Jennifer Good:
0:05
You have to be an eternal optimist because it's a tough business. And by nature, I'm somebody who always thinks we can get through this.
John Simboli:
0:14
That's the voice of Jennifer Good, co-founder, president and chief executive officer at Trevi Therapeutics. Listen in now to my conversation with Jennifer I'm John Simboli; you're listening to BioBoss This afternoon, I'm with Jennifer Good, President and CEO Trevi Therapeutics. Jennifer, how'd you find yourself here at Trevi?
Jennifer Good:
0:36
I'm actually one of the two co-founders of Trevi. I co-founded this company with a neurologist named Dr. Thomas Sciascia. We had worked together prior at a company called Penn West Pharmaceuticals where, the last few years, I was CEO. Prior to that I had been chief financial officer and Tom had been chief medical officer. So that company was acquired and when that transaction closed in late 2010 there was a drug inside of that that we'd been interested in. And Tom had had some interesting ideas from a neurologist's perspective about what to do with that. So I went back down, negotiated it out, and we started Trevi. And so that's how, so I find myself here because I started it and I'm still here, which is a good thing.
John Simboli:
1:16
How did you choose New Haven?
Jennifer Good:
1:20
A a lot of the people I knew that had worked for me at Penn West lived in Connecticut, Connecticut, when I started this company, if you recall, 2010, the world was falling apart and the state was in a very tough financial situation, arguably still is. And so I knew I wanted to go ahead and put it in Connecticut. New Haven was interesting because of the Yale connection. It was on the train line and it felt biotech, you know, biotech-ish. And so I really was trying to think about this company being part of multiple solutions, employing people and being in a community, trying to build some critical mass around biotech and New Haven just made the most sense to me. I have to say it's been a terrific place to build a company. I've had really good success, hiring quality people. I'm on and off the trains all the time. So, I would say the theories proved out.
John Simboli:
2:10
What about this opportunity made you say, this is the thing I want to start. Rather than any number of places you could have gone or presumably places you could have started. What was it that made it clear, this is the path?
Jennifer Good:
2:23
So there was a drug inside of our prior company. It's an interesting drug because it was an opioid, which you know, with all the opioid crisis going on. But it's a new antagonist, which is like naloxone and a kappa agonist. And I had always felt that part of the solution to this opioid crisis was trying to deal with that pharmacologically and being able to get people the benefits of opioids, which is they have very good efficacy and good longterm safety without the baggage of being scheduled and you know, abusable. And so, we need to finish all of our development work here. But that molecule was attractive for that. It was something we knew we had developed a Penn West. And, to be honest to some extent, you know, it's just staying home with what we knew. We had come out of the whole pain world. We knew this molecule. I knew good development work had been done and being just opportunistic. So I didn't go through any kind of sieve of, you know, if I evaluate 50 things, is this the best? It was opportunistic and seemed like the right thing to do. So I followed the path.
John Simboli:
3:22
What were you hoping to achieve here that you might not have been able to at another place?
Jennifer Good:
3:27
I think multiple things. First of all, getting things done, really focusing on the things that matter. I do think small biopharma has an advantage because you're not mired in all the processes and things that you have to have in bigger companies. And so coming here, you're very motivated. You're focused on one, usually one deliverable. You get venture backing, they're very involved with you and you hire really top notch people and you focus down on a problem, a medical problem. I also think that one of the things that Tom and I have talked a lot about here is we really wanted to hire good people and treat them right. And we've had different situations come here where we've had the opportunity to support people at difficult times in their life. We hired somebody who was in a big time of need in their life and sort of taught them a new skill set. So I think we've been able to be both socially responsible but also very locked down, focused on sort of answering these medical questions. And so I would say I'm trying to create an environment here that people are proud of the company. They feel like they're very involved in all levels on building. But you also can do the right things from just an overall societal point of view as well. And we've been very focused. Not to mention the patient groups that we're serving. You know, there's a lot of, always a good focus in biopharma on these huge unmet medical needs and how you can be part of that answer.
John Simboli:
4:45
What's been your experience with whether you can find the people that you want to find here in the New Haven area?
Jennifer Good:
4:50
That was actually, I have to say that's been a pleasantly good surprise. My prior company that I ran was in the Danbury area, which was much more challenging. You were kind of over on that corridor. In New Haven, you're just in a centralized part of the state. People that live in Connecticut generally want to stay in Connecticut. They don't want to move. And so, that's been helpful. And there's been some turmoil at some of the bigger companies here at Bristol Myers Squibb. A lot of people have left. Alexion has moved, and that creates opportunities for small, you know, I always say when things are in disarray, it's sort of an opportunity for things to spring out. I really do think innovation comes and you get an opportunity to go pick off some of these people, have some terrific experience and bring them in a smaller environment. So I have had very good success in hiring the staff that I need and bring them all right in here to New Haven. So that's been, that's actually been a nice surprise. As far as retention, I actually think retention here is easier than what you see in Cambridge or San Francisco because I've heard this from other peers because CEO peers and Cambridge, that these people are hopping jobs every couple of years because constantly getting an incremental $5,000 to do this or bumps here and there. And so people, it's a bit of a revolving door. I would say, people here, they settle in and if you're treating them well and you're doing something interesting, I have not had turnover. I haven't, matter of fact, I haven't had anyone leave me to go to a different company and part of that's we're doing interesting things and I think I'm empowering people to do things. But I do think it's just not that constant competitive cycle of so many companies coming around.
John Simboli:
6:34
What do people say is your management style? What have you found that works for you and doesn't work?
Jennifer Good:
6:41
I have joked to people that I manage my company like I manage my kids. You know, I'm clear about what the expectations are. I'm clear about what the boundaries are, but I generally let people find their own way. You know, in this business and biopharma, you hire incredibly talented people who have a deep skillset. You know, we have a lot of MDs. We have two MDs, we have PhDs, people who have an expertise in quality and commercial. So for me to sit here, my expertise happened to be through the whole finance area and think that I know their job better than they do. I don't. But what I can help them do is understand the vision, help them assess risk. I can help open doors for them, you know, a lot of different connections. I end up sort of being a liaison with a lot of people and thinking about what's in their way. Some people need leaned on. So I don't know, I think it works here because it's a very talented group of people that don't need day to day management. They need direction and they need help, help when they get stuck and when things, you know, things go wrong in this business. And so sometimes being that steady hand in the room. And also I will tell you too, you'll probably hear this from other biopharm CEOs, you have to be an eternal optimist because it's a tough business. And by nature, I'm somebody who always thinks we can get through this. We just, let's put our heads together. I'm also not somebody who has to analyze everything to death because you can't know everything in this business. So you know what you can know, you make your best decision. When things don't work out, you course correct. And so I think bringing that steadiness to the team, because, of course, they don't want to be the person that sort of jumps off the cliff without, you know, but when you say, look, we can't know anymore, so let's make our best decision as a group and if we get more information, we're going to revisit this. And so I'm lucky because I manage a bunch of very bright, talented people. So it's all about setting direction and then just sort of staying on top of what's going on and helping to course correct as we move our way forward.
John Simboli:
8:38
There's vision, which you talked about. There's also courage. What part does having courage play in running and being the top person in a biopharma?
Jennifer Good:
8:47
It's funny. So courage is definitely a big aspect for anybody here, not just the top job, I think. For me, I always view this as I'm in role, I have a certain function. I raise money, I know how to manage a board. I'm good at managing people. It's no more or less than someone running our clinical trials or someone worrying about the commercial launch. So I think for me, I've never try to get too crazy and things because it's all about designing a good experiment, running the right trial, doing the right things. If you never get yourself in any kind of ethical conundrum or you haven't been straightforward with about investors, or our board, look, here are the risks and keeping people informed, things don't work sometimes, you know? And then I think that's when you do have to have the courage to stop programs or you know, say we shouldn't be doing this anymore. There's sometimes you'll end up with people who just aren't the right fit for whatever reason. But again, if you treat them right, that doesn't have to be a bad thing. So I think over time I just viewed this as, that's part of this business model and people that are in this industry understand the risks. So as long as I'm managing and executing well and communicating the risks, that's all I can do. So I don't get too bogged down in getting crazy about the courage and this and that. I'm just here doing my job
John Simboli:
10:08
When someone you don't know, who's intelligent but just doesn't know the, field says what do you do for a living? How to answer that?
Jennifer Good:
10:13
In this role, most people know what a CEO is generally. And so you have to sort of take the evil black cape off of it. And I think people tend to accept that more, particularly when you're in a startup, they realize you're sort of scrapping along. Most people want to understand what medical condition you're working in, which almost everybody can relate to in some way. So I try to always bring this company back to, let me tell you the medical conditions that we're trying to solve, the unmet medical need, people like that. And frankly, when people ask me what my role in that is besides management, I do tell them that, you know, obviously drug development requires a lot of money. So, you know, fundraising is a big aspect of what CEOs do. And so people get that. But I think most people now are much better healthcare consumers so they think about that aspect of it. I wouldn't have said that probably 15 or 20 years ago, but people now are much more educated in that whole world so they understand the role. The piece that people always look at me blankly is that we have no revenues. They cannot comprehend how you survive when you don't have revenues. You don't have anything approved and it's probably going to be eight to 10 years before you get there. That's always the piece where people are like, I don't understand that business model.
John Simboli:
11:20
If you can think back to when you were eight or nine, like for me, I wanted to be a baseball player. Do you remember back to what you wanted to do and does it have anything to do what you ended up doing?
Jennifer Good:
11:32
No, I always had an interest in business. I had no idea in industry and I would've had no idea about biotech for sure because those lights came on when I started out at Ernst and Young, auditing. An at first got put on a bunch of financial institutions, banks, and I remember being so bored thinking, what do you do? Like what problem do solve? Of course money is important, but I didn't realize it then. And I remember going to the managing partner saying, you have got to put me on a company that does something for real because I can't keep doing this. So in that journey I had switched over to high tech biotech and that's when I realized I loved the growth aspect aspect of that and how I could leverage sort of my finance accounting background and into that whole model. But at eight or nine, I don't think so. I was riding my horse and playing sports and doing what young kids do, not thinking a lot about it. I came from a very blue collar family actually. So I would say my world was small, my dad was in construction, we lived on an island, small town. And so my world was small. I probably didn't have a big lens on sort of what was out there.
John Simboli:
12:35
Which new at Trevi?
Jennifer Good:
12:37
Yeah, so really the focus at Trevi is moving along our clinical pipeline. So our lead indication is in a severe dermatologic condition called prurigo nodularis. We've started our pivotal phase three study, that is enrolling in the U.S. We'll get Europe open first half of 2019 and we expect to report out data first half of 2020. So that's a huge focus. We're running this U.S. - European trial in a severe condition. Behind that we're also studying a condition called chronic coughing and idiopathic pulmonary fibrosis. So very severe disease. The number one presenting symptom for patients is breathlessness and really severe coughing that goes with that. It's a quality of life issue. Most of these patients end up dying within three to five years. So it's really all about sort of maximizing their quality of life. We will initiate, in sort of mid-2019 a trial in that condition and report out data by year end. So that's a busy effort as well. We're also looking at a Parkinson's disease indication, Levodopa-Induced Dyskinesia, that we're gearing up for trial that will run in that condition. And we're also looking at liver, pruritis in liver, liver failure essentially. And that trial is underway and we'll get data in the next few months and decide how to move it ahead. So we have four different busy clinical programs that we'll be executing throughout 2019. We have a drug that works centrally and peripherally in the nervous system. We are targeting serious neurologically mediated conditions and so things that sound disconnected really are not disconnected because if you think about the brain to the brainstem, to the peripheral nervous system, things like pruritis, there's a lot of receptors, opioid receptors where we're working in the skin and the nerves to the skin. When you think about cough, there's a lot of receptors in the lung, the peripheral nerves to the lung and they signal to the brainstem, which is loaded in opioid receptors. And then of course we're working in the whole brain area, which is the reward center around pain, around itch and some of these movement disorders we're focused on. So we are focused on leveraging the drug we have biologically in the body to deal with these serious neurologically mediated conditions.
John Simboli:
14:48
When people try to understand what Trevi's about, what do they get right, what do they get wrong?
Jennifer Good:
14:55
I think they get right that our drug has shown efficacy in some very serious tough conditions. So I think people, when they see the data presented, they think the drug's for real. And you know, that's not always a given in this business, that drugs work. So I think we're sort of over that hurdle. The drug we're using is actually available in the market as a subcutaneous injection for severe pain. So people sort of get the biological activity. I think the thing people that I have to spend some time on is people hear the word opioid and want to run for the hills, you know. The opioid crisis is real. I am a big believer that we all need to be sort of part of that equation. But I do think our drug is, because pharmacologically, again, it's this new antagonist which is like Naloxone, Narcan, which most people recognize, and a kappa agonist, which really hasn't been linked to abuse. And so I think what people do is they'll see that word and sort of say, uhh, I don't want anything to do with this. And I think you need to spend a little bit of time and understand the chemistry and the pharmacology to understand that no, not only is this not an issue, I think this is part of the solution.
John Simboli:
15:57
What makes Trevi therapeutics different from other companies?
Jennifer Good:
16:01
So this is all about the science. And I would say what differentiates a company is really all about the drug because we run all these different clinical programs around our one drug, Nalbuphine ER. I think what maybe is interesting, half this company had worked on this compound in a prior company and believed in it enough that we all sort of wrote a personal check to try to move it over here and be able to explore it that much further. So I would say there's a deep understanding of the compound. There's a lot of conviction around, some of the opportunities it may have. Again, this is a science experiment. We have to go test them, but there's a good understanding of the biology, it's a good understanding of the compound and we're moving forward in a very locked down focused way.
John Simboli:
16:46
What kinds of partners are a good fit to Trevi?
Jennifer Good:
16:49
So at this point in time we are not partnering off indications because we want to get the data and sort of reserve the rights to possibly take it to market ourselves in the U.S., so no kind of marketing partners at this point. At some point. I think when we get good data, there could be some very interesting strategic partners. For instance, our cough in idiopathic pulmonary fibrosis. There's companies out there, Boehringer Ingelheim, and Genentech have both developed anti-fibrotic drugs for the lungs. They do nothing to treat the cough, so they're just slowing the fibrosis. So I think they're calling on these doctors anyway. And the fact that you would have something to offer them that could also treat the number one symptom. So I think as we move through this model and sort out which of these indications work, you know, you got to get to the end. I think there could be some very nice strategic partners that are invested in some of these different serious conditions because we're not treating the underlying disease. We are treating typically the worst symptom of the disease. And these are sort of life threatening diseases that these patients are dealing with. So I think who's ever invested in the underlying diseases could be a good partner for us, but we're not there yet. That's probably three years out.
John Simboli:
18:04
As you build the company, what kinds of people are you looking to bring in? Can you generalize about the kinds of people who would thrive here?
Jennifer Good:
18:12
I have built out this company, I would say from the top down because it's the kind of environment that when you all need, we have 16 people now. I mean, I remember when it was five, when you only get a handful of people, you need people who can operate up and down, you know, doing all kinds of activities. So you typically have to hire someone at a higher level who's willing to roll up their sleeves and work. That's not always an easy person to find, particularly people that have grown up in big pharma because it's very siloed. People had a very distinct job description and they're very, extremely good at what they get hired to do, but they're not used to worrying about all the things that can go wrong up and down the food chain. When you come in a company like this and you are the only commercial person or the only quality person, you gotta be able to think about all the things that can affect that. So I would say the person that does well, generally, in these kinds of companies are, you have to be nimble. You can't be wed to a very specific job description. You have to be super collaborative, which sounds obvious, but you know, when you're so small and everybody started criss-crossing, not with distinct boundaries, that can get tricky at times. So there has to be very good collaboration about that. You know, this whole concept of shared leadership here is absolutely critical because again, there's so few bodies that it's all about, people taking pieces and moving the ball down the field. So, I would say, and I don't foresee that changing anytime in the near future. I mean, I think there's really, there started this whole small innovative sector and then you often jump up to sort of big pharma and even a lot of the big biotechs now are just so enormous that you do get people more siloed. So I think in this very sort of small innovative hustling part of the industry, that's the type of personality you need. It's not easy to find it. I'll be honest. And the people I've had to make changes around are the people that just can't keep up with that pace. And there is a constant pressure because there is no hiding in a model like this. You know you have to deliver because everyone can see it when you're not because there's no one else to backfill you. So not everybody likes to come to work everyday and have that kind of pressure either. And I, I appreciate that.
John Simboli:
20:19
Do you ever allow yourself to step back and say, gee, if this works out I could really do some good?
Jennifer Good:
20:26
I would say that's not even in the future. I think from the time Tom and I started this company, we thought a lot about that because I think the two can go hand in hand. I sort of alluded to this about where the company came from. But you know the first obvious thing we're trying to do is treat serious unmet medical needs. So for patients and their families, that's a very serious contribution. I also think that you can hire a group of people treat them well. You know, it's nice when you like your job, you're being treated well and then I can reward people. I've given everybody stock in the company. If this company does well, it can be life changing for people here. So I like this ability to share the wealth. I also think that we can contribute to our community generally, you know, whether it's the state of Connecticut or New Haven, you know, we've tried to be out, be active. I also try to get involved in different biotech things going on here in the community, because I think there is some building that needs to go on. So I would say there's a general commitment here to being good citizens, treating people right, being good citizens and that, you know, within our own state and community and then trying to solve unmet medical needs. So I think that that sort of inculcated into the really the fabric of the company. And there are times that gets tested a bit. You have to come back to things and sort of say, you know, I have an ability to do the right thing here. And sometimes it means, you know, whatever, somebody's got some kind of sickness here that needs some extra time. And you know, I have an ability to do that because we're not so big that I set a lot of precedent. So I try to think about that thing that, that whole concept is I make decisions around where we spend our time and what's important here and how treat people.
John Simboli:
22:07
When you come to work each day and you're dealing with the things you're dealing with, do you tend to see it as, I'm in this space in New Haven or I'm in a space in Connecticut, or I'm in a space in between Boston and New York? Or, I'm in this national or global thing? I'm sure it changes all the time, but what tends to be your focus?
Jennifer Good:
22:26
I would say, generally, for my world, I mean certainly biopharma in the U.S. is sort of an important lens, but probably more sort of in a centralized way. I would probably say I think about our world as sort of Boston to Connecticut and a bit New York, but my role tends to be more this Cambridge . . . again, the trains make that so accessible. I'm in Boston at least once a week, probably. So it's very easy to get back and forth. So I would say I think that certainly Connecticut as my employee world, I would say as our business world, that sort of, it's more focused around I do my board meetings in Boston, etc. But then when you think about funding or sort of broader strategic partnerships. I would say just the broader biopharma industry in the U.S. And we do do things in Europe as well. So there's also disease-specific things. Yeah, I would say our community is sort of Connecticut to Boston.
John Simboli:
23:20
Have you found that being here in New Haven provides the access to capital that you'd like to have?
Jennifer Good:
23:25
My feeling is on that. I get this question sometimes. I don't know that it particularly matters where you are to be honest, because capital, they're going to come find the best ideas. And the first round of capital I got for this company, I was sitting at my kitchen table, you know, working at it. So, I think people do know New Haven. I did get questions from our initial venture investor, should we think about locating in Boston or Greenwich or somewhere else. But it was easy enough to say no, and here's the reasons why and Connecticut's been good to us while we're here. So I don't know that the access to capital, I think that's really all about having a good product idea, a good business plan and, and also having a credible management team that people want to back. Is being here in this building in New Haven . . . Is it the same as working in Boston, in Cambridge, in Francisco? Is your work, your work, your work? Or does it feel different? Well, I really like working here. First of all, New Haven's beautiful. I mean the green, there's, this town is so great. I love shopping and you know, when people come here, I always have people stand in our conference room window and stare out over the green and say, this is such a cool little town. And I do think that's true. You know, I always try to get people out to go eat in one of these fun little restaurants here. And there's so much history here as you know. I do also think that the thing I like about New Haven is you don't have the terrible traffic that you deal with in Boston or New York, I mean it's so much easier to get to. You don't have as much public transportation options, probably, but I think it's just really manageable to get in and out of New Haven. It's also pretty centrally located in the state, so I can pull people from all over the place to work here and they can sort of get here in a reasonable amount of time. So I think it's a great place, especially to start up a company, Lease rates are very reasonable. I mean, I said, why would I pay Cambridge rates for a company that I'm trying to figure out if the product even works at this point, you know, when we started. So I'm really happy being here and I wouldn't look to move the company.
John Simboli:
25:31
Everyone knows about Yale. Many people know about the other academic centers in the state. When you're trying to attract talent, how do you make it clear that there are multiple centers? There's the Farmington/Hartford center, there's the UCONN/Storrs center, there's a Stanford one. There's the New Haven one. Do people know that? Do you have to help them to understand that?
Jennifer Good:
25:53
That's interesting. And I guess the bigger question would be do people care? When I'm attracting talent? I'm not sure. I think more people are interested in the company, what you're doing, what you're bringing, you know, the connection taking on such a powerful one. I do think UCONN has a really . . . I've been up in that Farmington community, they're doing some cool stuff up there. That's why linking I think these institutions together is so important. So I would say it doesn't matter a lot on my business today, but it probably should. It probably should be helped. But there's, there's just not enough sort of synergy there yet to have it be. And I think there's enough different biotech companies here that with a bit of focus and energy around hiring and what can we do to support the growth of your business? And how we help others get started. Some kind of maybe mentoring programs that, you know, that takes a little bit of support at some level because I don't have time to organize the community and you know, I've got a company to run so I have to say I've been a little disappointed because I hear the mantra that biotechs an important industry for this, this state, and I believe it is because it's high paying jobs, it's doing innovative things. You have the Yale, you have the UCONN connection. So I think it's a perfect fit here. So I don't know how Massachusetts did it, but somebody here should be looking at that and thinking about how to continue that corridor down through Connecticut because the pieces are here.
John Simboli:
27:19
Jennifer, thanks for speaking with me today.
Jennifer Good:
27:21
Yes, thank you.
John Simboli:
27:22
Thanks for listening to Bioboss today, and my conversation with Jennifer Good of Trevi Therapeutics. When Jennifer says, "You have to be an eternal optimist," I think of something Intel co-founder Robert Noyce said—"Optimism is an essential ingredient of innovation. How else can the individual welcome change over security and adventure over staying in safe places? Check back each month for fresh CEO insights on BioBoss. And if you haven't heard my conversations with John Houston, CEO of Arvinas, and Erika Smith, CEO of ReNetX Bio, check them out now. I'm John Simboli. You're listening to BioBoss.
