Operating a business means understanding and being able to step into any position within the business and function properly. This will make you both a better entrepreneur and boss.
It was in 1978 when Dr. Hanid Audish’s family made the decision to move to America to create a better future for their children. They lived in New York for approximately 10 years before moving to California, where Dr. Hanid Audish still lives today. He did his undergrad at La Sierra University in Riverside, California, in science and pre-med and went on to medical school at Western University of Health Sciences in Pomona, California. For his residency, he chose to pursue family medicine at Downey Regional Medical Center in Downey, California.
After residency, he and his family moved to San Diego where he took a job as a family practice doctor at a small, primary care medical group for 11 years. During his time there he began looking into clinical trials as alternative care for some of his patients.
Dr. Hanid Audish began working part-time with a research group as a sub-investigator around 10 years ago, and he transitioned full-time into the field of clinical research as a principal investigator approximately five years ago. He focuses a large portion of his studies and research in the primary care arena mainly on diabetes and osteoarthritis.
When Dr. Hanid Audish isn’t focused on work or his CMEs, he’s spending all of his free time with his wife, three sons, and daughter. Dr. and Mrs. Audish enjoy attending their sons’ year-round basketball games and taking family vacations.
Where did the idea for your company come from?
While I was working as a family practice doctor in a small, primary care medical group, I treated many patients with diabetes and osteoarthritis and many of these patients were asking me about clinical trials and research to treat their conditions. Initially, I didn’t encourage it, but I started looking more and more into these trials and discovered that these clinical trials were good alternatives for some of my patients. I had patients that weren’t getting the right results from the treatments they were receiving. For whatever reason, due to the side effects, they couldn’t tolerate the medicine or the medication didn’t improve their condition, the treatment regimen wasn’t working for them.
I began looking into clinical trials for my patients and looking into what it entailed. Eventually I began working part time with Encompass Clinical Research as a sub-investigator. I began to see patients and observe how the process of participating in a clinical trial was beneficial to the patient. It became a small part of my week, but eventually, it took up more of my time and I finally transitioned full-time into the field of clinical research as a principal investigator.
I see the field of medicine now in a completely different light than I did before. Clinical research has become my passion.
What does your typical day look like and how do you make it productive?
I get to work around 7:30 a.m. and my patients are usually ready to be seen, waiting patiently in the exam rooms. Along with the coordinators, who are the nurses, we obtain vitals, we collect blood work, perform a physical exam, and then have a conversation with each patient. This is the most important part of the visit. This is where we discuss and find out from the patient how they are doing on the study medication. All of this information is then entered in specific portals and captured either electronically or in the patient’s chart. This process takes up most of our morning.
The afternoon is mainly taken up with meetings which are held with staff, coordinators, recruiters, and business development staff. Time is designated to meet with each of them to discuss where we are currently in terms of short term/long term goals, what needs to be prepared for, review overlooked agenda items from previous weeks, etc. After these meetings we generally have a clear plan as to the duties and assignments that are needed for the next day, week or month. Training and education is also done with the staff about any new protocols or review current protocols with them and make sure each person understands their responsibilities for each trial. This is a very important part of my job as a delegator of these specific tasks for every clinical trial.
How do you bring ideas to life?
Leading our research team, specifically the recruitment team, in meetings to implement our ideas is where it begins. When we meet with the recruiters, staff members that are responsible for finding and scheduling new patients that qualify for our studies, we’ll sit down and brainstorm on how to notify qualified patients for these studies. Eventually, we come up with a plan that we will implement. Building this team of recruiters with diverse backgrounds is key to the success of launching our recruitment campaign. It’s a collaborative effort.
What’s one trend that excites you?
Within clinical research, there is one disease process that is in much demand—that is the area of diabetes. This illness is a huge disease that encompasses a huge population in this country. Approximately 100 million people in this country have diabetes or prediabetes.
I find it extremely exciting to be able to work with the pharmaceutical companies that come up with these novel ideas on how to treat this condition. Currently there is no one magic pill to target all the issues involved with diabetes. We learn so much about the disease process by doing research. We are constantly learning, through clinical research, more and more about the physiology and the different mechanisms responsible for diabetes. Once you have that information then you can formulate a targeted treatment option and put it to the test by designing a clinical trial.
What is one habit of yours that makes you more productive as an entrepreneur?
I think it’s surrounding our team and staff with diversity. We have staff members that have zero medical background and then we have staff members with only medical background. Having that mixture gives us an advantage when we have to problem solve. We all contribute to the growth and solution of a problem with these unique ideas. Also, maintaining a healthy balance between work and personal life is key. This balance is what maintains energy levels and decreases the stress of day to day work. Finally, keeping things in perspective is important to minimize stress and increase productivity.
What advice would you give your younger self?
I would tell a younger self to continue asking those questions and to continue to follow those answers wherever they lead. Continue to follow that passion and interest in medicine. Do not give up and continue to ask and seek the answers that are the source of this interest. If you don’t give up the reward is great at the end with a satisfying career. I would also tell a younger self to not forget how he got where he is. I would remind him to be thankful and to appreciate the fact that as a second generation immigrant you are able to go to school in the land of opportunity and succeed.
Tell us something that’s true that almost nobody agrees with you on.
I believe there are a lot of people out there who think the pharmaceutical industry’s main focus is to make money and not focus on coming up with new treatment options for patients to treat or prevent disease. Being outside of the industry and now being on the inside I can confirm that the main driving force is to advance medical knowledge and bring forth better treatment options. The pharmaceutical industry is actively engaged in R&D and will continue to do so as long as there are diseases to treat.
The pharmaceutical industry spends millions and millions of dollars on different clinical trials despite over 80% of these trials never advancing to FDA approval. Only about 10%-15% of these trials actually succeed and continue on to FDA approval. The public never hears about these trials, the money spent, the time spent or the effort spent in putting these trials together. Some of the reasons these trials fail may include lack of effect of the study drug, poor protocol implementation or poor study design, lack of continued funding, complicated eligibility criteria, not considering the burden it places on patient’s, poor recruitment efforts, etc.
In addition, the pharmaceutical industry helps many patients who have a specific condition but don’t have medical insurance. When a new drug has been approved and it’s the only one on the market for that specific condition, many pharmaceutical companies develop patient assistance programs. These programs offer huge discounts or even supplying the medication for free to these patients who qualify.
As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?
I think it’s important that as a principal investigator (PI) that you are informed about every aspect of the trial and that you can help in all of the tasks delegated at your site. You need to be able to step in to any of the positions within the delegated tasks and be able to do that job correctly. The PI needs to understand how everything works from a coordinating (nursing) side, a recruitment side, a business development side, a data entry side, and a managerial side. If you need certain information you know exactly where to go to get that information.
One area in particular that I had to learn about was the recruitment part of the industry. This is not something you learn in medical school. Recruitment involves understanding marketing techniques and understanding advertising through traditional media versus social media. Effective marketing for most trials in this day and age, we quickly found out, was through social media. Through the help of marketing companies specializing in research advertising we learned together how to tailor our campaigns for each specific trial. The learning curve was quickly learned.
What is one strategy that has helped you grow your business?
A few years ago we signed up with a research company that assists research sites like ours by locating smaller pharmaceutical companies that are doing trials. This partnership helped us to identify smaller pharmaceutical companies doing trials that we could help do as well. By partnering up with this company, it helped us grow our research site through this awareness to these newer sponsors.
Another strategy that continues to help us grow is the development of a relationship with a local specialist. Building a relationship with a local specialist that may have the patient population for a specific study is a great way to increase referrals to our site for that study. This relationship helps us enroll for the trial, it helps the specialist offer an alternative treatment option for their patients and it offers the patients a chance to participate in a trial that may help their condition. We continue to work with many of these specialists to build and increase awareness for these clinical trials.
What is one failure you had as an entrepreneur, and how did you overcome it?
A few years ago we were doing a clinical trial for patients with elevated triglycerides. Patients had to have a certain level of triglycerides, and if they qualify they could enroll in this trial and begin study medication to potentially lower their levels. When we took the trial on, we were a little overconfident at the time thinking we were going to enroll a certain number of patients for the trial. After a few months into the trial, it became more and more difficult to identify potential patients.
Many patients thought that the trial was to help with high cholesterol, and many did not qualify because their cholesterol was elevated but their triglycerides were normal. It became more and more difficult to find the right type of patient for the trial.
Our recruitment team met and came up with alternative ideas on how to identify these patients because traditional advertising with TV commercials or newspaper ads were not working. This meeting led to our outreach programs and to the relationship building with the local specialists. We were able to reach out to a local cardiologist at that time who had a large database of patients with this condition. He presented the trial to his patients and offered it to them as an alternative treatment option. It translated well because he was able to refer many patients for the study. In the end, we were able to successfully enroll for the trial.
What is one business idea that you’re willing to give away to our readers?
I recently heard about how nanotechnology and how microscopic devices were being investigated to be taken orally to be delivered to distant parts of our GI system like our small intestines. This nanotechnology was being used to deliver the medicinal product. By attaching to the inner lining of the small intestines this device could internally deliver the medication over a period of time. The medication mentioned that could possibly be delivered was insulin. Imagine how this can dramatically change how someone who is on insulin to treat their diabetes and not have to perform any more injections? That would be a major breakthrough in drug delivery, specifically for patients on insulin.
I think designing a clinical trial to investigate this potential delivery method would be an amazing study for a pharmaceutical company. Translating this into a business idea would be complicated but partnering up with the right pharmaceutical company who has the experience and resources can definitely increase the chances of success. These types of creative ideas emerge constantly within the research world all across the nation and all across the world. Putting these ideas to the test in a clinical trial is the ultimate justification for these novel ideas.
What is the best $100 you recently spent? What and why?
One day we had a patient who forgot about his appointment and it was very important that he come in on that day. It was important to collect certain blood work from him on that day. When we got a hold of him we found out that he was about an hour away from the clinic and he didn’t have any transportation. So we decided to Uber him down to the clinic and Uber him back home after his visit. The patient was accommodating and we were able to avoid not collecting that important information.
What is one piece of software or a web service that helps you be productive?
We recently signed up with a company called SimpleTexting. This company allows our recruiters and staff to securely text information and to communicate with patients through a texting portal. By having this service we were able to communicate with patients more frequently, remind them about their appointment or schedule them for their screening visits.
This service increased our ability to connect with patients using a more convenient, less formal way of communication. Most patients have a smart phone that they carry with them most of the time. By replying with their smart phones this form of communication increased the response time from these patients. By having this service we saw a drop in our “no show” rate. Patients were definitely comfortable using this form of communication.
What is the one book that you recommend our community should read and why?
Back when I was in residency, I remember reading When Doctors Don’t Listen by Leana Wen and Dr. Joshua Kosowsky. The book wrote about real-life case scenarios of encounters patients had with their doctors. These encounters eventually lead to a wrong diagnosis or it led to ordering multiple unnecessary tests. The book explains that because the doctor did not spend enough time with the patient it lead to a poor or wrong diagnosis. The book also explains how patients can sometimes not ask the right questions or be too passive during their doctor visits which can also lead to the wrong diagnosis.
What I learned from that book is that spending time to listen to the patient is a very important part of the office visit. In medical school you were taught that you can come up with the diagnosis 80% of the time just by listening to the patient. Listening and asking the right questions to obtain the medical history is key to this. Being able to cover all the aspects of the patient’s medical history, the social situation, considering environmental aspects and considering the psychology of the patient is important during this visit. As a physician you hopefully become more efficient to cover all of those issues during the office visit.
What is your favorite quote?
“Treat the whole patient.” and “Learn the art and science of medicine.”
Learning the “art of medicine” comes after years of implementing the knowledge you acquired during your training. As this experience builds you become better at this art of medicine. The key to this process is appreciating the uniqueness of every individual.
“Treating the whole patient” is considering not only the biological makeup of the individual but also considering the social factors, environmental factors and psychological factors that make up this unique patient.
Both of these principals were constantly taught to us in medical school by our teaching doctors and professors.
● Always treat the patient, not just their symptoms.
● Approximately only 10%-15% of pharmaceutical trials succeed and make it to FDA approval.
● Operating a business means understanding and being able to step into any position within the business and function properly. This will make you both a better entrepreneur and boss.
Steve (Stefan) Junge hails from Germany and helps with the day-to-day publishing of interviews on IdeaMensch. While he and Mario don’t share a favorite soccer club, their enthusiasm to help entrepreneurs is a shared passion.