Diagnosing GI diseases using AI with Iterative Health’s Dr. Jonathan Ng

Episode show notes and transcript

Nucleate Singapore

and

John Joson Ng

Dec 15, 2023

About The Guest

Dr. Jonathan Ng is the CEO and Founder of Iterative Health, a company that focuses on AI diagnostics for gastrointestinal diseases. He graduated from NUS Yong Loo Lin School of Medicine with an MBBS and went on to pursue an MBA and MPA program at Harvard and MIT. Dr. Jonathan Ng has a deep understanding of the industry and is passionate about using technology and AI to improve patient care.

📄 Summary

Dr. Jonathan Ng is the CEO and founder of Iterative Health, a company that focuses on AI diagnostics for gastrointestinal diseases. In this episode, Dr. Jonathan Ng discusses his journey from medical school to entrepreneurship and the development of AI diagnostics for gastrointestinal diseases. He shares his experiences in healthcare and the challenges he faced in starting a company focused on AI. He also talks about the importance of mentorship and the role of AI in transforming healthcare. He emphasizes the need for business model innovation and the gradual adoption of AI tools in order to ensure patient safety and improve outcomes.

🥡 Key Takeaways

Iterative Health focuses on applying AI algorithms to complex endoscopic procedures, helping to improve diagnostics and reduce cancer rates.
The adoption of AI in healthcare requires a balance between evidence-based practice and market education to build trust and ensure patient safety.
Dr. Jonathan Ng's goal for Iterative Health is to be ubiquitous in GI suites worldwide, solving knowledge asymmetry and improving patient outcomes.
The relationship between doctors and AI should be collaborative, with physicians actively engaging in the development and implementation of AI tools.

💬 Quotes

“I think we have plenty of really smart Singaporeans, but have we done enough to build that foundational work as well to facilitate that work? Because I think that's a huge cause for burnout entrepreneurs when you're having to fight at every single corner versus prioritizing what's really important for the business”
"I don't think by and large, companies like mine, we're trying to replace physicians. I don't think we're of that illusion that we can even do it. I think what we're trying to do is really support our colleagues and to come to a better outcome for our patients, which is, I think, in everyone's interest.”
“I think there is a journey that needs to be taken by companies like mine, where a gradual de-risking, a very close listening to our customer, i.e. the clinicians and regulators, have to be undertaken.”
“I think a lot of clinicians have moved from a skeptical position to I say there still are many skeptics out there, but we see a broader segment of the market moving from skepticism into a ready to adopt phase.”
“I frequently point them to the underlying foundation and enablers of entrepreneurship rather than trying to focus their efforts on, say, finding the next Mark Zuckerberg or Elon Musk.”
“I think right now we're still in the phase of impedance. I think we're still trying to find our middle, where we want to go with this, where good regulation sets up for, say, a great sandbox for innovation while setting the right guardrails.”

⏱️ Timestamp

01:22 - Introduction
04:04 - The inception of Iterative Health
06:40 - Challenges and evolution of AI adoption
09:42 - Entrepreneurial journey and mentorship
11:29 - Comparison of ecosystems
13:16 - Future of AI in healthcare
19:15 - Advice for entrepreneurs

🎙️ Transcript

Episode Preview

Dr. Jonathan Ng: So I frequently, whenever folks from Singapore government come and chat with myself around "Hey, how can we make Singapore become a more successful, entrepreneurial ecosystem. I frequently point them to the underlying foundation and enablers of entrepreneurship, rather than trying to focus the efforts on, say, finding the next Mark Zuckerberg or Elon Musk.

Joson Ng: Hi, thanks for joining us on Nucleate Singapore Pulse, Singapore's premier podcast on the biotech ecosystem. I'm your host, Joson Ng, an MD PhD candidate at Duke NUS Medical School. Whether you're a student thinking about creating your own startup, or an industry professional looking for diverse perspectives, this is the podcast for you.

The show notes and transcripts for the episode can be found on nucleatesingapore.substack.com.

So, joining us today is Dr. Jonathan Ng, who graduated from NUS Yong Loo Lin School of Medicine with an MBBS. He subsequently went into an MBA and MPH program in Harvard and MIT, and went on to found Iterative Health, which is a company that focuses on AI diagnostics, especially for gastroenterology diseases.

Thank you so much for joining us, Dr. Ng.

Dr. Jonathan Ng: Hi, Joson. Thank you for having me. Really excited to be here.

Introduction

Joson Ng: Do you mind giving our audience a brief introduction of yourself?

Dr. Jonathan Ng: Yeah, sure. So I'm Jon, I'm the CEO and founder of a company called Iterative, founded about six years ago. I've spent about 20 years in healthcare, good amount of the circuit from trying to build hospitals and healthcare systems in developing countries like Cambodia to attending med school, as you mentioned, in Singapore, and then setting up my first company in Singapore and subsequently moving out here to the U.S. to pursue my graduate degrees. So it's been a phenomenal journey, a fantastic journey in healthcare, so to say, professionally.

Joson Ng: Were there any experiences that you had before or during your time in medical school that nudged you towards founding a startup, towards entrepreneurship?

Dr. Jonathan Ng: Yeah, I think. I've always been somewhat entrepreneurial growing up, especially, even growing up as well way before med school.

I think for me, what nudged me into entrepreneurship was really, I grew up in a pretty entrepreneurial environment and observing how through entrepreneurship folks could take an outcome and have so much control over it, so much influence over it and own the outcome. That was really attractive to me. And then combined with healthcare and the impact that we can have, what's not to love there?

Joson Ng: I understand that you also, after graduating from medical school, went on to do housemanship and MO-ship, which is very typical for medical graduates here. How did you make that leap into going to Harvard and to MIT to do an MBA and MPA?

Dr. Jonathan Ng: You're right. I spent my first couple of years doing my housemanship and medical officership.

For me, the journey was a little bit of a windy one. The actual trigger was I broke my wrist in a car accident in my third year of practice, and ended up putting a pause on clinical practice. I really loved what I was doing, but I think that pause allowed me to take a step back and get curious around, how do I want to think about the broader healthcare ecosystem?

Do I want to work from a patient to patient basis perspective? Or do I want to think about the entire system. And I think for me, the entire system perspective was very appealing. And yeah, I basically ended up applying to school, having a chat with a lot of my mentors and receiving a lot of help, a lot of insight into these programs.

To be frank, I had no idea what an MBA was, seven years ago before I applied. But a ton of my mentors, my deans from school, they're very helpful in helping me to think through what were my next steps and where I could best apply myself.

The inception of Iterative Health

Joson Ng: At which point did the idea for Iterative Health come about?

Dr. Jonathan Ng: So Iterative Health itself, the idea came probably about three, four months after I arrived in the U.S. Just as I was thinking about the healthcare ecosystem and also thinking about the technologies I was experiencing at MIT, wondering how I could mesh the two together.

Joson Ng: Can you tell us a little bit more about what Iterative Health does and what you focus on?

Dr. Jonathan Ng: Sure, what we do is we apply artificial intelligence algorithms over complex endoscopic procedures.

We have a two-sided business model. On the provider side, we help to enhance diagnostics, help to find polyps better, faster, help to reduce cancer rates. We help to also detect the number of features which clinicians might be interested in to enhance their practice, and do a variety of activities with them.

And then on the back end, we also utilize this data to help pharmaceutical companies to help them to find the right sites to run the clinical trials at, or find the right patients and the right dosage for that patient populations.

Joson Ng: How do you come about deciding that the focus of Iterative Health would be gastrointestinal diseases?

Dr. Jonathan Ng: I think for myself, we're always told and we're always taught to pick a narrow beachhead when you're approaching a tough technological solution. And to me, G.I. represented a extremely narrow beachhead being natural where the gut has one way in and one way out, basically, and we could consider similar technologies, say, in laparoscopic surgery or general surgery, but those have many permutations that you need to think about, and it's just each permutation represents an exponential amount of complexity for technology to work. That's how I thought about why I would pick GI diseases as my beachhead market.

Joson Ng: And then how did you come to the decision of headquartering Iterative Health in the U.S.?

Dr. Jonathan Ng: For me, the U.S., firstly, I was in school when I started, so I was probably my fourth or fifth month of school when I decided to start Iterative as a company, that was part of the decision and choice.

I think beyond that as well, essentially, I view U.S. as a very large market that is able to afford a lot of this, say, emerging technology that's very difficult, very expensive to pay for, and having a market like the U. S. to sponsor this technology was very advantageous to me and made it pretty easy for us to spin out and to maintain Iterative in the U.S.

Challenges and evolution of AI adoption

Joson Ng: Most recently, especially after the pandemic, everyone's been talking about AI and there's been a lot of hype about it, but how was it like starting Iterative Health back then when it wasn't yet the hype?

Dr. Jonathan Ng: Yeah, it was pretty challenging to start Iterative. You'd be amazed at the challenges we had around folks. There's even one competition we participated in at a business school where folks were mistaking AI for artificial insemination, rather than artificial intelligence. That was a pretty challenging one.

And yeah, I think that, and then the whole market education, are physicians ready and willing to accept our solutions?

Do they trust our algorithms? Do they trust the ability to get it done? These were all difficult situations starting the company. They still are challenging, but not as challenging these days.

Joson Ng: You spoke about there being a little bit of a challenge in terms of getting physicians to adopt newer technologies.

On the clinician side of things, how has the reception been for newer technologies like Iterative in the clinics?

Dr. Jonathan Ng: Yeah, I'd say it's been really good. I think a lot of clinicians have moved from a skeptical position to, I say there's still many skeptics out there, but we see a broader segment of the market moving from skepticism into a ready to adopt phase.

And we see also the clinician mindset moving from a, this is optional, or in fact, this is probably not even worth my time to now this is the future perspective. And that move in mindset has been very helpful for adoption.

Joson Ng: How much of that do you think is based on the hype of AI versus of medicine moving towards a more evidence based approach towards curing and treating patients?

Dr. Jonathan Ng: I think it's a mix of both. I think the evidence that's generated has proven that there is a very evidence based benefit to our patients and there's a lot of upside to be had here. And then the trust is obviously helped by a lot of the hype that we see ongoing now. The way it comes across as hype, but really I think of it more as I'd say, like market education, there's a lot of opportunities to educate the market as to what AI can and cannot do. And that's been very helpful.

Joson Ng: What are your personal goals for the company? How do you see Iterative growing in terms of the kind of challenges or unmet needs that you aim to tackle?

And how do you think of it eventually influencing or impacting how we care for people with gastrointestinal diseases?

Dr. Jonathan Ng: Yeah, I'd say I'd love to see Iterative products be in every single GI suite, both in the U.S. and internationally as well. The primary premise for why I set up the company was really to solve for knowledge asymmetry that's present in the market.

And being able to solve for that with AI tools, there's a huge need for that. And yeah, so I'm looking forward very much to being ubiquitous across the world, not just within the U.S. itself.

Entrepreneurial journey and mentorship

Joson Ng: You mentioned earlier on that you had to talk to a few mentors to figure out whether or not MBA or an MPA was for you.

Who are some of these mentors or strongest supporters of yours and what kind of support or advice did they impart with you during your career journey?

Dr. Jonathan Ng: Oh, I've led a very privileged life in terms of being able to seek out and to lean on so many mentors throughout my journey. Folks like you mentioned one of them earlier on, Jeremy Lim from AMILI. He's been a critical part of my journey. I'm grateful for his support, but also mentorship and how he's lived his life and modeling it, being able to learn from that.

I've got other folks say in the tech world, for example, Freddie Kerrest from Okta, who founded a company called Okta. It's publicly listed as well, 35 billion dollars in market cap today. And there's so much to learn from his entrepreneurial journey and how to think about how to become the best version of yourself, and yeah so many more.

Joson Ng: I understand in business school you guys are exposed to a lot of case studies and looking at what are things to do and what are things probably not to do. Were there some role models that you looked up to in terms of how you decided to go about your entrepreneurship journey?

Dr. Jonathan Ng: Yeah, I think I mentioned earlier on, Freddie who is really one of these role models that I've had had, just really admired the way he has so much structure on his thinking of the market, of his understanding of how people think and how to serve customers better, as well as the dynamics around how markets work around startup companies like mine. These are, I would say like just really critical success points that have been so helpful in my journey.

Comparison of ecosystems

Joson Ng: I wanted to also zoom out a little bit, and you've had a lot of experience here in Singapore, but you've also spent quite a lot of time there in Boston and Cambridge, Massachusetts, and Boston and Cambridge over there, they're known as a great ecosystem for innovation and entrepreneurship.

What do you think are some of the best practices that you've observed in terms of the infrastructure or the culture that Singapore can adopt as we're trying to mature our own local ecosystem?

Dr. Jonathan Ng: You're right, Boston has that crazy, great infrastructure around healthcare and innovation. In my mind, everyone's so used to innovating and change in healthcare that, for example, you might approach a clinician with a new tool and they wouldn't blink twice.

They're so used to entrepreneurs like myself walking in through the door and trying to pitch something novel. It's really nothing new to them, and that helps so much. That helps a ton. Everything from that to even, for example, the lawyers that we have, the legal counsel that we have, being used to dealing with complex IP issues from companies such as mine and not having to train them from scratch. That speeds up the process so much.

So I frequently, whenever folks from Singapore government come and chat with myself around, "Hey, how can we make Singapore a more successful entrepreneurial ecosystem?" I frequently point them to the underlying foundation and enablers of entrepreneurship, rather than trying to focus the efforts on say, finding the next Mark Zuckerberg or Elon Musk. I think we have plenty of really smart Singaporeans, but have we done enough to build that foundational work as well to facilitate that work?

And because I think that's a huge cost for burnout in entrepreneurs when you're having to fighting every single corner versus prioritize what's really important for the business.

Joson Ng: What do you think, in terms of AI, are the biggest challenges and opportunities in healthcare over the next 5-10 years? Because we've seen a lot more of these tools being tested, potentially getting adopted, but definitely a lot of papers as well, even within Singapore.

Dr. Jonathan Ng: Yeah, I think that one of the biggest opportunities would probably be in business model innovation. So just thinking beyond single payer systems, or thinking beyond. The classic provider patient financial relationship, being able to tease out additional business models that might serve other ecosystem players and help us then to innovate or have deeper insight into patients and how to serve them better, or how to sell them at a lower cost.

I think healthcare cost is going to be a huge challenge within the next decade. It's already a huge challenge in many parts of the world, but a growing challenge within the next decade. And I think that business model innovation is going to be really critical.

Joson Ng: We've skirted around it, but one issue that usually comes up in terms of adopting or testing new tools in healthcare is in terms of the regulations, and especially with something as new as AI, regulation is still in the process of trying to catch up.

What are your thoughts on whether AI regulations enable or impede innovation in healthcare?

Dr. Jonathan Ng: I think right now we're still in the phase of impedance. I think we're still trying to find our middle, where we want to go with this, where good regulation sets up for say a great sandbox for innovation while setting the right guardrails.

I just don't think we're right there yet. I don't see that playing out yet in the AI and healthcare ecosystem with either too much skepticism and too much of a heavy hand or in some cases this unclear regulatory processes which is challenging to then implement.

Joson Ng: Is that the same case over there in the West as well or is it just a more Singaporean phenomenon?

Dr. Jonathan Ng: I think to a different degree. I think Singapore is right at the very start of its journey. I think in the U.S. there's just so much market demand and so much of the market is just moving that the agency here has had to respond and get really inspired about AI regulation real quick.

The other part is, I think they also have many more reps in play. Reps mean repetitions. Just because of the sheer volume of companies and sheer volume of people trying to innovate here, so they get to see the much wider variety way quicker and are able to adapt much faster to this wave.

Future of AI in healthcare

Joson Ng: You have experience treating patients, seeing patients, especially with your clinical background, and you have had the opportunity to really see things from a clinician's perspective.

How much influence do you think standards of care and clinical guidelines that have been set, how much influence do they have over the adoption of newer healthcare technologies? And how do you make that balance?

Dr. Jonathan Ng: I think guidelines and regulation, guidelines in particular, these tend to have a really important role, but they tend to have an important role, I'd say in the mid cycle of growth.

The early adopters, we're never going to get, say, standard of care changes this early in the cycle of adoption, just because it's really difficult to prioritize which one should get, say, the guidelines written for and prioritized for. And so the earliest adoption, I think, will always be predicated on some very forward leaning physicians taking a risk and working with entrepreneurs like myself to bring innovation to clinic.

And then thereafter, there's a whole conversation around how do we get this to say, when we have gotten from zero to one, how do we get it from one to a hundred for the rest of the clinics? And that's where I think guidelines come into much more important play.

Joson Ng: When you bring up the idea of AI to healthcare and you bring it up to doctors, the common perception is, "Oh, I'm going to get replaced, AI's gonna come for my job."

We talk about AI replacing radiologists, pathologists. What do you think will happen to the relationship between doctors and AI? And how do you disentangle or demystify that?

Dr. Jonathan Ng: I think the only way to do it is actually frankly for physicians to engage more with companies like ours and really get involved and be involved in the development of such roles.

I think companies like my role is trying to get better at engaging with our stakeholders. And yeah, I think if folks decide to avoid it, then yes, there is a real risk that someone decides to go off the rails and try and design something that is the worst nightmare that you just described.

But I don't think by and large companies like mine are trying to replace physicians. I don't think we're of that illusion that we can't even do it. I think what we're trying to do is really support our colleagues and to come to a better outcome for our patients, which is I think in everyone's interest.

Joson Ng: The other flip side, I guess, clinicians also think about is, will me choosing this technology or adopting this technology compromise in any way for my care for patients.

Something that usually gets asked as well is, how do we accelerate adoption of AI-based healthcare solutions while de-risking or removing as much risk as possible or minimizing any sort of potential compromise to patient care?

Dr. Jonathan Ng: I actually don't think we should be trying to overly accelerate the adoption of these tools.

I think there is a journey that needs to be taken by companies like mine, where a gradual de-risking, a very close listening to our customer, i.e. the clinicians and regulators, have to be undertaken.

I think moving too fast in this arena risks us making careless mistakes, unintended consequences. I think if you say like anyone wants to move faster, what I would advise would be just to listen better to your customers, listen better to your doctors and try and have a better fit quicker for their use case.

Advice for entrepreneurs

Joson Ng: Dr. Ng, you also have traversed this path in AI powered healthcare solutions for quite a while. What kind of advice would you give to other potential entrepreneurs who are interested in developing similar AI powered healthcare solutions, and what are the biggest lessons that you've had so far?

Dr. Jonathan Ng: Yeah, I think we're just at the start of this journey. I think there's a lot of opportunity and I think it's very much needed in terms of this innovation and innovation in the healthcare space. And I'd say it's a very exciting time to be in this space. So I highly recommend it. Folks thinking about how they can get involved in AI and health care innovation.

It's by no means easy, but it's exciting and fun.

Joson Ng: Absolutely. Do you also have any advice you could give early career professionals, graduate students, or medical students? For example, if you were to give advice to yourself 10 years ago, in terms of creating impact or thinking about a successful career.

Dr. Jonathan Ng: Yeah, I would say a lot of times we are worried and afraid of uncertainty. I'd say if you really just put your best foot forward and embrace not just uncertainty, but also embrace your strengths, take some time to yourself. Frequently, we're always rushing to grind and rushing to do more work, but giving yourself enough time to step back and strategize and think about what you really want to do in life, I think that's really critical. And I'd say with my younger self, I had more time to myself as my younger self and just to think more about how I wanted to live my life.

Joson Ng: Amazing. Thank you so much, Dr. Ng. Thank you so much for being so generous with your time and sharing your insights.

Dr. Jonathan Ng: Yeah. Thank you. Thanks for having me on.

Joson Ng: Stay tuned for monthly podcasts with key stakeholders of the biotech ecosystem, including founders, investors, and policymakers. If you have suggestions for the podcast or who you'd like to hear from, feel free to send me an email in the episode description. Join the Singapore Life Sciences Community Slack channel powered by Nucleate Singapore, where we are building an open community to enable conversations in the life science ecosystem of Singapore.

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