First in Human Episode #17 featuring Dr. Torsten Schröder

For episode 17, we catch up with Dr. Torsten Schröder, Founder & Chief Medical Officer of Perfood. Stay tuned to find out what Dr. Schroders opinion on the future of personalized medicine and what that looks like. First In Human is a biotech-focused podcast that interviews industry leaders and investors to learn about their journey to in-human clinical trials. Presented by Vial, a tech-enabled CRO, hosted by Simon Burns, CEO & Co-Founder & guest host Co-Founder, Andrew Brackin. Episodes launch weekly on Tuesdays & Thursdays.

Andrew Brackin: [00:00:00] Hi, this is First in Human. I’m Andrew Brackin, the co-founder of Vial. Vial is a next generation CRO, built for biotech, offering faster and more efficient clinical trials for biotech companies. Today, I’m here with Torsten Schröder, the founder and CMO of Perfood. Hi, Torsten. 

Dr. Torsten Schröder: Hi, very nice meeting you. My name is Torsten. I’m a trained physician. Now, I serve as chief medical officer at co-founder at Perfood. We are a German-based company developing digital therapeutics and we base that on personalized nutrition.

Andrew Brackin: Why don’t you tell us more about your background. How did you start Perfood?

Dr. Torsten Schröder: As I said, I’m a trained medical doctor and a very engaged researcher, so I was classically pursuing a career in the university hospital. I was working in the field of metabolic medicine, diabetes, and internal medicine and we were starting doing research. 

 We founded the company five and a half years ago. Roughly one or two years before, we started to learn about personalized nutrition and its opportunities to improve nutrition medicine. And so we started to think about can we use personalized nutrition to bring effective treatments to patients in various diseases? We ended up founding a company and not doing that in the university. 

We founded Perfood as a spinoff from the University of Lubeck, here in the north of Germany, more specifically from the Institute of Nutritional Medicine. It all started with setting up a founder team. Bringing all the expertise you need from medicine and signs and software development.

To tackle this problem and evolve personalized nutrition, you have to know that approximately 80% of all the chronic diseases are very strongly related to nutrition and that you can use nutrition, on the other side, to really treat these diseases. So from just a medical standpoint, it’s really clear that you have to find good ways to bring nutrition as effective therapies to the patients.

And another thing is that research has shown that the maximum of 30%, presumably less of how you metabolize a food after you’ve taken it in, is determined by the food itself. The majority of the reasons why you have, for instance, a good or a bad metabolic reactions after you’ve eaten, is determined by factors from the person like genetics or microbiome, and a lot of other factors.

The way how we usually do nutrition is that we tell people, “This food is healthy,” and, “This food is not healthy for you.” But we can only address 30% of the reaction, because the rest comes with a person. What we do is try to analyze data from each person and use that to personalize dietary recommendations and that’s used in the treatment of various diseases.

Andrew Brackin: How exactly does the product work? Do I get a test kit that I take home as a patient? Is it prescribed by a doctor? , 

Dr. Torsten Schröder: It’s actually both. We have multiple products that may be working differently a little bit but in general we really focus on glucose reactions. Because we know that glucose reactions after meal intake something which you can very well use to personalize and it’s easy accessible and it’s you monitor your own glucose levels, it’s something you learn a lot from.

And our products usually look in a way that you indeed start with a test phase. Usually the test phase in our products is two weeks long, and in that phase, you continually monitor your glucose levels using glucose monitors. We normally get the patients to have access to our applications and with that applications they can record a lot of symptoms, what they eat, how they slept, how they felt and depending on the disease, we are dealing with, a disease specific symptoms.

Our leading indication is a migraine. And our migraine product works in such a way that the patients with migraines start with a test phase and there they not only recall glucose but also nutrition and all these migraine symptoms. Headaches and nausea and how migraine interferes with their daily life.

And with all this data, after the two-week test phase we are then able to get a personalized report. Our algorithms use all this data to calculate the best way that the patient can stay on a low glycemic diet. A diet which keeps the blood sugar reactions very low. Depending, in migraine, for instance, we have a 12 week phase in which the patients just learn to adapt to this new way of eating and to bring step-by-step these new recommendations in they every day life.

Andrew Brackin: My understanding is your product is available today in Germany. Is that correct?

Dr. Torsten Schröder: That’s correct. It’s like a digital therapeutic. It means this is a software designed to bring evidence-based therapies to patients. In Germany, we have to, first of all stick to this medical device regulations from the EU. We have a very interesting path in [00:05:00] Germany. We can apply being a DiGA, DiGA is a German abbreviation and it means something that can prescription digital therapeutic. And the great thing in Germany is we have a centrally organized healthcare system. As we receive this approval to be a DiGA, all the patients in Germany who are insured can get access without paying for that digital therapeutic.

 , they’re would go to their physician, and together with the physician decide, “Now, should I take some pill to treat my migraine. Or, as an alternative, or an addition to that, shall I use that new, novel, digital therapeutic?” They will get that on prescription and just would have free for them, but it’s covered by their health insurance.

This is really unique and interesting, because now we can really make good medicine, but digital therapeutics, because you know that it’s easy for patients and easy for physicians to get access to that.

Andrew Brackin: Absolutely. how have physicians reacted to prescribing your digital therapeutic? How have patients reacted? Obviously, it’s critical to inform the physician and have them distribute your product, right?

Dr. Torsten Schröder: Yes, absolutely. You have two customers, right? On the one hand, the physician has a customer because the physician has to endorse the therapy and at the end prescribe it. But, you also have the patient being the customer really using that product. It’s like a lifestyle intervention, so the patient has to be doing that and taking part and being willing to change, their lifestyle according to the advice.

 Physicians really play an important role to make patients also aware that they have to promote that and, just give to patients the knowledge about this as an opportunity. Because this is very new, we have that for two-and-a-half years in Germany. So thinking healthcare means two-and-a-half years is just a very short time. You need more time to educate physicians and patients.

But what we really liked to learn is the physician easily see the benefit of a digital therapeutic. Because you have a lot of opportunities to treat diseases with pharmaceuticals. This is very good, but, pharmaceuticals often have side effects. Not all the patients tolerate pharmaceutical interventions. And very often patients ask for alternatives to that. 

Now, the physician has a digital therapeutic which is approved by an authority. It’s very easy for the physician to be sure that this is something they can trust. They can be sure that this really brings an effective treatment to the patients. We learn that physicians are very open doing that.

On the other hand, we also learn that a lot of physicians still have to be educated about this new form of treatment. So, it’s both. We have openness, but we have still a lot of physicians who have to be educated.

Andrew Brackin: How have you educated them? I know this is a huge challenge for any new therapeutic and new biotech company that gets to market.

Dr. Torsten Schröder: Yes, absolutely. It’s an every day challenge. We try to teach physicians in several ways. One very classical thing is to go to congresses to make events or to have a stand on the congress and just to talk to physicians and explain what we’ve come up with, and show them the data from our studies we’ve published. Then, of course, we like to give talks, because physicians have to be educated and they have to educate themselves.

 In Germany they have to collect education points and so very often, they really like being online in a talk for one hour and learn about new, approaches. These are the two classical things and then, also physicians that are very active the internet and social media, for instance. We have a lot of advertisement in social media for the patients on the one hand, but also, for the physicians, too, just tell them about this new, um, way.

And we are a very physician dominated founders group. So, we, uh, the five founders, were at the beginning physicians. So we have an own network and we talk about with our friends and families and… it’s a little bit mouth to mouth, social media, congress [inaudible 00:11:11], education and… Yeah. a lot of tasks, but then of course, the physician can talk about their colleagues as well about this new technique. And so it’s getting, it’s growing bigger, actually.

Andrew Brackin: That’s amazing. Given the kind of nascent and unique nature of digital therapeutics, what are the biggest challenges you’ve seen in running clinical trials within today’s existing infrastructure?

Dr. Torsten Schröder: First of all, recruitment is a big challenge in studies. Also, having enough trial physicians and enough physicians who can offer enough study visits. So, it’s the same challenge you would face in a classical clinical trial with pharmaceuticals. But what is different though is that as this is a digital therapy, you can easily digitally approach your patients.

What we do is recruit our patients online and use the same channels I was talking about like [00:10:00] social media, for instance, to get out this information about this study. This is still a challenge, but compared to classical trials, we are quicker. We have already included 800 patients in a study in Germany out of 1,000 studies. To do that in a classic setting would take years, I assume. But this is like the classical setup. 

What is cool is that we hear, especially now, a migraine product have a product which is easily organized remotely because you don’t need to draw blood, for instance, in migraine you can get a lot of information with questionnaires. We run a decentralized study. This is a very effective and innovative way of doing clinical trials.

Andrew Brackin: For sure. That makes a lot of sense. The existing kind of research site model might be less situated for additional therapeutic…

Dr. Torsten Schröder: absolutely

Andrew Brackin: …Can you tell us about your plans of expanding to the US? Obviously, very pertinent to many folks listening. What are you exploring in terms of new indications and how you’ll break into the US market? How does US think of digital therapeutics as well, compared to Germany?

Dr. Torsten Schröder: There are various aspects. While one aspect is like the disease. First of all, when we talk about migraine epidemiology and the individuals, as well as ,the societal burns of migraine is very similar between the US and Germany. We know that the US and Germany share a lot of lifestyle circumstances. As a prerequisite from the disease and the circumstances, makes it plausible that our migraine device would thrive in the US as it does currently in Germany.

We learned that in the US, the patients have the same thinking that they want to be in the driver’s seat to tackle their problems and their diseases. Patients are really open in the US, as has smaller, research, evolved so far. Secondly, we started to talk with migraine experts in the US to ask what a US physician would think about that kind of treatment. We also learned that, they think this is neat and something which could be of high effectiveness but also, high interest for the migraine patients they usually deal with.

What we want to do is use all these assumptions and all our contacts and network to bring that device to the US and start with smaller studies, as you would normally do with a medical device doing trials and just work on your hypotheses and then get in contact with the patients. At the end really using that product and giving us feedback to adapt that product step-by-step to a n Americanized version.

Andrew Brackin: We just announced Dr. Stewart Tepper to our SAB. He’s a leader in headache medicine. We should, connect the dots there, for your…

Dr. Torsten Schröder: Yeah, perfect.

Andrew Brackin: … future US studies

Dr. Torsten Schröder: I’ve met Dr. Tepper in Vienna just a couple of weeks back on a congress. We exchanged already emails…

Andrew Brackin: He’s really impressive.

Dr. Torsten Schröder: We may have the same contact there. That sounds really interesting.

Andrew Brackin: I’m incredibly excited by what you guys are doing and I’m excited for you to come to the US. There’s a lot of opportunity for what you’re doing. What do you think the future of personalized medicine looks like? What advice do you have for biotech companies looking to build in that space?

Dr. Torsten Schröder: Every day we learn more about the individuality of people. How differently and individually people interact with their environment. Food for instance but, also, the way pharmaceuticals act on the bodiy is very individuous. With more data it will be easier. Increasingly, we will be in the position to perfectly tailor treatments to the patients’ requirements. 

I assume that in the future we will have more products dealing with personalized interventions. We will have easier products because more data will make more effective predictions. Maybe we don’t have to interact in all the products with a lot of sensors but you can rely on lesser numbers of input data.

What is really interesting is that with each data set, this understanding of diseases grows and we can easily understand patterns. With all these advances in artificial intelligence, this will really change the way how patients can get access and interact with effective treatments.

 Biotech companies should be open for such kinds. Everybody should look in trials not only for the mean, but also for the outliers, right? Very often, you see in studies people responding better than the mean, but also people responding not so well as the mean. For these outliers, you have to make effective treatments as well. 

But the way clinical science is, shaped is that we try to find a intervention group in which the mean is better than the mean of the control group We forget that people are individuals and have distinct requirements that we should also try to think more from the patient, not so much from the pharmaceutical, for instance.

Andrew Brackin: Absolutely. Thanks so much for the time today, Torsten. We’re excited about your continued expansion [00:15:00] and success as you grow the business. I really appreciate the time.

Dr. Torsten Schröder: Thanks a lot. It, was a pleasure talking to you.

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