An Interview with Dr. Chien-hsiang Tang on Genomics Era: Three Major Biomedical Challenges in Taiwan

The hottest topics of the global biomedical industry include immunotherapy, liquid biopsy, as well as the Next Generation Sequencing Technology (NGS), and companion diagnostics. Many experts and scholars believe that NGS will replace the traditional Sanger sequencing, and become the mainstream of the genetic testing market due to its advantage of high quality and low price. Is it really so? How can Taiwan assemble its domestic resources and promote the excellent R & D capabilities to the global market? It is with a great honor to interview the director of scientific research of Libo Health & Medical Corporation (Libo Health), Dr. Chien-hsiang Tang (唐建翔), who will share his recommendations with us through his own observations of the industry.

How should Genetic Testing be going? Just follow the Medical demands.

In the post-genome era, the biotech industry generally agreed that NGS will replace the traditional Sanger sequencing both in acuity and density, and a complete genome sequencing analysis can be obtained for only 1,000 US dollars for the mass market, thus, one after another all invested in NGS and genetic testing related fields. But now, the price of companion diagnostics is still unattainable, and NGS also has not yet replaced the Sanger sequencing completely. In consideration of this, Dr. Tang thinks it’s better to find the true essence of NGS applications from the needs of the patients and the physicians, rather than waiting for the bright future to come itself. Therefore, Dr. Tang choose to get involved from the perspective of pathology, and set up a laboratory under the molecular pathology department in the hospital to commit on assisting physicians on clinical treatment and diagnosis.

Besides to find the demand side, Dr. Tang also realized that there are often 300-500 gene items in the genetic testing panel, if a patient has to ask a physician one by one, it’s difficult for a physician to explain those outside his/her own specialty, thus not only it would delay the medical treatment time but also confuse the patient. For that reason, even though major international pharmaceutical companies all have cancer panel products, do patients really need as many genetic testing panels? For patients and physicians, the NGS services for actual medical testing should be developed based on their medication and treatment needs to save unnecessary analyzing time.

Other than that, the popular immunotherapy, such as PD-1 has about 20-30% effectiveness but very expensive, is not affordable to many patients, while they would also consider whether to spend so much money? When the patients consult their physicians, the physicians would also struggle as the treatment is very expensive while many clinical cases in Taiwan showed immediate side effect such as edema or liver failure. Hence, it is essential for physicians to screen the appropriate patients for certain treatments through the use of new detection technology to improve the therapeutic effectiveness, as well to ensure the patients.

NGS still remains “non-mainstream”, and the price is the key!

Dr. Tang indicates that NGS is a very good technology, yet many applications have not become the mainstream of the market, it is difficult to popularize due to its “high prices.” It is a real pity that such a good technology cannot be widely used.

In order to overcome the pricing issue, Libo Health laid out an all-in-one industrial chain to include design, manufacture, and development to cost down to a reasonable price range which physicians would be willing to recommend the service to their patients. Some banks and venture capital firms have told Dr. Tang that “such action would undermine the market price.” But Dr. Tang indicated: “Whether it’s the 1st or the 2nd generation sequencing technology, the developing cycle is about five to eight years, so when the market price is destroyed, it can actually accelerate the development cycle, and catalyzing the evolution of the NGS era.”

Pricing down not only can benefit physicians and patients in hospitals, but also can help units, such as rare disease centers, that lack of resources to subsidize treatments or testing costs for patients. Recently, Libo Health and Taipei Veterans General Hospital (Taipei Veterans) are applying for a cooperative research project, hoping to focus on screening rare diseases and metabolic diseases for newborns, as well as 29 most commonly seen and curable genes, in order to benefit more people in need. “Many genetic testing companies had contacted Taipei Veterans earlier, but all got turned down due to the overpricing. This is why I emphasize on pricing, as it is the key factor to determine whether it can be widely applied to patients,” Dr. Tang mentions, the U.S. has the same pricing issue just the same as Taiwan, but the insurance coverage often pays off the costs, so genetic testing can be easily popularized.

No insurance and healthcare insurance pay for such costs in Taiwan, patients have to take the testing at their own expenses. However, there are many insurance companies contacted Libo Health recently, Dr. Tang said happily: “this is great, because we all want to lower the price, and provide concentrated effective information for medical use, then have the insurance companies cover the costs for patients.”

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Vela Diagnostic of Singapore once remarked: “the biomedical industry in Taiwan is quite outstanding as it has plentiful and inexpensive human resources, it can definitely boil a good pot of soup.”

On the other hand, as Taiwan lacks of the “market”, the genetic testing companies should look into the global, assist the physicians to turn their rich treatment experiences and sophisticated skills into genetic testing products, lead Taiwan into the global markets, while draw the cash flow back, in order to have a positive circulation for the local medicine and research industries, “and this is the principal of Libo Health at the moment,” said Dr. Tang.

People often heard rumors like “China has the cutting edge genetic testing technology” or ” genetic testing in China wins over Taiwan”. Dr. Tang takes to Libo Health as an example that though Libo Health has not yet been in China for long, it has marketed into the top tier hospitals already, due to the credibility of genetic testing skills of Taiwan, so we really shouldn’t underestimate ourselves. He also encouraged: “despite the large market therefore a great number of genetic testing companies in China, the performances of those companies are very uneven, and for this reason, we should seize the opportunity to apply our R & D capabilities onto products and export them to China. This would be a good chance to lead transformation of the biotech industry.”

As for developing new drugs, genetic testing not only can support on R & D, but also can implant the existing advantages to open up a bigger market. Libo Health is currently discussing with 2 pharmaceutical companies about RNA fusion as fusion has always been the blind spot of NGS, but we have made a breakthrough on the fusion technology last month, and now have the ability to perform a fusion detection kit. “Thus I believe Taiwan can make a breakthrough in the NGS field as there are very few companies in the world perform fusion kit with NGS, or available with a very expensive price. I think we can make it with the human resource and the capability of Taiwan, but we need to look for a bigger market to promote more diversified developments” Dr. Tang indicated.

The Three Challenges of Biomedical Industry in Taiwan

Dr. Tang pointed out that there are three challenges to the development of biomedical industry in Taiwan. The first is that there are limited bio-informatics personnel. Though this is a global issue, Taiwan has actually started to promote bio-informatics personnel training long before biotech industry became popular. As bio-informatics requires multidisciplinary students, it’s a pity that many college students had no clue about how multidisciplinary would play in their later career planning, therefore, many were never properly guide to the genetic testing field during college.

Second, the biggest obstacle for Taiwan is that the market is too small, yet too emphasis over the in-island competitions. It is recommended that the industry to work together to develop a larger market, to conquer all with our technologies. Dr. Tang compared the United States, China and Taiwan, and found that the U.S. has a rather completed insurance payment system; therefore the NGS technology can be used largely with companion diagnostics, and also very popular among medical industry. In contrast, without insurance payment to back up, only large hospitals are willing to accept. Then it is another case in China, as the genetic testing technology is over popularized, but the level of testing companies are uneven due to asymmetric information, so the hospital acceptance rate is low. With all the above being said, the U.S. has the most mature market, and Taiwan is most suitable to develop the Chinese market as we share the same historical background, as well as that 1st tier hospitals, such as National Taiwan University Hospital and Taipei Veterans General Hospital, have the capability to update the technology as fast as the U.S., so that technology from Taiwan can definitely be trust in the Chinese market.

Finally, the integration of big data, though Taiwan has its own genome project, and the case is collecting fairly smooth, but it still cannot be offered to even more companies, thus cannot exert the advantages of data sharing.More importantly, the genome project is designed to collect all the genetic information in Taiwan, but as it is lead by the government, so the specifications of case collection is also drawn by the Government, for which, Dr. Tang suggested that the Government and the industry should decide on the theme before collection, so the rich diverse ethnic genes won’t be wasted.

Brief Introduction of Libo Health & Medical Corporation

Founded as a cancer molecular diagnostic laboratory, Libo Health has established a gene database for tumor mutations, and also established the CAP International Accreditation Laboratory. It has successfully developed a variety of cancer target drug treatment and detection reagents, and also discovered the world’s first indigenous tumors Drug resistant mutant gene, which can be used as an important diagnostic target marker. It also plans to develop a high-end stem cell storage and immunotherapy technology as well as develop a complete functional health food and functional medicine, with the goal of targeting and developing targeted cancer screening and research based on tumor molecular diagnostic technology. Libo Health leads toward preventive medicine and cell therapy as a blueprint for planning to play a synergistic effect for the benefit of the people and create “value chain” type of medical services.

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