio.
Emmanuel Fombu:
That's interesting. You mentioned IRB-approved patient education. So we have a standard protocol, and that goes to IRB process, and it's approved, and then you kick out the clinical study. So if someone does a patient education video, the clinical study, that has to go to IRB as well?
David Grew:
It does. So every institution will have its own sort of nuanced way they want to handle that, but some will let us just submit the written script and the video at the same time. And they, we've had a lot of repeat customers, like at New York Presbyterian, at Cornell and Columbia, we've submitted stuff, and they know our product, and so it gets approved pretty much same day now. But other institutions, and for NCI-funded trials, it goes to the CIRB, their turnaround is a little bit longer, but we basically submit the script, and then that gets approved, and then we submit the video product where the narration matches the script, and they're just approving the integration of the narration with the images and everything. And we've had really good luck so far. I was surprised, I thought we'd get a lot of pushback or a lot of comments and have to change script, and it would be this painful process, but we must be doing something right because IRBs haven't rejected anything that we've sent over so far.
Emmanuel Fombu:
And I wouldn't expect them to reject, because this comes from experts, especially in the field of oncology, where I've spoken to several oncologists where you go online into this world where we have a lot of information, we also get a lot of misinformation. So having content that comes from an expert in the field, that comes from a clinician that is a proven IRB process, makes the content that comes out to patients and caregivers like, highly trusted. I'll take that, so I think that whole process of the IRB is actually is solid piece of it, and I'm very happy to know that there's a platform where patients can go and actually get expert-based information because I'm sure you probably have stories of people getting the misinformation, especially with cancer, right? When you have, mortality is right in your face, and then everyone has all the snake oil solutions people have around it, correct? That's ...
David Grew:
For sure. Oh, yeah, definitely. We have patients who are seeking alternative treatments, which I generally support at least investigating that, but as a trained oncologist, board-certified, I have to ethically adhere to treatments that have been investigated and compared to standard of care, and in any event, for clinical trials, it's a different can of worms, right? So these are patients who oftentimes are metastatic, and if they're not, they don't have metastatic disease, then they're at least, they're interested in exploring access to either drugs, devices, or assays that they otherwise perhaps wouldn't have access to. So we need to be extremely cautious and careful about establishing trust. They're not going to go and participate in a trial if they don't trust that the trial is being run in a professional way. There's a lot happening with politics over the last involving clinical trials and vaccines and everything, and so I think we have a little bit of an uphill battle to rebuild that trust, especially as it relates to clinical trials. So we're trying to shore that trust up and establish credibility and trustworthiness at the very outset of these early conversations about enrolling on a trial. It's really difficult to start with a 40-page consent document and go from there because that sort of erodes trust. That kind of feels like there's attorneys that have had their hands all over this, and I'm going to be a guinea pig and stuff. So we're basically replacing that with a two-minute video that's really easy to understand, just to give a high-level overview, it's not going to replace that 40-page consent document, obviously, but it will help patients understand the basic questions. And we try to lay the videos out in a systematic way where we review first, here's the problem we're looking at. Here's the current standard of care solution. Here's a key question that's currently unanswered about the standard of care. And on this trial, here's the intervention that is going to try to answer that key question. And so, all of our trial content follows that very logical sequence, and I think that just helps patients to the way that they tend to think about that. All of our content is driven by the questions that I've been asked by my own patients. And so it just provides a logical sequence of knowledge transfer, if you will, that maps onto the way that my own patients have asked me questions along their journey.
Emmanuel Fombu:
I think it's quite impressive. I remember several years ago, I did a study using wearables in the cardiovascular space, and we had issues with patient recruitment. And the sites were telling us it was too complicated, the patients couldn't understand how to use these watches or the solutions. And we randomly made a video, and we gave it to the site. We realized that recruitment actually picked up. We realized that the challenge was not the fact that the patients did not, could not use it, but there was a difficulty in explaining to the patients what the devices actually did and what they actually had to do with it. And so, I wish that idea had stuck in my head and something out of it, but I'm happy to see that you actually identified this opportunity because there is a clear need in this particular space, right, to make to educate the consumer, to educate the patient, to understand what is it that they're going after. So I think if you educate someone, I'm sure you end up in clinical trials, especially being improved recruitment in those clinical studies, right? You improve retention, and someone understands why we actually research ... stay longer. I think the research and some of the metrics that KPIs that you're actually tracking because I'm sure you just started, but I would like to have a conversation with you, 2 or 3 years from now and then see all those wonderful numbers of things that you've done, ... what the future will tell.
David Grew:
I hope so. I'd be delighted to come back if that is the case. But I think you keyed on a really important point, Manny, because it's not just about the recruitment, it's the retention, right? So we could recruit 1000 patients to a trial, but if half of them fall off, we've lost the power to draw any meaningful conclusions from the trial, so that's a really important point. So we're now starting to work with some trials that have issues with retention and ongoing engagement along the timeline of the trial to create not just that first video to introduce it, but perhaps to pepper patients or participants at this point with drips of additional content to keep them engaged, especially for longitudinal studies involving wearables that are more observational studies and not interventional.
Emmanuel Fombu:
I find this quite fascinating. I, like you, picked this particular therapeutic area, which of course, that's where your expertise is ... right now in oncology. I like the breading of it, simple, classic finishes and things like that, pretty straightforward. But other resources, I noticed you have everything broken down into specific kind of cancers, like brain cancer all the way down to prostate cancer, as I said. Are there any additional areas? Are there more cancers that are currently included? I mean, I don't see leukemias, for example. So is there, or do you have it, just not seeing your website, right? So tell me what the strategy is and how you're including things. Are leukemias under like a broader picture of general cancers, or how is that structured?
David Grew:
Good question. So you've keyed on the key, the weakness of a radiation oncologist. We don't treat leukemia. So really, what you see there is mostly guided by my own clinical practice, so mostly solid malignancies. I do treat a little bit of lymphoma, but not leukemia. And so, it, again, it gets back to the origins of the company where it was just born from this need from my own patients in my own clinic who needed some asynchronous access to content to understand their disease, and everything in our library is stuff that I actually use in my own clinic. So when a patient comes and checks in for a new consult for breast cancer, for instance, we have a printed PDF that has thumbnails in color of all the videos from the library, and it has a QR code at the top. So when they check in with the MA, they get vitals, they do the Med reconciliation, and the MA hands them this PDF and teaches them how to use the QR code, and then, on their phone, they begin going through this content library. And then, when I'm ready, I come in the room. They've already just watched this probably 12 minutes worth of very targeted, very curated educational content about their specific problem, and they're ready to get into the details of the nuances of the treatment. And they're also, they're ready, they're prepared with questions that are really driving their own experience, things that they've seen in the videos that they want to talk more about. So it allows us to go a few layers deeper into what their concerns are, rather than spending 20 minutes doing the super high-level stuff. And I think it amplifies the patient experience, but it definitely helps me too, because it's more fun for clinicians to really get into the meat of what is concerning to a patient and what's going to erode their patient experience. Priming them with content allows us to get the root stuff out of the way and really cut to the important stuff.
Emmanuel Fombu:
I'll tell you, if I had cancer, I'd definitely want to have you as a doctor, right?
David Grew:
I hope you never do, but I'd be delighted to take care of you.
Emmanuel Fombu:
Hey, but I'll tell you something quite interesting is, one of the videos that I found on your website is about, is actually explaining the clinical trial process, they call it Clinical Research 101, right? And when I watched that video, it goes through informed consent and what it was, like a Phase One of the study, a Phase Two, and Phase Three of studies. I think this goes way beyond getting someone to understand what we're actually doing. You actually explained observational studies and all the retrospective studies, and it's very simple for someone to actually watch and feel more welcome in that whole process. And ..., I don't think it's a gap, or you're missing something being, you know, radiation oncologist looking at solid tumors and not dealing with leukemias. I think we have a good, solid baseline foundation of where your expertise is, right? And I think that the same concepts will emerge and expand as you grow. You can't solve everything in one day, but I think from where you are, I think it's a valid need. And I'll tell you that from being on the pharma side, designing clinical research, and looking at what you provide, I think that it's quite fascinating all, what you've done and how simple you've made it.
David Grew:
Thank you.
Emmanuel Fombu:
So with that being said, what, where do you see the company going in the next six months, the next year?
David Grew:
Yeah, so we have big, ambitious goals. We're building a team, and we're pretty internationally distributed. My team members are located in the Philippines, Ireland, Poland, Canada, the UK, and some in the Bay Area, and some in China. A really widely distributed team, but that's reflective of the nature of clinical trials. So we're trying to build a team that's multilingual and has multiple cultural competencies, not just for trials in the US but global trials. We obviously have a huge need for DEI on trials, and so we're building out our team with an eye on that, not just for language, but for other considerations as well. So we want to be, I believe, that patients suffer less when they understand more. The core mission is to solve that problem with simple education and doing the education in a sort of a stylish way that's disarming and easy to follow and reduces sort of anxiety. I think you keyed on that with the color palette, every part of that is very intentional. But as it relates to clinical trials, the goal is to accelerate innovation by expanding the pool of patients who would consider enrollment, and I think we can do that with educating patients about what the options are. So I would like PRIMR to be the de facto patient education company for clinical trials. I think every clinical trial ...
Emmanuel Fombu:
Apology ... go beyond culture?
David Grew:
We need to start with our expertise. So I do think it maps, once you really establish yourself in the beachhead of oncology, I don't think it's very hard to expand into other areas because right now, we have built out standard operating procedures and massive efficiencies in verticalizing the content creation process in oncology. You can easily build that out into other entities, cardiovascular, GI, all kinds of other disease sites where there's a lot of innovative developments going on. So I do have long-term plans for that, but in the short to mid-term, certainly, we're sticking to our beachhead. But I think every industry-sponsored trial should provide patients with a basic foundational education about what the standard of care is and what this trial, what's the question of this trial, and I think that should happen in the form of simple content, and we're the company that's prepared to do that.
Emmanuel Fombu:
And hopefully, eventually, you might actually get some of those European leaders and PIs involved with these studies to actually make themselves available so patients can actually ask questions to them. I understand a lot more about this.
David Grew:
Yeah, that would be amazing, yeah. They're eager to do that, so I think that we're quite close to that.
Emmanuel Fombu:
Great. I think it's very fascinating. And thanks a lot, David, for being on the show. I know we're running out of time, but I would love to have you back in maybe six months and see where you're going. And look at ... KPIs, which I'm quite confident you actually met. And if anyone listening, please reach out to David, we need David to get more sponsors on board, to get more studies out there, make sure that patients are being enrolled in these studies, and we're getting products in the market sooner than later, to actually improve this quality of life for all these patients. But once again, thanks for taking the time to join us today, David.
David Grew:
Thanks, Manny. This was great. Appreciate it.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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David Grew:
Dr. David Grew is a board-certified radiation oncologist with a passion for patient education and the founder of PRIMR. He is driven to enhance the cancer patient experience through simple explanations paired with clear visuals. He believes optimized patient education results in less suffering. Fear, anxiety, and suffering arise from uncertainty about the future. Patients who understand their disease fear less because they know more. Dr. Grew lives in Connecticut with his wife and four daughters. He sees patients at St. Francis Hospital in Hartford, CT.
Things You’ll Learn:
PRIMR began as a solution to help Dr. Grew's patients better understand their diagnosis and treatment options, using simple drawings and later converting them into videos.
The platform aims to accelerate medical innovation by expanding the pool of patients willing to participate in trials through effective education.
Dr. Grew's approach to providing patient education through engaging and concise videos has been well received, resulting in multiple IRB approvals for the content.
The long-term vision for PRIMR involves potential expansion into other medical areas beyond solid malignancies.
PRIMR's content benefits patients and aids clinicians by enabling more profound and meaningful discussions with informed patients.
The company is open to working with pharmaceutical and device companies to provide standard and branded solutions for patient education across trial portfolios.
Resources:
Connect with and follow David Grew on LinkedIn.
Follow PRIMR Med on LinkedIn.
Discover the PRIMR Med Website!
Explore David’s website!
For office or telemedicine appointments, visit his practice's website.