GeorgeGoldsmith:
0:00
The most creative thing in the world for me is just how does an idea get transformed by the people who collect to round it.
John Simboli:
0:08
That's George Goldsmith co-founder and CEO of Compass Pathways. Join me now to hear my conversation with George when we were at the CNS summit in Boca Raton, Florida. I'm John Simboli. You're listening to BioBoss. This morning I'm speaking with George Goldsmith, co- founder and CEO of Compass Pathways. Today, George and I are at CNS Summit 2019 in Boca Raton. George, how did you find yourself as co-founder and CEO at Compass Pathways?
GeorgeGoldsmith:
0:39
Well, it was a a long and winding road as these things sometimes are. I think we often like to talk, I co-founded this with my wife and, we—she's a physician—and, my background is a serial entrepreneur and we had an issue in our family which was a Katya's son became quite ill with depression and OCD. And we thought that, given the fact that we were in h ealth c are, i n certain ways, it would be fairly easy to find a solution. And it proved to be really, really difficult. Even despite kind of working with some of the leading institutions and so forth. And our son just got worse and worse with every kind of interaction, with new medicines and so forth and became less and less recognizable. And that kind of came to a crescendo with a massive side effect, adverse event with SSRIs and Katya, being a doctor and a mother spent so much of her sleepless n ights, so many of her sleepless nights, looking at medical literature, trying to figure out how to help. And, one day, one morning in February, 2013—this a ll started about a year and a half before she came to me—and said, I just found an article on this medicine called psilocybin. It's really part of the magic mushrooms. You w ere in the sixties and seventies. What do you know about this? And I think that that started the long and winding road. I think that what we saw in this was that there were some very interesting, promising results not seen before in OCD—this paper was focused on OCD. And I think that the signal led us to start talking to researchers who were doing this work. Psilocybin, for those of you who may not be aware of it, is a psychedelic medicine, a drug , that was first synthesized in 1958 by Sandoz. Back then, research looked different than it does today. So people shipped the drug around and psychiatrists used it but there was never a formal clinical trial. So we became interested in this, met all, the researchers, started to fund it. And then it became, as Katya likes to refer to it an involuntary startup. We just saw enough promise in the research to go do this.
John Simboli:
3:08
How did you decide you wanted to lead a biopharma company as opposed to many other paths you could have taken?
GeorgeGoldsmith:
3:14
Well, it's really interesting. So I'm a serial entrepreneur and I think that can mean a couple things. One is it can mean that we're totally unemployable, therefore we have to create our own things. I think it's also someone who sees a particular opportunity and can't not do it. So I think for us , whether it's biopharma or any of the other types of business—I've done software businesses, services businesses. I've worked at large firms after I've sold businesses to them. But I always had to go back to the drawing board and start new things. And so the fact that it's a sector for me, this is an amazing sector where we can really help people. My last work was actually the company I created called Tapestry Networks. And we were really working with regulators and pharma executives and payers and patients to really look at how do we eliminate late-stage failure in clinical trials. And in many ways this just felt like a way to, okay, I've studied it, now it's time to go do it. And I think a lot of what I learned in that environment is really part and parcel of how we think about Compass.
John Simboli:
4:26
What we hoping to achieve that could be done at Compass Pathways and you couldn't imagine being able to do it someplace else.
GeorgeGoldsmith:
4:36
Having the experience at a kind of a front row seat, the challenges confronting mental health patients became really clear that, what if we had the model wrong about what care looks like. And what happens if, in fact, so many things that we accept kind of as known fact may no longer be true. And so this might be things like chemical imbalances that we were told our son had without anyone ever doing a blood test, really interesting. And so we started to think that a target rich environment would be really looking at the patient experience and mental health and looking at how new tools, new technologies, new medicines, new ways of caring for people who are suffering, and there are far too many of them. How we could do that and how we could do it in an unconstrained way. And I think that's what startups are about. It's how do you not be constrained by other things. And then, let's go see if it works. Right? It's so cool to be able to find people who are interested in that mission and build a company. The most creative thing in the world for me is just how does an idea get transformed by the people who collect around it. You know? And it always gets better. It always gets different. And so for me, company building is probably one of the most creative, it's almost like a play, right? And more and more people show up and they show up as partly starting the audience and then they become the actors. And it's just quite cool.
John Simboli:
6:23
When people say, George, what do you do for a living? I'm sure it depends who asks you.
GeorgeGoldsmith:
6:27
Right now what I do for a living is really try to attract the highest quality people who are really engaged in transforming mental health, often because they've experienced it in their own way. And I think that experience is really instructive. And so mostly how I spend my time now is really expressing a vision for how it might be different. And seeing who shows up and then seeing how we can articulate that better together. And I think that's been pretty much our journey for three to four years now of building the company, building the advisors , building the board of directors. It's really assembling a group of people around a vision of what would a world of mental wellbeing be? What would that look like? And are we on the right path? Are we getting closer? And what might we do to actually get closer to that? And when I look at the current situation, quite often we have, you know, the most severe end of the spectrum. We have, institutions which sometimes feel like incarcerating patients, they just wear different clothes. It's white coats instead of jailers. And I think this whole model that we've developed around care probably needs to be rethought given the fact that it is the 21st century. And so I think we have a huge opportunity together .
John Simboli:
8:03
What have you learned about what works for you as a management style?
GeorgeGoldsmith:
8:09
I think what works for me is having really, really bright people around me and watching the collision and always doing it as kind of, I think, our frame of "We are smarter than me." And so to kind of set out a perspective and then let people go and, and go for it. I think also the other thing is to kind of spend a lot of time in the details. I really believe that God is in the details, as Mies van der Rohe said. And I think that you know, it's an interesting contrast. Some people think I'm kind of a fairly broad conceptual thinker, but I find that really the work has to be done at incredibly detailed level because that's what builds up to a broader vision. And so I think sometimes what I find works well for me is being able to go really deep, deep, deep down in details. Also keeping the big picture. And I think finding ways to do that in a way that isn't intrusive for people, doesn't feel like micromanaging, but does kind of make sure that the foundation is firm, for whatever we're building, I learned that in software and I certainly see it in biopharma now, as well,
John Simboli:
9:36
For myself, when I move up and down through that zone from the very detailed to the broadest ideas I can think, I sometimes get lost. I sometimes lose track of where I am in that. Is that an aspect of dealing with something like that or is it just a skill that one has?
GeorgeGoldsmith:
9:53
I think that it's a skill that you've certainly got, I'm not sure any of us are smart enough to know exactly which are the 43 layers we're in at a moment and I think what I love about really deep expertise is you get to a particular level where that's, I'm pretty tapped out, and then you will lift the portal or the manhole cover and you see there's a whole other world below it. And so I think it's also understanding kind of the level of analysis that I'm comfortable in and letting people, really excel and kind of going deep in a way that is something that I'm not capable of in that same way because of the expertise. When I was at McKinsey, we had a really, I think a wonderful way to talk about this, which was kind of looking at creating T professionals. And what we mean by that is the really deep spike of expertise, but also a breadth and a lateral thinking that would allow us to join across disciplines. And I think this has really been the core of what I've seen in everything I've done is I've had really incredibly diverse and interdisciplinary teams working on things that matter. And I think that's probably, as I think about it a bit more , the consistent thread since my first business in my late twenties.
John Simboli:
11:20
Can you remember when you were eight or nine and what you wanted to do, did you want to be a baseball player, fireman and then how did that connect with what we find ourselves talking about today?
GeorgeGoldsmith:
11:30
Well, my parents thought it was really interesting and fun to have me be three years old and say I want to be a nuclear physicist. So , I was early trained to be aspiring to be a nuclear physicist. I think I was always attracted to the future in a kind of an interesting way. And so , I'm sure I remember what I wanted to be at eight or nine, but I think it had to do with being an astronaut and a kind of an explorer in that way.
John Simboli:
12:05
What do you say when people ask who is Compass Pathways?
GeorgeGoldsmith:
12:09
I say that we're a company seeking to transform the patient experience in mental health, that we're aiming to a world where mental health and wellbeing are available to many. And then if I need to double-click, I'll say that our mission is to do that by accelerating patient access to evidence-based innovation. And we don't really care where it comes from, that evidence-based innovation. We really are looking at how it can be assembled in interesting ways.
John Simboli:
12:41
When you tell that story, as you tell it in more depth than you just gave me the intro for and they misunderstand it, what do they get wrong? What do you help them to understand?
GeorgeGoldsmith:
12:50
Well, I think many people have this narrative when they've looked at what we've done as somehow our son became ill and somehow magic mushrooms were involved in him becoming better and therefore we were motivated to create a magic mushroom company, right? And I think that's an easy narrative, unfortunately. It's incorrect. And I think really what motivated us was seeing how much the system, how many opportunities for excellence, should I say, exists in the current system. And then we came across this really interesting substance that looked like it was perhaps circuit based , it really had an impact on circuits. And that was kind of certainly a very contemporary view of CNS and mental health. And so what people often get wrong is somehow that we're a mental , a psilocybin or psychedelic company. But what we really are is using that as a , a way in to really rethink what care could look like.
John Simboli:
13:55
When you give that description you just gave to me, does that satisfy the people that you're attempting to meet? Do they say, Oh yeah, now I get it?
GeorgeGoldsmith:
14:03
I think most of the time it does because , often, when I speak, I did this yesterday, I ask people to shut their eyes and raise their hand if they, or someone in their immediate family has been touched by mental distress witnessing that or feeling it, being part of it. And then I ask, people who have don't have it in their immediate family, for people they know. And often 90, 95% of the room is there. So, I think that people know what that feels like.
John Simboli:
14:35
What, what makes Compass Pathways different from other biopharma companies?
GeorgeGoldsmith:
14:40
I think first and foremost, we're not a biopharma company, so that makes us a little different. We're a mental health care company and it is something that is different in the sense that so many biopharmas are organized around the product and kind of developing the product to a level of evidence where it then gets picked up by another firm. And it's a wonderful model. And I've been part of companies that do that and invested in companies that do that, but I think we have a little bit of a broader perspective, which is really that we're here to transform what it means to, or how to put the care back into mental health care . So that gives us a kind of a longer pathway and it's fascinating to be part of a company that has a 50-year mission, right? It's not something that's going to be kind of done and dusted in the next three years with a phase two B trial. And so being a steward of that I think is a really cool thing.
John Simboli:
15:47
What do you foresee for how you might take your thinking and turn it into a thing or some things that will help patients?
GeorgeGoldsmith:
15:55
Well, I mean, first and foremost, what we're doing is working with a very, very different medicine at the core of what we're doing and we're referring to what we're doing as psilocybin therapy. So this isn't just a molecule, but it's psilocybin therapy, not unlike probably the way people would think about chemotherapy. It's an agent in the midst of a protocol. And so our protocol is one where people need to be prepared for what could be a very unusual experience, a very powerful experience. And so we have to spend time preparing them for that and understanding kind of how they see the world, how their suffering manifests itself. And so that helps us prepare them for this experience. And I think that this is different than many medicines that it is an experience that people have. And that that's something that's quite notable for them. Then they come and they receive a relatively high dose of a psychedelic medicine under a tremendous amount of support and care by someone who's present with them , who's been with them along the preparation. And then they come back the next day after a four to six hour experience and they kind of talk about what they observed. And, you know, from a scientific perspective, what's interesting is this is a rapid acting antidepressant. People have a really significant difference in their mood the next day, for those who respond, and quite a number of respond. And thankfully not everyone does. So it's not a panacea. So as much as that would be wonderful for patients, I think I get suspicious when I hear about panaceas. And so, too much irrational exuberance around this. We have to do the science, but so how does this move out into the world? I think it's about digital support and preparation. We're already doing that in our trial. We have, handheld device on your phone or whatever you can practice breathing exercises, learn about what this is like and kind of learn about how to think about your issues. The therapy model that we've done is very much based on perceptual control theory and kind of how do I think about my current experience rather than the narrative about the past or the future. And so, what we're looking at is, this is a very different kind of approach. It's not taking tablets every day and hoping the medicine will work somehow. It creates a great deal of personal agency. And I think one of the interesting things for us that got us started in this was some brilliant researcher, I think it was probably Roland Griffiths and his team at Hopkins, asked patients how meaningful was this experience with psilocybin therapy? People would say, what would he mean? Like going out to dinner with friends or family , you know , holiday and they'd say, no, how about the birth of your first child, your marriage, your wedding, the death of a parent. And people, over two thirds of the people, at five weeks and at six months, and there wasn't much trade off on this or decline, over two thirds said it was in the top five and nearly a third said it was the most meaningful experience. So this is a really different thing than a traditional SSRI, right? And so I think that, we're really interested in exploring what is the nature of that experience and how does that really lead people to see their lives in new ways and what's our responsibility to care for people and how do we enhance that? And that's a lot of what we're focused on.
John Simboli:
19:49
In your presentation yesterday, you talked about as you moved towards these, larger scale, as you move towards clinical trials that require GMP practices to create the drug that needs to be produced in a uniform way, that itself is a considerable undertaking. Yes?,
GeorgeGoldsmith:
20:08
It was where we started actually. Our whole journey on this was really about, well, if you want to do research, and when we first met with some of the regulators that I had known and worked with in my past life , doing regulatory innovation work , it became clear we had to actually make the medicine and making the medicine to GMP standards was something I had never done before. I did what I do, which is call people who are smarter than I am. I kind of got the band together and we went and found contract manufacturers and we've done this and , and we've done it to the highest standards of purity. And we actually were really proud of the fact that we did this in a way that meets all the green standards. So we actually had accelerated patent reviews because we did a green development process for medicine in the U.K. And so we learned a lot in that. And now we're working on the commercial formulation for this, should our trials be successful.
John Simboli:
21:16
And I presume that puts you in a different spot than other people who are exploring this turf?.
GeorgeGoldsmith:
21:25
Well, I think there's a lot of different approaches, right? So what our approach has been very much focused on medicinal purposes. How do we reduce suffering at scale for people who might be very concerned about taking magic mushrooms? Some of our patients that we've had in clinical trials, and one comes to mind, that we heard was, you know, it's been 17 years and they're living pretty much without going outside in their parent's home after suffering from depression in graduate school. So those people are not going to be rushing off to magic mushroom ceremonies. Some people do and benefit from those, but that's not where we're focused. We're focused really on the medicinal side and doing what we need to do.
John Simboli:
22:09
Let's talk about partnerships a little bit. What kinds of partners, what kinds of relationships with companies, with researchers, are looking for n terms of partnerships?
GeorgeGoldsmith:
22:21
I'm going to go in a different direction first and foremost because I think it's something that I've learned in my experience that I think too few biotech companies think about and it's not a partnership, but it's a relationship and it's a relationship with regulators and payers and health technology authorities. And I spent a lot of time before Compass working in this area. And I found that far too often people think about that relationship as kind of a hurdle to either jump over or sneak under depending on where you are in the process. And I think that what I've learned and I think we've had as a core value of everything we've done is engage early and often with regulators. They're really there to provide a representation of how to bring something safely. It's your public health focus. And work with them from day one, sharpen your indication area, sharpen your science, agree on methodology because they are really there to protect public health and so work with them and engage them and also engage with payers around your value proposition really early. So before we even get to partnerships, it's really about how do we set the course and what is true north. And I think defining that through those early regulatory engagements across multiple countries too. I think that's really been a core part of our strategy so that you understand this is, health is a global thing. And so understanding how different cultures view different aspects of your program I think is really important. I think one of the things that also became really important to us given that we're working in psychedelic medicine is finding academic partners who actually were the leading-edge thinkers in mental health care and depression research. In the psychedelic research, the incredible work that was done at Hopkins, NYU, UCLA, Imperial, all of these organizations. You have very courageous people doing the hard work and all of that was necessary. And now as we look at how do we bring this to patients based on those early signals, building out that whole network of is really important. And then the last group of partners I think is really the partnerships around how do we understand patients. And another really important partnerships strategy again, early in development is patient groups. How do you work with them?
John Simboli:
25:02
And you have a patient in your, on your advisory board, is that right?
GeorgeGoldsmith:
25:05
Yes. This is really important because again, we started this with saying we're here to transform the patient experience and it's not just one patient. I mean we're spending a lot of time with different patients and I think what we can learn there is really important , because this is an opportunity for excellence, or it's broken, your choice, right? And there's a lot of time for us to really learn specifically what could be improved and how do we think about that from day one?
John Simboli:
25:42
Frequently when I talk with a CEO about where they are it's just required that they're deeply enmeshed in flawless execution of getting through the clinical trial and seeing where the data take them. It also seems that there's never a moment when they're not thinking about the good that they can do, but they somehow have to be in those worlds simultaneously. So my question is when you can step back and think about the success the company might have, the good that you can do, what do you picture?
GeorgeGoldsmith:
26:16
I picture, first, that there are new things available to people who wouldn't have them if we weren't around. And that isn't done in an egocentric way. It's just that that kind of motivates the entire team of can we create some new things for people that enable them to see their lives differently for depression. And I think one of the really interesting things that we saw out of our healthy volunteer trial and also some things we've seen in the prior work that we help support is gratitude. It's a fascinating thing, but people say they're grateful for the experience, whether it was as a healthy volunteer. And so I think doing that at scale is kind of what motivates us.
John Simboli:
27:08
One of the words I heard you use yesterday, and Katya, too, was the word narrative. That one can hope that a patient can make a choice about seeing their life in a different way. I think that's an interesting idea.
GeorgeGoldsmith:
27:24
Well, I think that what we're seeing, and I think this is really important , is I think the role of narrative and schema and cognition is critically important in mood disorder. I might even be as bold as to suggest that, we wonder, whether in fact the mood follows the cognition rather than the other way around and whether in fact there's this wonderful concept of attentional bias and, looking at people who are depressed and to have a negative attentional bias, and seems to have an effect which reduces negative attentional bias. And obviously when people are absorbed around negative thought patterns internally, they ruminate a lot and they think about this a lot. And so if we can shift the narrative and shift how much time people spend in that, suddenly the world can look a little different.
John Simboli:
28:30
It's also, I think the word, Katya used the word empowerment yesterday.
GeorgeGoldsmith:
28:34
Exactly. And I think that's really different. Tom Insel, who was the head of NIMH and one of our advisors early on after he left NIMH, he said, finally, medicine that can really empower patients because you don't take it every day, you know, it's not something you feel dependent upon. And I think that's a really important part for this because so often people who suffer with some ill mental health, this is a thing, they don't feel a lot, right? They don't feel empowered.
John Simboli:
29:07
Why did Compass Pathways choose to locate its headquarters in London?
GeorgeGoldsmith:
29:09
It's really simple. I think one of the things I learned early on is the headquarter should always be really near where you live. And we're living in London. I actually moved to London to work in health care because I wanted to, obviously you hear my accent, it's not an English accent, but I moved there in 2006 to work in health care because I was really intrigued about how to work in a system where health is a right, not a privilege. And that access to care is a right, not a privilege. It really enables us to look at things that are harder to do in the United States. Like do you have one really expensive cancer medicine for one person or insulin for 500 people. And these are real decisions that are hard to talk about in the U.S. system, but we do talk about them in the U.K.and so it just is kind of the sharp edge. And I like being in public health systems where we can look at that. Obviously, I love working in the United States as well. But that's why I moved there and that's why we're there.
John Simboli:
30:15
And what role does the New York office play?
GeorgeGoldsmith:
30:18
Well, the New York office is really, it's where we're building out a team here. It's a global company; mental health is a global thing that we want to move the needle on. And so our U.S. group is where some of our therapy optimization is going to happen, where some of our early pipeline and discovery work is happening. We have a broad ambition and that's not going to be bound by any geography.
John Simboli:
30:48
What organizations do you find help you to express your ideas and learn new ideas about what your colleagues are doing?
GeorgeGoldsmith:
30:55
Well, I think, just here we are at CNS summit and I think that's a new community for us, but it's one that's been really interesting, right? I think that FasterCures and the group around FasterCures. And the Milken Institute is another one that I find really interesting and valuable. We're just starting now as a new company, so we're going to explore other, different kinds of professional organizations, and so forth, in the United States. So that's where we are right now. It's still early days.
John Simboli:
31:35
The fact that you're located in London, how does that affect access to capital for Compass Pathways?
GeorgeGoldsmith:
31:41
We have an incredibly diverse group of investors and many family offices. One of our early investors was a venture capital fund that actually has, the majority of its money is the pensions, of the doctors who work in the state health system in Italy. And yet we also have about half our investors from the United States. So we have a pretty diverse group. As we're going into our next round of financing , we're going to have more a U.S. traditional biotech funds involved. And I think that'll grow over time. I think because of the somewhat unusual nature of what we're doing ,, we've appealed to a lot of family offices on both sides of the Atlantic.
John Simboli:
32:31
What milestones do you foresee for Compass Pathways that are exciting to you?
GeorgeGoldsmith:
32:37
So I think one of the things we're really excited about is, you know, we discovered what many people have been saying, which is that psilocybin, when provided in a safe, supportive environment actually is a very safe medicine. And our adverse event profile is , pretty much all restricted to the time people were taking psilocybin, the six hours. Certainly, by the day after, almost everyone had resolved,, so the safety profile that we expected is something that we found and that I think is really important for patients. This is safety again in a supported, controlled environment. So we're not advocating for people to take psilocybin on their own or magic mushrooms, because that's a very different environment. But given what we're doing, we found that it gives us a lot of confidence in how we'll be able to help patients.
John Simboli:
33:38
Can you tell me about the training that you do for the therapists who work with the people in your trials?
GeorgeGoldsmith:
33:42
So I think what's really different about psilocybin therapy is that there are therapists. AND This is an area that we're really working hard on with the FDA and the regulators in terms of, what does this need to look like? Not only in terms of how do we think about the training, which now, it's a multi-tiered training. It's five days of roleplaying and work, thinking about what could come up in sessions and how to support patients through that. We have a wonderful platform of videos and online learning. It's about 20 hours for people and then they have to actually have clinical experience in some of our trials so that they get exposed to what this is like in the real world. It's not all just book learning and role play . So that training process has been really wonderful to evolve in our healthy volunteer trial that I just referred to We really looked at two innovations. One was, could we give this substance simultaneously to patients. So we actually had up to six people simultaneously taking psilocybin with one therapist per patient, which is quite different than the two therapists that have been used historically from the 60s with one patient. And obviously we're thinking about cost effectiveness and care and never compromising safety, but looking at how might this be used in the real world. We always challenge ourselves. The size of the problem is so huge. We want to make sure that, however, we're solving it can scale. So that was the first thing we did. And the other thing we did is we actually trained 50 therapists who could witness this psilocybin experience. And that was really kind of part of this model of how do we do research while we build capacity. And that's a core model for us because we're doing something different and we need both. The research and the capacity.
John Simboli:
35:50
That makes me think of the thing you said I think at the end of your presentation yesterday, near the end you said, I'm trying to think about what h ealth c are will look like in, think you said, 2025, 2030.
GeorgeGoldsmith:
35:58
So you know we've talked about the first digital, and I think for those of us who work in mental health, this is an interesting place to look. We have the first digital generation; people who grew up in the internet and didn't know the world before it. We have another generation that's overlaps with that, which is the first medicated generation. These are kids who were on psych medicines from the time they were six. And what we've started to see is they have a different view about medicine and it's this interesting mix of people who are not wanting to be dependent. It's back to that empowerment theme. Right? And so I think we're designing into this world where maybe a different approach to medicine, a different approach to digital tools, a different approach to sharing issues of mental health, where really this world is shifting a bit and I think what we're trying to do is to plant ourselves into what does that world look like? How does it operate? How do people operate? What does peer support look like online? All the little threads that we see. ].
John Simboli:
37:13
George, thanks for taking time to speak with me today.
GeorgeGoldsmith:
37:16
Thank you. I really appreciate the opportunity you've provided. It's been a really special experience.
John Simboli:
37:23
George told me some people see him as a broad conceptual thinker, but he believes in the words of architect Mies, van der Rohe, that God is in the details. A place where diving into facts can lead to a portal, a manhole cover opening into a whole new world.This perspective enables George and cofounder at Compass Pathways, Katya Malievskaia, to build up to a broader vision where they and their colleagues bridge disciplines around a vision of what a world of mental wellbeing might look like. As George likes to say, put the care back into mental health care. For George, it's not taking tablets every day and hoping the medicine will work. It's psilocybin therapy like the way people think about chemotherapy: an agent in the midst of a protocol that could potentially help patients with depression see their lives differently. That could make a world of difference. I'm John Simboli. You're listening to BioBoss.
