Naji Gehchan: Hello, leaders of the world. Welcome to “Spread Love in Organizations”, a podcast for purpose-driven healthcare leaders, striving to make life better around the world by leading their teams with genuine care, servant leadership, and love.
I am Naji, your host, for a special episode in partnership with Jill Donahue for her new book “A Dose of Inspiration: 100 purpose stories from Pharma Leaders”. I am joined today by Adam Castano, VP of Global Clinical Development at BridgeBio after having led Global Clinical Development teams Merck. Adam is a board-certified cardiologist and industry professional dedicated to the singular unifying purpose of bringing innovative therapies and breakthroughs that improve patients’ lives. Previously he led development programs in cardiac amyloidosis at BridgeBio and Pfizer Inc. He also served as Assistant Professor and Co-Director of the Center for Cardiac Amyloidosis at Columbia University College of Physicians & Surgeons.
Adam, it is such a pleasure to have you with me today!
Adam Castano: Thank you so much, Naji. Pleasure to be here with you.
Naji Gehchan: Can you first share with us your personal story from your passion to cardiology to now joining the biotech world. What is your purpose?
Adam Castano: I guess we can start, um, with my, my story starts with my parents. I would say, um, my, my mother, uh, is a, uh, Freudian psychoanalyst.
So as you can imagine, you know, Uh, someone who thinks very deeply about the mind. Uh, my father is a cardiologist. Um, so again, someone centered in the heart, uh, like myself. And, um, um, so growing up in that context. With two parents who sort of, you know, one talked a lot about, uh, thought and deliberate, um, process and, um, sort of, uh, intellectual topics, um, and the other, um, being more, uh, uh, heart driven, if you will, um, was someone centered in sort of the Uh, you know, uh, the, the, the marks of sort of, uh, I don’t want to say emotion, so to speak, but, um, more, more raw intuition.
Um, uh, and, uh, so I grew up with, with sort of that, um, overarching philosophy. Um, and this was all in an international setting. So I, I went to an American school, um, uh, the American school foundation in Mexico city, um, for early parts of childhood. Um, and also, um, spent, um, a majority of childhood here in New York City, where, um, my mother’s family is from.
And so in that context, um, had sort of an international influence on, um, you know, how I viewed the world, um, and that, you know, drove me, I think, uh, growing up, um. Uh, I had a early affinity for science. I remember my, uh, parents, uh, gifting me a microscope when I was young. Um, and, uh, spent a lot of time with that, perhaps too much time.
Um, but enjoyed it. And that flourished into a love of, uh, science, um, that continued on throughout, um, you know, my, um, high school and then eventually, uh, undergraduate training, um, at Princeton, um, where I studied molecular biology and Spanish literature, um, and, uh, again, one for the heart, one for the mind.
Um, And, uh, and then went on to study medicine, um, uh, and it wasn’t until sort of medical school that I. Discovered that cardiology, um, was, was, uh, you know, a field of internal medicine that was best suited for my particular, uh, background and interests and, and sort of future aspirations. And so that, that brought me to, um, you know, my clinical training.
Um, uh, I, I did that at the University of Michigan in Ann Arbor, go blue. Um, and then, uh, after that, um, had, uh, the opportunity to come back to New York where I essentially stayed and have, um, done, uh, the rest of my medical training. So, uh, residency, um, at Columbia University, uh, in internal medicine, and I stayed on for fellowship in cardiology, um, during that period of time, I, I.
Um, took some research years and also, um, got a master’s in patient oriented research and, um, clinical trial design at the Mailman School of Public Health. Um, and then stayed on as well for an extra advanced, uh, cardiac imaging, uh, fellowship. Um, so, um. You know, that’s why I have a lot of gray hair spent, um, perhaps too much time in training, but enjoyed every 2nd of it.
And, um, it was during that training that I came across my 1st academic mentor, uh, Matt Mauer, who. Really inspired me, um, um, from an intellectual and a clinical sense. Um, um, we encountered a patient with cardiac amyloidosis that really fascinated me. Um, this was at the time a rare. Um, um. Uh, disease that. Uh, was, uh, undiagnosed, uh, underdiagnosed, uh, not a lot of, uh, physicians, uh, knew about it or how to treat it.
There were no therapies, um, and I thought to myself, you know, I was a young intern at the time. Wow, this is really a fascinating, um, disease process with, you know, not a lot of therapy and it’s an awful disease. These, uh, these patients often, um, develop end stage heart failure and live, uh, quite a Um, poor quality of life, um, if untreated, um, especially if they’re under, you know, unrecognized as this disease often goes, um.
And so I decided to sort of buckle down and start studying that disease with my mentor at the time at Columbia and we, you know, we’re lucky to have come across some early findings and how to diagnose the disease early. We made some clinical observations of, um, potential populations at risk, uh, that were not thought to be at risk.
Um, uh, patients with aortic stenosis, for example. And even made some therapeutic advances, um, with, uh, the development of the 1st, uh, stabilizers, uh, to treat, uh, the, the disease, um, and that, um, eventually brought me to my faculty position, uh, at Columbia, so I co directed the cardiac amyloid center with him for a couple of years and enjoyed every second of it, really I think my favorite part was the patients and the day to day patient work, um, but sort of nagging at me in the background, um, and this is where the international context of sort of my childhood comes in, is that I felt that I, I wanted to have a more global impact, um, with the day to day work that I was doing.
Um, and, and that’s when an opportunity came, uh, about for me to join, um, a team at Pfizer that had just, um, come to the Uh, end of phase 3 for, um, uh, to famine is the 1st, um, TTR stabilizer for a TTR cardiac amyloidosis. Um, that, um, my mentor and I had helped actually work on on the, on the academic side and now there was this opportunity to come and.
Um, you know, bring bring this breakthrough therapy to patients across the world, um, on the biopharmaceutical side. And so I decided to make that important leap, um, uh, into the biopharmaceutical industry, um, that brought me to Pfizer. Um, I. Uh, really cherish that experience. I sat at the apex of sort of, you know, the intersection between, um, development and commercial interests and, uh, regulatory interests and, um, uh, business development and, um, legal, et cetera.
Um, really learned a ton, um, early on in that process, um, and had an opportunity to see what a, you know, a major global launch was all about. Um, and then, um, um, I had, uh, after that, a new opportunity to lead, uh, an important program, um. Uh, in prevention at, um, bridge bio, um. Which is, um, uh, biotech based, uh, in Silicon Valley, uh, that is developing, uh, a novel, um, second generation, or I should say next generation TTR stabilizer called Acarimidis.
Um, and the, um, work that I do there is focused on, um, supporting that, um, important, uh, potential therapy, uh, after the completion of its, uh, phase 3 clinical trial, um, just earlier this year, um, and, um, furthermore to advance the science of, in the field to help, uh, essentially understand the question of whether we can use these novel therapies Um, to prevent disease or at least slow the onset of disease.
Um, and that’s a hypothesis that’s not been tested clinically. Um, but certainly makes sense. Um, when you think about the mechanism of disease and, um, really could do a lot of good to, um, to patients who, um, who, uh, might otherwise not have been diagnosed or, or die, get diagnosed too late and then end up, um, you know, in this continuous sort of, uh, spiral of, Late diagnosis, um, and and, you know, unfortunate outcomes that that result from that.
So that’s that’s sort of in a nutshell. Um, I should say, I, I had a, a year as well before this current, um, last, um, process where I spent a year at Merck, uh, in clinical development. Uh, helping to bring a novel, um, oral PCSK9 therapy, um, to, uh, phase three. Um, and I helped design the clinical, uh, trial for that, uh, particular compound, which I, I hope will, will, um, you know, uh, ultimately I think has a lot of promise, but we’ll see how the, the clinical trial, uh, reads out in the next few years.
Um, and I also, um, learned a lot working on a phase two clinical trial, um, or a separate compound called, so tattercept, um, that is being studied for the treatment, um, of pulmonary hypertension. Um, so that, that in a nutshell brings me to, uh, present day. I hope that wasn’t too long winded. No, that’s
Naji Gehchan: great, Adam.
And I’ll obviously go into some of the pieces you already shared and I relate to several parts of what you do. Um, as you know, I’m also leading development in the breast cancer field. Um, so I’d love first, you said you took a big leap and moved to pharma and I, uh, I know like this is usually how physicians we would feel when we, uh, when we move from clinic being in front of patients to, uh, to the biotech.
Pharma industry word. First, the first question on this is really more personal from a leadership from a personal leadership standpoint.
Adam Castano: Yeah.
Naji Gehchan: What is your biggest learning? And is there a common thread you felt from moving from academics? you still rely on strongly or ones that you felt you need to let go?
I don’t know. Like it’s more, what is your biggest learning as
Adam Castano: a leader? Sure. Um, yeah, it’s a great question. Um, I, I would say the biggest learning I’ve had, and I can’t emphasize this enough. Is that, um, you know, leaders talk a lot about different skills to, you know, organize and, and, um, sort of motivate or galvanize, um, people around them and, you know, within their spheres of influence to accomplish a particular task.
Um, and that’s all really important, but I think 1, 1 thing I’ve learned in particular, um, and this started early on, I think. Probably in, in early medical training was the idea of humility, um, and, and it’s something that I think gets brushed over perhaps, um, too often. It’s something that I think should go into, um, much more formal, uh, types of leadership training, both in business and medicine, um, in law and other sort of, you know, across the board.
Um, this idea that, you know, humility. And what what we bring to the table is is important, but there is a whole world out there that that other people also bring to the table. Um, that we can learn from. Um, and it really is what what we do in in life is a team sport and and that. Is something perhaps that, um, you know, when you think of medical school and medical teams and, you know, sort of how health care tends to be structured, there’s sort of.
Um, you know, the, the doctor at the flagship, you know, who sort of commands, you know, the ship, um, and everyone around them sort of is in a supportive role, but, um, one thing I’ve really come to learn and appreciate, especially in the biopharmaceutical sphere is that, yeah, we need doctors to help develop, you know, important breakthroughs, um, but, uh, we’re just a Piece of the puzzle, right?
And we’re not any more or less important than, um, other members, uh, of, uh, large biopharmaceutical, you know, um, uh, structures, right? Uh, we need, um, the expertise of legal colleagues and regulatory experts and, um, you know, um, People who are more on the basic science side of things to help us understand whether molecules can even do what we expect them to do in a mechanistic sense, right?
Can they bind the target? Um, we need safety experts to help us prove that our therapies are actually safe to put into humans, right? We need. Um, globally, business leaders and commercial folks who, uh, can help us understand the landscape of how, um, a particular, uh, breakthrough can get translated, um, into a product that can help, um, you know, the most number of people, um, where it’s needed, um, you know, most so, so, um, I think, I think, I hope that answers the question, you know, so it’s a sense of humility within a team structure, and that’s, that’s something I’ve really come to appreciate, um, over the years.
Yeah, it certainly does, and
Naji Gehchan: that’s, that’s such a great, uh, learning, and you, you certainly appreciate, as you said, it takes a huge amount of people and expertise. To bring a drug from an idea to pre clin and through all our clinical stage and at the end really getting it in the pharmacy and for the patients, it’s you really beautifully expressed all the different functions and several others that will get together along the way to get it as a reality for patients.
So what would you say to physicians and I’m sure you do as I do talk to several physicians who are thinking about this who are usually. Kind of worried of losing this immediate impact on patients. And I was an ER doc, right? Like you, you, the impact you see it, you, you have, you have, yeah. So what do you, how do you talk with, uh, with physicians who are thinking about this and thinking of broadening their impact, but differently?
Adam Castano: Yeah, it’s a, it’s, it’s, um, a very natural question that I think a lot of folks ask when they’re sort of at the crux of uh, an important decision and it is an important, you know, this is perhaps one of the most important decisions, uh, physicians ultimately, um, make if they decide to transition, um, into a biopharmaceutical role.
So, um, I would say You know, when I, when I, I’ll share a bit of my personal sort of journey and then, you know, perhaps that can help help us sort of glean some, some understanding. Um, but, um. I didn’t want to lose the, uh, day to day patient care aspect of it at 1st and I had something I wasn’t ready to give up.
Um, and I was fortunate when I 1st joined. Uh, Pfizer and, uh, Bridge Bio and even at Merck that there was flexibility built in for me to be able to continue to see, uh, patients in a clinical setting, um, as long as, you know, the, there were parameters put around that in terms of sort of, um, you know, time spent and, um.
You know, allocations of, uh, windows of time within my sort of global work schedule. Um, and, uh, um, in addition, and this is an important piece to ensure that there’s no sort of overlying conflicts of interest between the clinical work and the biopharmaceutical work. And as long as those boxes are checked, um, I think it’s something that, um, I think most pharmaceutical companies would actually encourage.
And that’s been my. My, um, my experience is that I was encouraged to say, Hey, if this is part of your journey, and you feel that this is important to you, um, uh, you should, you should definitely pursue this. And, um, and so I appreciated that flexibility. And so I continue to see patients from a broad preventative cardiology standpoint.
Um, um, for a few years into, um, my biopharmaceutical, um. Work and, um, and really enjoyed it. Uh, eventually I found that, um, my, um, my biopharma development work, um, was essentially satisfying, um, a very important piece of what I needed to feel like I was making, uh, a difference and bringing again, the ultimate sort of lighthouse at the end of, you know, a dark tunnel, um, for me is, you know, am I, am I, Achieving my purpose, am I having impact on improving the lives of people around me?
And the work that I did in bio pharma, I eventually came to, uh, realize and be quite satisfied with achieve that purpose. So I found the need to do clinical day to day work less and less. And so I’ve gradually, you know, sort of wound that down. Um, and that’s, you know, that’s probably common for many physicians, I think, who enter the pharma space.
Some actually give it up entirely. Um, right off the bat. And that’s part of, um, another part of the journey. Um, I think it’s different for each individual. Um, and there are some who continue it all throughout their, their pharma, uh, careers where, you know, they still see, uh, or teach, uh, in medical schools or have important roles, um, uh, in, uh, an academic setting.
Um, so I, I think, you know, we frequently think about these as a dichotomy, but I, I actually think it’s a false dichotomy. It’s something that can, can coexist. Um, there, there, uh, is crosstalk between academia, clinical and biopharma industry work. It’s necessary for effective drug development. Um, and, um, I would hope that it continues to be fluid and that those walls, you know, do not get thicker or taller.
If
Naji Gehchan: you will, I said, I certainly agree with you, um, Adam on this and, um, it’s, it’s important to keep those instructions. And as you said, the impact is just different, right? And what you will be able to do it instead of being. On the frontline, it’s obviously helping more patients by, you know, two steps, maybe further away, but you’re still helping and bringing impact, uh, on, on people.
Uh, so how are you ensuring, because we talked a lot and we’re obviously always passionate about the impacts you have on patients at the end of the day. That’s why we do what we do. How do we bring this to life? With your teams on a daily basis, constantly having to juggle the operational things like a lot of, uh, really tactical pieces.
And how do you make sure that your team is always centered around the patient at the end of
Adam Castano: the day? Yeah. Yeah. So I love that question. And this is something I actually share often with my teams. Um, first I, I tell everyone that I work with, if you’re in the meeting and you’re. You find yourself discussing something or being asked to do something or, um, you know, uh, you’re, you’re, you become pulled into something that doesn’t quite jive with, you know, your personal mantra of, hey, uh, am I achieving my purpose?
Am I, um, is this ultimately going to, uh, create. You know, a meaningful advancement for the grander purpose of bringing breakthroughs, um, forward to patients, then don’t don’t do it and tell everyone that Adam said, it’s okay not to do it. Um, and and and so. You know, again, it means, you know, hey, maybe this meeting got off track.
Let’s refocus on sort of what what is the most meaningful thing we can accomplish here. Right? And so that’s sort of the North star. I think that should guide. Uh, I hope guides all of, um, the folks I work with and. And it certainly does, um, the, the 2nd piece, I would say is, um, this is something I share a lot and comes back to sort of the earlier childhood sort of heart brain connection that when we do something, I think there’s an important.
Um, uh, interactivity there where it has to make intellectual sense, it has to be logical and, but it also has to be driven from a place of heart, a place of passion. If it’s missing any of those elements, then it’s, it’s going to fall flat. And so any initiative that we embark upon any project, any work, any PowerPoint presentation, um, you know, memo meeting, whatever it is that you might have it, um, it has to accomplish those 3 core things.
Does it help patients at the end of the day? Does it meet intellectual rigor and is there heart and passion behind it? So those, those are sort of my 3. Big things that I try to impart. Um, they’re, they’re. You know, overarching big concepts, I think, uh, maybe get talked about, um, in different ways. Um, but for me, I’ve found that they, they seem to resonate and, um, and bring about, um, productivity.
I love
Naji Gehchan: that, uh, help patient. It doesn’t make sense scientifically, intellectually and heart, and it goes back to your very first story with your parents, right? You said heart and mind, and you’re taking this and putting it through your career and life. That’s great. I’m going to give you now a word, and I would love your reaction to it.
And the first one
Adam Castano: is leadership.
It’s a big word. It’s loaded in many ways, but, um, I think the 1st subset of words that come to mind are those that center or cluster, if you will, around the concept of, um, character. Um, and that’s also a loaded word, but, um. You know, I think all of us seek to, um, lead meaningful lives that are centered in, um, you know, doing the right thing, um, some moral center, right?
Uh, or, um, a compass, if you will. And that can mean different things for different people. Um. But leadership, I think, is not any different from that. I think character is, is inherently a very important piece of leadership. Um, people tend to want to follow leaders who they feel display, you know, ethical and moral character.
Um, people who are driven by, you know, values that are, um, clearly communicated and I think resonate with with others. Um, and so that’s, that’s, uh, I think probably the 1st piece of this that that comes to mind. The 2nd, 1 is
Naji Gehchan: health
Adam Castano: equity, health equity. Um, that is, um, again, another, you know, commonly discussed concept.
Um, but is increasingly more and more important now, perhaps now, you know, more now than ever before. Um, it. It means not just, you know, um, getting people, um, equitable care, but also, um, in clinical trials, you know, from where I sit, um, ensuring that the drugs we test. Are tested in as broad a population as possible in order to answer the scientific question at hand and to be able to say broadly this drug was shown to work in X, Y, or Z population.
So, therefore, based on again, go back to the scientific method and here, you know, it makes logical sense to do this. And also there’s part and passion behind it. Um, we can tell you it works in, you know, this subgroup of the population, this set of ethnicities, this, uh, country, this geography, et cetera. And so, um.
Talked about a lot needs to be talked about even more. Uh, and more more than talk action upon an actual, um, you know, um, workflows and clinical trial goals, um, that we set forth for ourselves. Um,
Naji Gehchan: I love that. You’re bringing that. I don’t have, um, obviously I, you know, we spontaneously think about access.
and equity in access and also equitable health care. And I’ve been working a lot, uh, on, uh, equity in clinical trials. It’s such an important, uh, it’s such an important topic. And We will never do enough, but making sure that we have a diverse population within our clinical trials, both to bring access.
Sometimes clinical trials are the best option patients would have in the current schema of treatment. And exactly, as you said, also to make sure that whatever we’re developing has its effect as we are envisioning, not only at a broader population, but really at the different, for different. People, right?
And, uh, ethical, uh, art is super important. So thanks for sharing that.
Adam Castano: Yeah. Yeah. And thanks for bringing the access piece up to that’s that’s obviously a critical piece of the equation as well. The 3rd word is Lego Lego. Um, my 5 year old loves Legos. Um, that’s the 1st idea comes to mind, but I will say. Um, I love Legos too, actually.
Um, I know
Naji Gehchan: we both share this passion of Lego. This is why I saw this.
Adam Castano: So Lego, I find Lego actually to be a little bit like yoga. There’s a Zen to it. Um, you know, there’s a process. Um, and in order to achieve this higher state of sort of Lego mastery, if you will, you know, become a Lego Yoda master, you have to buy into the philosophy of There’s, there’s an order and a process, right?
And so you can’t just build the unstructure by throwing all the pieces, you know, into a bowl and, you know, trying to replicate the picture that you see on the box. You have to open the manual. You have to understand the steps. You have to sort the pieces. You have to put them, you know, in different categories before you even begin.
And then once you start, it makes the process a lot easier. You take things in little pieces, and that’s kind of what we do in biopharma. Um, right. You, you don’t just magically think of a molecule and, you know, go to the pharmacy and say, Hey, let’s, let’s make this pill. Um, there is. A intricate, an intricate process, um, that is much akin to Lego building, I would say.
So I actually love that, that, um, that, that concept.
Naji Gehchan: That’s, that’s a great analogy. And yeah, I never thought of it purely from a process. And it certainly is, right? Like there is this creativity, the process, the creation that you do. So I, I love what you’re sharing. The last one is spread love in organizations.
Adam Castano: Yeah, yeah, I think that speaks to, um, you know, we hear this concept, a lot of authenticity, um, um, being, you know, again, and this gets back to the sort of moral centeredness of things and character. And if, if we share bits and pieces of our personal stories, um, our authentic selves with those who we interact and work with on a daily level.
Uh, I think others will feel that sense of community, um, and, um, it helps build ties, right? Important ties that are necessary, um, to make teams effective and functional. Um, and, uh. And ultimately, I would venture to say, perhaps loving, um, you know, that’s a, it’s a, it’s a big leap there, but those are the most effective teams, I think, where you kind of feel the love, uh, everywhere, um, there’s joy and camaraderie, um, and, uh, a true, um, sort of looking forwardness, if you will, positivity to doing the day to day work is needed.
Any final word of
Naji Gehchan: wisdom for healthcare
Adam Castano: leaders around the world? I’m sorry. What was this? Do
Naji Gehchan: you have any final word of wisdom for healthcare leaders
Adam Castano: around the world? Yeah. I don’t know if they’re words of wisdom. They may just be words, but, um, one thing I think, I hope, um, we see a lot more of, uh, in healthcare leaders and this spans the gamut, not just in biopharma, I would say all healthcare leaders within all healthcare industries is, again, purpose, keep the patients first.
It is, does this. New initiative patients and how will it do that? And how will it make lives better? Is this is there an intellectual thorough rigorous process that has been put behind? This new initiative that we’ve done our homework, you know, so to speak, um, and 3rd, um, love and passion, right? Again, it’s it’s tying the 3.
It’s a marriage. I think I’m happy triumvirate of 3 things that, um. That I hope if, if are at the forefront of everyone’s, uh, mind and their day to day work, I think can ultimately help, help us get to a better state, um, uh, for everyone.
Naji Gehchan: What a great summary, Adam. I’m really thankful to you for being with me today and it was great to connect again.Adam Castano: Thank you. Thank you, Naji. Really, really enjoyed it!
Naji Gehchan: Thank you all for listening to SpreadLove in Organizations podcast. Drop us a review on your preferred podcast platform
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