Small is the new big: My gestalt moment at BIO

When I first arrived in Chicago for the Biotechnology Industry Organization (BIO) conference in May, I couldn’t help but feel small. The buildings are taller than in Boston, but I felt especially small inside the gigantic conference center. The ceilings were far overhead, and the walk across was marathon-long. The number of attendees was over 15,000, an ocean of people. I felt further diminished by the keynote speakers, who included George Bush, Bill Clinton and Al Gore. I’d like to believe it was BIO’s lobbying clout and the sway of the scientific industry that attracted these politicians.

Our booth representing Children’s Hospital Boston, eagerly seeking partners to develop our technologies, was among the smaller ones at BIO, ants to be squashed by the larger booths with premier locations: “Take our swag! Admire our heights and colorful plaster!” Feeling my smallness, I was reminded of the smallness of our patients, our tiny NICU infants in particular. They are the suns of their families’ universes, arguably our most important citizens, seeds of the future. At our hospital, small children captivate the time, thoughts and energy of the world-renowned doctors and researchers who could just as easily could be using their gifts elsewhere. They are the driving motivation for all of the inventions my office processes, and for many of the philanthropic and investment dollars that come our way.

Many of the conference sessions I attended also celebrated the small: namely, nanotechnology. In one session, “Hard Science in a Soft World,” a speaker suggested that one solution to realizing the potential of stem cell therapies was to change the surfaces of traditional implants at the nanoscale, roughening them to help cells attach and integrate. At another session, a company called Nanosphere described its biomarker detection platform technology, featuring gold nanoparticles one ten-thousandth the size of a human hair.

I began to think, maybe small is the new big.

Another reason this may be so: lately, in the office we’ve seen increasing industry interest in orphan diseases, or unmet medical needs affecting only a small number of patients. These diseases, once overlooked by industry, are now being viewed as a way to obtain 100 percent of market share, enjoy a streamlined FDA trial, and charge a premium price. Companies such as Biomarin are forming new business models to reap these benefits. At the same time, more and more “big” drugs are turning out to work in only a small subset of patients, steering even supposed blockbusters to narrower applications. In fact, the increasingly common market entry path involves identifying small numbers of patients as responders to a therapeutic through the use of biomarkers. An abundance of sessions at the conference focused on the necessity to stratify patient populations into responders and non-responders, aided by a companion diagnostic.

At BIO, my new frame of mind was confirmed on the last day when Stephen Hernan from Neuroscene, a pop-science series of podcasts about recent findings in neuroscience, visited our booth. I asked him how he managed to attract listenership. Easy, he said: He took the initiative to call some well-known scientists. “It doesn’t matter who you are,” he said, “It just takes the right attitude. You’re not that different from Al Gore, or any other celebrity.”

I felt newly empowered by being, in so many ways, the agent of the small, and inspired to accomplish something with my own smallness. Big conference, big city, big booths. Small booths, small patients, small diseases, small technology. Bigness isn’t everything. Maybe small is beautiful.