Craig Eagle of Guardant Health: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

Place greater focus on healthcare equity — COVID-19 was a reminder of how disease disproportionately impacts certain groups, including people of color and lower socioeconomic status. Unfortunately, cancer, which remains a leading killer of Americans, is no different. We must continue to promote more equitable access to healthcare and the latest advancements, including easier-to-perform tests like liquid biopsy, to help democratize cancer testing and make the best treatments accessible to all people.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Craig Eagle, Guardant Health CMO.

Dr. Craig Eagle is Chief Medical Officer of leading precision oncology company Guardant Health, and plays a vital role in furthering the company’s goal of transforming cancer care by unlocking data that can help patients across all stages of the disease. Dr. Eagle is a seasoned executive and respected thought leader in oncology, and prior to Guardant Health was Vice President of Medical Affairs Oncology for Genentech, where he oversaw the medical programs across the oncology portfolio, and before that spent 19 years at Pfizer, including as Global Head of the Oncology Medical and Outcomes Group, where he oversaw the worldwide medical programs and development of numerous commercially successful drugs. Dr. Eagle attended medical school at the University of New South Wales in Sydney, Australia, completed his specialist training in hemato-oncology and laboratory hematology at Royal Prince Alfred Hospital, was granted Fellowship in the Royal Australasian College of Physicians and the Royal College of Pathologists Australasia, and currently serves on the Board of Directors for Generex Biotechnology, MyMD and NuGenerex Immuno-Oncology.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

My pleasure, many thanks for having me. The heart of my backstory, what brought me to my career path, began at a young age. When I was 12 or 13 years old, I participated in a community service program that required me to take first-aid courses, and that’s really where I found my passion — well, two of them. One, was the passion to help people. The course taught me that you can treat people to a point, but once the nurse or emergency medical technician arrived, you stepped away and let them take it further. That made sense and led to my second passion, which is continually learning how to better help people and continuing to understand what’s really going on, getting behind the scenes, learning why we do things and how they can be improved. This was truly the start of my interest in healthcare. In my career today, I still carry these passions. I’m passionate about helping people, and passionate about continuing to learn everything I can, down to the last molecular nuance, to better help people.

Can you share the most interesting story that happened to you since you began your career?

I like to look at my career as two phases. There’s the clinical phase and the industry phase. An interesting story that happened to me took place during the transition between the two. I’ll never forget it, I was still working in the ER (Emergency Room) at the time, applying for my first industry job. I specialized in hematology and cancer, and part of my role in a major academic hospital in Australia was I covered the entire hospital, as the most senior physician in the hospital, which meant you were in the ER. I was preparing for interviews in industry, often at 2 or 3 in the morning, after seeing patients in the ER, having just a moment’s break, when I realized I didn’t really understand certain important things, like regulatory and payer perspectives. As I sat there studying and preparing for these interviews to join industry, and trying to understand these interview questions, such as what’s your understanding of the FDA or health economics, I realized how much of a divide there is between clinical practice and what goes into getting a treatment to patients on the industry side. Having this realization, at 3am in an ER, on my breaks between patients, is a moment that will always stand out to me, a moment that motivated me to better understand and cross that divide, and was a turning point in my career.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

Well, “funny” is perhaps a subjective term, but sure, I can happily share, let’s say a “unique,” mistake I made when I first started and what I learned from it. During the early part of my career, I was working with a cardiothoracic surgeon and part of that involved taking sections of a patient’s veins in their leg and transferring them to their heart for bypass surgery, because they had heart disease. My task was to simply close up the leg while the surgeon focused on the heart. Unfortunately, one time, as I was tying the suture on one of the veins, I tied it wrong and it slipped off, and the vein started to bleed. I put pressure on it and desperately tried to retie the suture but it just wouldn’t work. The surgeon was very adept and experienced, and I’ll never forget, he said, “Relax. Just keep pressure on the leg. I’ll come help you once I’m finished with the heart.” Essentially, I couldn’t carry out a simple task. But because of his calm, deadpan response, I persisted, soon realized my mistake, and figured out how to tie it the correct way. What that mistake taught me was that this was a safe environment for me to learn, and also to fail. I’ve kept that lesson with me through my career, of how to coach people effectively and give them the space to learn and fail. He was a great mentor and it’s a lesson I’ll always remember.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Though admittedly I never had much success in classical literature in school, I’ve always been fascinated by the eloquence of the great writers and thinkers of our time. One of the quotes that I really cherish is from William Shakespeare, from Hamlet. It’s a quote that is well known but one I do value very highly. The quote is, “Give every man thy ear, but few thy voice.” To this day, I take this to heart. To me, it’s a reminder to really make sure you listen, truly listen to someone’s perspective, not just listen to then think about how you‘ll respond to their perspective. This importance of listening is something that has presented itself throughout my career.

Are you working on any exciting new projects now? How do you think that will help people?

Absolutely. Here at Guardant Health, we’re always working on a number of exciting new projects that are accelerating adoption of precision oncology across all stages of the disease — from extending life in advanced cancer to detecting cancer early when it can most easily be treated. One project I’m especially delighted to talk about is our historic ECLIPSE clinical study, which is completing enrollment now. It’s one of the largest cancer screening studies of its kind, enrolling more than 13,000 men and women between the ages of 45–84 from across the U.S. to evaluate the performance of our LUNAR-2 blood test to detect early signs of colorectal cancer in average-risk adults. Our vision at Guardant Health from day one has been to make a simple, non-invasive blood test for cancer screening a reality. We’re starting with colorectal cancer, the second leading cause of cancer death, where screening rates remain lower than recommended due to the barriers of today’s screening tests, including colonoscopy and stool-based tests, which can be invasive and difficult to perform. A simple blood test easily done at your doctor’s office is a game changer, and will help more people get potentially life-changing cancer screening. The ECLIPSE study is expected to support a premarket approval submission to the FDA. FDA approval is so important in making any health innovation widely adopted, and our test has the chance to become the first FDA-approved cancer screening blood test.

How would you define an “excellent healthcare provider”?

Broadly speaking, I would define an excellent healthcare provider as, above all else, putting the health and well-being of the patient first. Doing whatever it takes to improve patient outcomes and balance their quality of life. At Guardant Health, our company values start with putting the patient first, and we collectively try to never lose sight of this. When you are thinking about the unmet needs of the patient, areas where outcomes can be improved, everything else will follow. I believe this to be true, whether you’re a cancer care company like Guardant Health, a pharmaceutical company, an oncologist, primary care physician, nurse, hospital, lab, or any other entity serving patients.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

A few examples that come to mind are healthcare inequity and delayed diagnoses. The COVID-19 pandemic was an unfortunate reminder that disease, cancer included, often disproportionately impacts certain groups, including people of color and lower socioeconomic status. Factors contributing to healthcare inequity during the pandemic included access to medical care, education and income gaps, and housing. Now, there’s a greater spotlight on this inequity and more minds working to change it. While it’s a complex, systemic issue, and there is no magic bullet, just a few of the ways the healthcare community is looking to improve these issues include collecting and acting on patient data, building better relationships and communication with underserved communities, and developing innovative technologies that are accessible to more people, of all socioeconomic status. As far as delayed diagnoses, we saw that the pandemic resulted in many people delaying doctor’s appointments, testing, and screening. This showed the value of innovative technologies, like liquid biopsy blood tests, that help make testing easier and, in some cases, can be done from the safety of a patient’s home. Additionally, many experts predict a spike in advanced cancer diagnoses following the pandemic. We must prepare for this challenging scenario by accelerating the adoption of these innovative technologies, including liquid biopsies and precision oncology, to help expedite noninvasive testing and ensure the best patient treatment.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

Some examples of ways our healthcare system really did well are the use of real-world evidence and rapid innovation. One critical advancement was the growing reliance on the power of real-world evidence (RWE) — enabled by the widespread adoption of electronic health records (EHRs), availability of diverse data sets, and advancements in analytics — all of which allowed researchers to gather data from everyday healthcare settings and collect real insights into disease epidemiology and treatment effectiveness. RWE was essential in understanding and fighting COVID-19, and now as we look to the future, it’s important we expand their use, particularly in fields setback by the pandemic, such as oncology. As far as rapid innovation, we saw COVID-19 diagnostic tests and vaccines FDA-approved and brought to market in record times. Even at Guardant Health, we rapidly developed a high-throughput COVID-19 diagnostic test to address the limitations of early testing options at the start of the pandemic. Though we are an oncology company, we knew it was our responsibility to help. Post-pandemic, we need to leverage more regularly this interdisciplinary, rapid innovation across healthcare verticals.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

In light of the COVID-19 pandemic, here are 5 changes that can be made to improve the overall U.S. healthcare system:

1. Place greater focus on healthcare equity — COVID-19 was a reminder of how disease disproportionately impacts certain groups, including people of color and lower socioeconomic status. Unfortunately, cancer, which remains a leading killer of Americans, is no different. We must continue to promote more equitable access to healthcare and the latest advancements, including easier-to-perform tests like liquid biopsy, to help democratize cancer testing and make the best treatments accessible to all people.
2. Adopt more flexible cancer testing options — The pandemic introduced many industries to remote formats such as tele-health. For advanced cancer patients who have weakened immune systems, visiting a hospital was simply not an option. More flexible testing options, including liquid biopsy, require only a simple blood draw, and with mobile phlebotomy, can be done safely from a patient’s own home. For the general public, COVID-19 prevented many from being able to see their doctor for regular physicals and screenings. Less invasive screening modalities, like blood tests, can help ensure screenings still take place safely and conveniently.
3. Embrace the power of real-world evidence — Real-world evidence (RWE) was essential in understanding and fighting COVID-19, and now we must urgently expand its use, particularly in fields setback by the pandemic, like oncology where enrollment in clinical trials has slowed down and needs to ramp up again. Because RWE represents patient populations in real-life settings, it can accelerate clinical trial execution, elevate patient-centricity, and identify findings more quickly in cancer care.
4. Increase cancer screening to reduce the healthcare burden of late-stage diagnoses — Experts predict a spike in late-stage cancer diagnoses following the pandemic, due to delayed cancer screenings and doctor visits in general. We must reduce this burden by increasing screening rates across the population, which for many cancers remain too low. This can be done with innovative screening modalities, like blood tests, which are easier, less invasive, and more accessible.
5. Adopt rapid and interdisciplinary innovation — The speed for which companies developed COVID-19 tests and vaccines was remarkable. Even at Guardant Health, an oncology company, we rapidly developed a high-throughput COVID-19 diagnostic test, to address the limitations of early testing options, which went on to receive FDA emergency use authorization and help essential organizations reopen. Post-pandemic, we need to leverage more regularly this interdisciplinary, rapid innovation In other areas where there are significant healthcare challenges, including diseases like heart disease, stroke, Alzheimer’s, and cancer.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages? Physician diversity? Burnout?

I think the best way to address that is at two levels. One is more difficult, and that is to increase the number of physicians and healthcare practitioners, and that’s far more difficult for many reasons and there are many incentives to do that, and I’m very much a believer in carrot incentives. When you get a lot of burnouts, that’s people saying, don’t do the profession. How do we manage burnout and make these professions interesting and desirable and compatible with work life balance. The other way is redistribution of empowerment to take care of your help. No one has more interest in your health than you. And so how do you get empowered to manage your health. And I think that’s one of the important lessons I see from COVID-19. If you think about it, the healthcare profession was burned out because of the acute demands of COVID-19. But in fact, we’re all accountable for going to get tested for it. That widespread adoption of a test out in the community. There’s no way we could have dealt with the pandemic if we kept traditional modes of testing, where brand new diagnostics are ordered by physicians only, after you visit the physician and then the physician assess is the diagnostic appropriate. The same goes for vaccines. We’ve started to shift vaccines delivery without the gatekeeper of the medical profession, so that’s taking workload off the profession, giving them back some of their work life balance, allowing them to focus on those who really need their help. Sadly, the tools for greater “self healthcare” aren’t that great. We are seeing at the moment the impact of limited healthcare tools, with the theme of vaccinated vs unvaccinated. As far as physician diversity, improving that is extremely important. Physicians treat diverse populations and they should reflect that. There’s unfortunately a socioeconomic filter as far as those who can access education, in line with the socioeconomic bias in the country. What I think we have to do is stem it back to the feeder as far as healthcare practitioners, the initial filter, at the education and access level.

What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

Part of the reason healthcare is so complex is that it’s not only about innovation. You have the

added complexities of proving the clinical utility of your innovation, in our case our blood tests, to improve healthcare outcomes. Using our tests as an example, this requires conducting the necessary clinical trials, amassing clinical outcomes evidence, gaining regulatory approvals, and reimbursement coverage, and more. We have known this from the start and we’ve approached all of our products systematically with these barriers in mind. But the fact is that no one company or entity can do it alone. To manifest the changes mentioned above, we as members of the healthcare community must join forces to rewrite a better future, continue to learn from these challenges, whether it’s the COVID-19 pandemic, the ongoing fight against cancer, or tackling other diseases.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

This one’s easy: cancer screening. There’s an age-old saying which I think helps explain it nicely.

“An ounce of prevention is worth a pound of cure.” The more we can shift to earlier detection, the easier it is to treat it. With most cancers, when you can catch them early, you can go in and destroy the cancer, and you’re essentially cured. Improving screening rates changes the whole landscape of cancer. We are at the 50th anniversary of the war on cancer and yet still too many people are not getting the necessary screening to catch cancer at this early stage, when it’s most treatable. In colorectal cancer, for example, 1 in 3 adults are not getting the recommended screening, even though the 5-year survival rate for people who detect cancer early, at localized stage, is 90%. We must inspire a movement toward more cancer screening. Plain and simple.