Innovating Around the Globe

In this episode of the OIS Podcast we get to hear another panel discussion from the last OIS@AAO meeting in San Francisco. Emmett T. Cunningham Jr., MD, PhD, MPH, led a great discussion about Innovating Around the Globe with two international Venture Capitalists and three Industry Executives from Alcon, Santen and Novartis.

Participants:
Laurent Attias, SVP, Corporate Development Strategy, BD&L and M&A – Alcon
Michael Keyoung, MD, PhD, Managing Director & Head, North America – CBC Group
Giovanni Mariggi, Partner – Medicxi
Naveed Shams, MD, PhD, Head, Global R&D, Chief Scientific Officer, Senior Corporate Officer – Santen
Jehan Tamboowalla, VP, Head of New Products, Ophthalmology – Novartis

Moderated By:
Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences

Join us this year at the 12th Annual OIS – November 12, 2020 » Las Vegas, NV

OIS Podcast Transcript:

OIS Podcast VOG:
In this episode of the OIS Podcast, we get to hear another panel discussion from the last OIS@AAO meeting in San Francisco. Emmett T. Cunningham Jr., MD, PhD, MPH led a great discussion about Innovating Around the Globe with two international Venture Capitalists and three Industry Executives from Alcon, Santen and Novartis. Let’s hear how it went.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
So from time to time, year to year… one of the pieces of feedback that either Bill or I get is that this is a great meeting, but it’s very U.S. focused. And we don’t really hear enough from our colleagues and friends in Europe or in Asia or in South America or around the world. And so we thought, let’s invite some of our friends who either oversee or are from those places and start to talk about how they think about innovation and the industry and products and product innovation, development, commercialization around the world, because we all have to, I think about that increasingly large proportions of our businesses. So, to start off, I’m gonna have. We’ll start with Giovanni. We’re going–I’m going to say who you are, where you are, what you do and… the extent to which you are interested in ex U.S. activities related to what you do.

Giovanni Mariggi, Partner – Medicxi:
So hi, everyone. Pleasure to be here, Giovanni Mariggi, partner Medicxi. We’re a Venture Capital firm based in Europe, London in Geneva more specifically. And we are probably one of the European funds and even also thinking about the U. S. that are really most focused on products. You know, even thinking about product visions of the idea stage. Medicxi itself is only three years old, was formed by the spin off the biotech team from Index Ventures, and has since raised almost a $1,000,000,000 worth of funds, the latest one having been raised this summer, 400 million Euros. So from anything from an idea, to financing Phase III’s… and really our focused on products has has been born out of the necessity for us as investors also to change your ways seeing how our environment has changed. We had really found that platform companies at least in our eyes, were not working out as investor, you know, as investments as well as focusing on products. And ultimately that’s what our customers, which either end up being pharmaceutical companies or the market are really looking for that. Maybe one point to note is the inner funds, we do have four corporate investors on top of the usual institutionals. So JSK, J&J, Novartis and Verily, have invested in our funds. And these are large, larger sums in the usual single digit millions that sometimes Pharmas do. And that is really being to… align themselves with our product focus, which very often is exhibited in the company as a very virtual company focusing on a single asset. In terms of how we look at the investment world ex U.S., we do have a focus in Europe, of course, because of our geographical perspective, but for us also was the important thing is… you can place a company wherever you want, that nowadays I think, is the easy part. First important thing is to source the IP, the idea the entrepreneur, wherever they may be. Even within Europe, there are heirs, that are quite well served, like the UK–Benelux, France–The Nordics. But you know, we’ll go as far as getting IP from a Croatian research institute, or, you know, we have in the past and currently collaborating with economics as far as Australia and trying to make that work right. And for us as I said, the company can be placed wherever is the place to make sense, whether it’s close to us in the UK or in the U.S. or wherever.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
You invest in Asia or South America?

Giovanni Mariggi, Partner – Medicxi:
So we have not done an investment in Asia yet, so it’s a market that we can’t ignore. We have taken assets from Japan, so we we have done a number of assets spinouts from companies there. South America is an area that I think we’ve probably never set foot as an investor yet.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Naveed?

Naveed Shams, MD, PhD, Head, Global R&D, Chief Scientific Officer, Senior Corporate Officer – Santen:
Yes, sir. So I am Naveed Shams, I’m the Head of Global R&D and the Chief Science Officer for Santen Group. And to answer your question specifically, as some of you at least maybe most of you would know… that Santen is a major player outside of the U.S. as of today. And you may also have heard that we’re going to land in the U.S. hopefully next year sometime with the device of all things. We are traditionally a Biopharmaceutical company, and yet we are going to come to the U.S. first with a Bio–Pharm with a device to manage Glaucoma. And that’s–it’s a long story and maybe another topic, but… we do… focus a lot in Asia, China, Southeast Asia, of course Japan. We have about at this point about 47-48% of the market. So we have to stay competitive in that area. So we do investments, and we look for partners in that area as well. And we continue to do that. We are growing in Asia and China at a very fast clip, almost 20-30%, year over year for several years now. And so rest of the world is very important to Santen. I will say that we do not have… activities in Latin America, but the rest of it, we are very active.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Laurent?

Laurent Attias, SVP, Corporate Development Strategy, BD&L and M&A – Alcon:
Laurent Attias, Head of Corporate Development Strategy at Alcon, BD&L and M&A. I think to answer your question, Alcon benefits from having a global footprint, obviously. And we look for innovation… not really in any kind of regions, but really more about where the source of innovation might be. As I think about your question, I was thinking about it, this year alone actually, I can tell you that we have investments in Europe, we have investments in Asia, also on the U.S. side. So I think we’re a bit agnostic to the region, realizing that there’s different opportunities for different disease states or technologies in various regions which might guide and influence that, I don’t know that we go for a particular mix in that, we really don’t. But… we–you know, the other thing, too its interesting is a lot of the companies that you would say start off in the United States, a lot of times do their clinicals and their work, sometimes out outside. So you may actually get a better view of some of the insides of technology by spending more time outside the United States. So I think I don’t know, we have a balance mix, but we were not trying to guide to a particular mix, but more follow the opportunity for the disease or technology, and then we’ll play–place our bets accordingly.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Good, Michael?

Michael Keyoung, MD, PhD, Managing Director & Head, North America – CBC Group:
Great to see you here. My name is Michael Keyoung, Managing Director Head of North America for CBC Group, formerly known as C Bridge Capital. We’re a healthcare investment firm, we’re five years old. We spun out of funding from Temasek, so our headquarters in Singapore. In the last five years we now manage over $2 billion we recently raise a fund, it under $52 million where, a third of the capital came from Asia, but third came from U.S., third came from Europe and Middle East. And we have 60 people in our firm, and we have four offices in Asia, Singapore, Hong Kong, Shanghai and Beijing we are pretty much of a big player in Asia. In U.S., we’re a new entrance, you probably don’t know us, but certainly we are focused on Therapeutics, Medical Devices as well as Hospital Services. That being said in Asia, we certainly have backed a leading companies in BioPharma who are listed in Hong Kong exchange as well as in Shanghai exchange and Shenzhen. We own hospitals as well as medical device companies in that part of the world where we do invest between $50-150 million check sizes for sure, and we control most of our companies. That being said, we have done a lot of partnerships, probably because I do believe innovation sits outside of China, especially, the major Asian regions outside of Japan as well. So certainly we’ve done a lot of partnerships with a lot of European companies, including, in the last two years alone, with an over 15 partnerships, including Swedish company, German company, also many companies here in the U.S. including the Bay Area. And we did a partnership, most recently with Samsung Bioepis, which is a leader in Biosimilars. We’re helping them enter the China market. But obviously we also recently had done investments here in the U.S. and we could talk about that little bit later, including a company called Graybug Vision, which we’re excited about.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Before we go to you Jehan, I just want to make an extra point because I often share deals with Giovanni and with Michael. But you do different things you’re a Venture Capitalist, but in different flavors. If I may summarize you are sort of traditional venture a little more global footprint, but you take companies to exit, which is either in public offering or an acquisition. And most of your stuff comes out of Europe and the U.S… fair enough? Where as Michael… You’re doing a little later stage stuff, you’re looking what products, you want to get them approved and you’re equally interested in China approvals and U.S. approval. So I think many of us understand what Giovanni and I have done historically. But this is a little different, so explain that so people have the context as we go forward.

Michael Keyoung, MD, PhD, Managing Director & Head, North America – CBC Group:
So in terms of where we see innovations was, we go after. Certainly, we’re looking for a typical clinical stage assets that could be best in class. Potentially first in class, if it is disruptive enough with significant commercial opportunity. And where we come in is certainly, you know, we do believe disease have no borders, and there was a lot of opportunity to help the companies go beyond the U.S…. typical U.S. And European markets. So when we helped the companies that we invest and partner with think about entrance to different market earlier than later. Typically speaking you have a U.S. approval and maybe U.S. company gets bought by a Big Pharma and the Big Pharma will take it to the rest of the world. But what we like to do and offer to our Biotech companies that we invest in/or partner with, is to help them think about entering different markets, for example, it could be Japan. But we are really good at how we enter the China market, so we help the U.S. company or European company think about getting a China approval same time. And part of the reason is there’s been regulatory changes in China that allowing,  global trial to include China at the same time in Phase III and you could get a simultaneous approval with U.S. and China as an example. So there’s a lot more of education that we like to do with a lot of U.S. companies as well as European companies. And how do we help them think through market expansion just beyond the typical U.S. and Europe. Partly because, as you know, I’ve been a U.S. Financial Capitalist before as well. Obviously we only give the capital to U.S. companies to focus in U.S. market, because that is the most important. Sometimes we say things about the European market and we always say, Japan partner… maybe a company like Santen. But what no one has actually talked about the other markets, and this is a part that maybe because… our firm, as was myself, have played in Asia as well as here in the U.S. We could really help our companies expand today and create new value, new NPV. Because all of a sudden, you could go beyond from one country, which is U.S., to become a global player by thinking about entering the second largest market, which is China.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
So we’re gonna come back to that. It’s an important theme of this, and the basic question is, when do you do it? I think everybody wants to be global and in as many markets as possible. Your premises do it when you’re small. It’s not that expensive, with guidance, you can do it and create a lot of more accelerated NPV. Well, I want to ask the big folks on the panel whether they like that you do that because they think they do it better probably, and would rather do it themselves. But maybe I’m speaking out of turn will come back to that. Jehan, tell us about yourself and if you’d like, you can answer the question.

Jehan Tamboowalla, VP, Head of New Products, Ophthalmology – Novartis:
I’m Jehan Tamboowalla, I’m the Head of New Products for Ophthalmology at Novartis. Thank you for having us on the panel. You know, for us, great science has no borders. And we really look for science wherever it has its genesis, be it in Australia, be it in China, be it in the U.S., be it in Europe. You know, if I might put in a plug, I think, you know, Beovu was approved on Tuesday. The roots of Beovu actually are not in the U.S., it’s from ESBATech, which was a European company. So, you know, one of our biggest launches is out of a company that came out of Europe. So, I think we too benefit from a global footprint. We look at opportunities globally, and we look at science globally. I don’t think we put up artificial barriers. You know, at the OIS meeting this time over the next couple of days, we’ll probably be meeting a good two dozen companies from all over the world. So, you know, we don’t put barriers up.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Okay. I’d like to touch, if we have time we’ll touch and turn on sort of innovation, its earliest creation where it’s coming from, Development… we talked a little bit about it, should be in the U.S.–U.S./Europe more global early, Commercialization and then where you see the future. I mean, I have a slide in one of my talks where the GDP of China passes the U.S. at some point, it’s 2040/2050, pick your number. But… and they’re very innovative in Asia, super innovative. When do they become the center of innovation? We’ll come back to that at the very end. But let’s start with the fact that in China there are an order of magnitude more stem scientists trained than there are in the United States. It’s just a commitment and interest. It’s happening. So, where are you seeing the best science being done now? And an early company creation being done now? And will that change over the next five years? What’s your prediction of the trend as you look at it? Maybe we’ll start with Laurent.

Laurent Attias, SVP, Corporate Development Strategy, BD&L and M&A – Alcon:
Well, in the scope of Alcon today, it’s going to be into Medical Devices for Ophthalmology and contact lens. And so I would say that, when it comes to Medical Devices for Ophthalmology, I think that… it’d be fair to say that most of that innovation resides potentially in the U.S. and maybe some Europe, less so in Asia.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Is that 90% – do you think 80%?

Laurent Attias, SVP, Corporate Development Strategy, BD&L and M&A – Alcon:
Probably very high, probably high… when it comes to the contact lens side actually, then Asia plays a bigger role. Including some segments that are maybe under served in the United States, more towards a cosmetic size and things where it’s a large portion of the offerings in Asia. So a lot of great innovation there when it comes to contact lenses. Also, you may see some innovation that are tied to disease prevalence as well in certain regions, Myopia comes to mind, and some of the contact lens approaches that you see in Asia because of the management of Myopia. So I think the disease prevalence also may guide a little bit where that genesis of the innovation might reside. But, at least in the core business of Alcon today in the… for the OR and the Ophthalmic Medical Device seems to still largely be in the U.S. and Europe.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
And if it’s… sort of 90, let’s say 80-10… U.S.–Europe and the rest is Asia or rest of world. Where do you think it is in 10 years? That makes 10 or 20.

Laurent Attias, SVP, Corporate Development Strategy, BD&L and M&A – Alcon:
Yeah, I think probably certainly… an increased balance with, Europe and the United States. I think that, when it comes to Asia on the Medical Device, certainly it is gonna increase as well, but, I think that Asia has such a stratification of segments, you’re gonna see maybe catering to, a certain maybe segment for wider adoption by wider populations, which tends to have, potentially a difference. Different price point, different feature set, maybe less of a what we would call a premium product, not just in price, but in terms of feature and benefits. So I think that, it may lead to actually a growth into moving into other upper segments and therefore focusing on products that might be more sophisticated, maybe. But I think that there’s such an opportunity there that continues to be had on catering to a wider population. It kind of guides also the innovation towards that segments of products as well. That’s why there’s a bit of a hold back or delay in Asia coming to… bigger play when it comes to Medical Devices.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
So, Jehan, I’m gonna let you take the drug side of that. I would think, that there’d be the devices would move into the ex U.S. faster than drugs, but I don’t know… you tell me. What are your numbers and what are the trends?

Jehan Tamboowalla, VP, Head of New Products, Ophthalmology – Novartis:
I think the trends that we’re seeing is that you know, there’s a lot of… sort of region specific activity. I mean, Myopia, you mentioned, I think you know, you have also the Pharmacotherapy push into Myopia. And I think some of the great work being done by the Singapore Eye Research Institute, you know, is world class. There’s a lot of innovation coming in sort of specific indications, specific diseases that are unique to that part of the world. I would say in terms of overall innovation, I think… there is a lot more stuff that we will start to see emerge out of Asia. We just frankly haven’t seen a lot of it just yet. I mean, there are other things to consider obviously when it comes to IP and other things. We want to make sure that whatever is coming through, you know, obviously meets the same standards we would put on it for the U.S., same standards we put on it for stuff coming out of Europe. And I think a lot of that is hugging harmonized and I think that’s a good thing. In the next 10 years, I would hope to say that we would see a lot more innovation on Pharmacotherapics coming out of Asia.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
China, Japan, both?

Jehan Tamboowalla, VP, Head of New Products, Ophthalmology – Novartis:
Japan has always been there. Japan has always been a leader in the space. I think we would see a lot more coming out of China. We’d also see a lot more coming out of countries such a Singapore.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Okay, so Michael… you and I are aligned on this, I’ll turn to Development. I’m a big believer in creating the NPV early if you have great teams and you can trust those teams and you can get solid approvals for good drugs. But give… if you’re talking to the startup companies, give that pitch to them. Why should they partner with you not only to finance U.S. and maybe E.U. development, but China development and early, as opposed to a regional partnership or waiting for a Novartis to buy the company and do it three years later.

Michael Keyoung, MD, PhD, Managing Director & Head, North America – CBC Group:
Right. Well thanks for the question. I think it’s an important question. If you think about the commercial opportunity, obviously U.S. is the largest Pharmaceutical Market, and we know China is the second largest Pharmaceutical Market and still 10% of the global market. But that being said, with the next 10 years, a trillion dollar per year, drug sales gonna be added… every year. So if you think of the market, opportunity… is significant. And only 6% of GDP in China still spent in China, in Pharmaceuticals, partly because Traditional Chinese Medicine that’s 5,000 years old, hasn’t worked. Generics… they say doesn’t really extend lives, they finally got to the point where they want innovative drugs so the middle class could afford it. There’s a lot of big support for it, regulation changed so that you could really bring innovative drugs, before Novartis and other places you’d have to get drug approved, and then you have to do the Phase 1-2-3 all over again. So nobody really focused on China market from commercial perspective because, they had to have the originator, in the country they were originally the science from approved first, before they could launch in China. So meaning if it was U.S., it was 10 years later. But now that the regulation changed and they’re really… are asking that innovators to come to China market–reached last year, there was a list of 53 rare disease drugs, the government said, please bring this to China… we will exempt clinical trial, you could launch tomorrow. That included a lot of the rare disease drugs as $2–300,000 per year treatment. So there was a wish list. So certainly there’s a big ask and regulation is in our favor. Hence the opportunity on what we would say to the U.S. and European as well Japanese company, to help them get to the China market is… if you have the right team members, which we have from our portfolio company, right clinical development and regulatory expertise. They’re all trained from Novartis and the well known Big Pharmaceuticals of China. They know how to develop innovative drugs, but they sit in the Biotech. And certainly, as we know in Biotech, they know how to develop the innovative drug faster than Big Pharma. And our counterpart in China is the Biotech company. So Biotech to Biotech, they understand the same lingo. So we asked, and we say if we do the clinical trial with you, in Phase III and we only contribute 15% of the patients, we could get the drug approved same time as you. So meaning you have to do say, 300 Patient Trial or x2 if it’s a Wet AMD if you contribute 45 from each of the trial, 90 patients in China. When you do your global trial, we could get that approved for you in China and we’ll pay for it, and we’ll pay for the upfront payment milestone and royalties. So that allows a U.S. centric company to recruit patients in China. And there’s so many naive patients in China. You talk about checkpoint being a breeze in Oncology. They just got approved last year. There’s all the patients in Oncology on checkpoint naive. Lucentis from Novartis, last year, they only had $100 million sales in China. They’re expecting about $200 million. Finally, they’re under diagnosed and under-treated. Now they’re finally reimbursing, so they’re not going to get treated. But that being said in China, they’re only reimbursing four injections, the government. So there is a huge med in terms of pricing and support. But that being said, they’re dying for innovation, cause patients are dying there. And there’s a big support.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
So let me have the strategics weigh in. And do you think that’s a good idea? Do you want these small companies to seek approval in Asian territories, or would you rather they either do a regional license with you? Or wait until you come in and do it yourself later? Would you give up the NPV to be able to do it yourself and why? If so.

Jehan Tamboowalla, VP, Head of New Products, Ophthalmology – Novartis:
I think as a global company for us, I think we obviously have a preference for a global product. I think having sort of selected countries pulled out creates some issues later on, once the product has commercialized. I think that becomes less attractive for us. I mean to be… to be perfectly honest, I mean, we’re–we love China. I mean, we are looking at adapting our clinical programs to get there earlier, using exactly the innovation that’s coming through from the Chinese government.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Well, let me ask it a different way. If Mike–Michael does a partnership with my company and he accelerates the Phase III in China, three years earlier, and then you love the company and buy it three years later. Are you happy he accelerated it? Or would you have rather, had your own strategy to enter that region?

Jehan Tamboowalla, VP, Head of New Products, Ophthalmology – Novartis:
I think as long as we are following standard good practices, I don’t see why not. But I think the challenge for Biotechs and I’m gonna be blunt, I mean, the challenge for Biotechs is a lot of times that doesn’t happen. You know, there are trials that are done without controls… things along those lines, and you know it’s not translatable. As long as it’s translatable and it meets our filters, then we don’t have an issue with it.
Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences
Yeah, well the reason people have always done these regional deals is because they didn’t feel they had the confidence in those regions. Michael would say he can arrange that, he can make it happen. What does Santen say?

Jehan Tamboowalla, VP, Head of New Products, Ophthalmology – Novartis:
Hahaha, so can we!

Michael Keyoung, MD, PhD, Managing Director & Head, North America – CBC Group:
To answer that point though… most of the time, if we participate in global Phase III, the driver of the global Phase III is the U.S. Biotech or European Biotech. But if you partner later–after approval, then the local guys have to do it or you will have to go back to China into yourself or Japan. The beauty is that if you partnered together, the innovator, will drive it – we just helped recruit, of course, you have to check the box, make sure that we’re doing the proper recruitment, etcetera. But that being said, we will be able to create NPV and help you commercialized much sooner.

Naveed Shams, MD, PhD, Head, Global R&D, Chief Scientific Officer, Senior Corporate Officer – Santen:
Yeah, it’s a slightly different equation for us because we are already there. We’ve been in China for 25 years, or more. We have a large presence, we have about 14-15% of the market and we do a lot of the stuff on the ground in China already. As a matter of fact, we would like to be expanding significantly in the next… short term, very short term. And the reason for that is what you just mentioned, because things have changed, they have joined ICH, there is more–a bigger middle class, you know… So for us, you know, we can–I think this model would work, could work in partnership with Santan, as well, because… and somehow that can be configured. But we can take some of the local stuff that innovation coming out of Singapore, for example, and do it first, in that region, and then take it from there. And for the same reasons as was mentioned, is that if you do it in China, for China, then the rules are a little different and you can expedite a few things. However, I will, in my view at least… there are a lot of bumps still, and it’s not as straightforward as it looks, and I think it may still–as of today, I–in my opinion, the fastest way to get in is to make China part of a bigger development program. And that will save you a lot of time. But we would probably…

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
We’re gonna end on the speed bumps, because that’s what everyone worries about. But, Giovanni, I want to ask you, is an investor… How often do you hear discussion at the boards of these smaller companies about entering China or Japan or Europe?

Giovanni Mariggi, Partner – Medicxi:
I think over the last… 3-4 years a lot, right? And because… as we’ve heard it is becoming such an important market. And I think, the point is which, we’ll get to is always, who do you trust to help you there? Right? And that’s, you know, it’s such a different world in a different regulatory path and how you work with hospitals and clinical site. So, you know, some of our late stage companies are having conversations about how do we try and create value there? Is it, do we take it? Do we do a joint venture? Do we just partner it with a local company? And so those are all things that, six years ago, probably you would say, yeah… maybe we can do a deal and get $10 million on diluted. But I think now it is becoming more and more… even as you’re starting clinical trials… You–you’re first clinical trial, it needs to be in the back of your mind, moving towards the front. How are we going to unlock that value there? I think Japan is… I still see it as a more classical, in terms of part of that is that it’s a very specific market. And there’s great players there, so… there’s maybe more, if I can say confidence in terms off when you hand it off, what’s gonna happen. But, I think it’s a very exciting time to be looking at China and maybe some of those neighboring countries as well.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
I personally agree. I’m hearing it more, more. It’s really a question of retaining… NPV vs’ the headache of doing–of going with the unknown. Because nobody here knows what Michael does or the other 6 firms that are looking to take assets into China. They don’t know the teams, they don’t know the–if the policy is going to change, they don’t know if the IP is an issue. Where as we figured, Novartis, Alcon Santen, they know… they’ve been doing it for 50 years, but they’re gonna take a big piece of the pie for that… for that security.

Giovanni Mariggi, Partner – Medicxi:
But I think it links with the earlier question, in terms of where we think innovation is going to come right. I think science is… it’s here in the U.S., it’s in Europe, it’s in China, it’s in Japan, the science is there. That’s not–you know, maybe they’ll be a bit more, a bit less. That’s not really changing. I think what is… happening is where the people that get things done are moving, right and somehow China has made it very attractive to–for people that have been trained outside to come back to China. There’s a lot of capital and that’s why I think we’re seeing a lot of activity there, because correct me if I’m wrong, but it’s really happened since a lot of experienced people have moved back, and I think once there’s recycling of those people within China, then you’re probably going to see, you know, a big boom, just like you’ve seen Boston do that because the aggregation of experience is so condensed. In Europe we’re lagging a bit behind, because there’s being less success story recycling right, these companies just–successful ones love to keep going. And the smaller ones maybe don’t go far enough to… to get enough experience to really… you know, catalyze more.

Emmett T. Cunningham Jr., MD, PhD, MPH, Senior Managing Director – Blackstone Life Sciences:
Good…I’d like to continue this discussion for another half an hour, but we are out of time. I wanted to thank the Panelists, I wanted to thank everyone who stayed to the very end here. You do have an Alcon Sponsored Reception to reward you for your… diligence and hard work. So please join us outside again. Thank you so much for joining us today.

OIS Podcast VOG:
Thanks for listening to this episode and stay tuned for more valuable insights from the movers and shakers in Ophthalmology.