Abdullah Baaj, MD, PharmD - Founder and Chief Executive Officer of Boston Oncology

What is the mission of your company, Boston Oncology?

We started Boston Oncology when I was in Medical School, sometime between the second and third years. There is one overriding mission for Boston Oncology which is to produce cancer medications in developing countries. It is important to not only provide drugs for the people in these countries but to also transfer the technology so the people in these countries can become self-sufficient. It is also important to point out that we are striving to meet these goals as a for-profit company, instead of a non-profit company. Even though we would like to provide the medications, access, and technology so that these countries are self-sufficient, we do it as a for-profit, which we believe is a more sustainable method for both the people of the local communities and for the people working on this project.

How has Boston Oncology grown and changed over its lifetime?

Since the company started, one major change has been the type of product that we are involved in. When I think back to my second year of medical school, the bulk of Cancer medicines at the time were broad chemotherapies, and now the major portion of medications are either targeted therapies or biologics. These a totally different way of producing and delivering medication, and require different strategies for production, stability, and compliance with domestic and international standards.

The scope of the company has also changed, initially we focused solely on cancer treatments, and now we include supportive treatments for cancer patients. Initially, we hoped to be in one or two geographies, but now it is within our grasp to be in double-digit geographies and multiple continents.

Why did you choose to focus on cancer medications?

I studied pharmacy before medical school, and I was always attracted to disease states that include compromised immune systems. I worked a little bit in HIV, I absolutely loved the infectious disease block. Oncology brings together this interest, plus it is at the cutting edge of technology and research. It was a decision born of interest rather than business or marketing.

The goal of starting a company that navigates the approval, distribution, and manufacturing of modern cancer drugs across the globe seems like a highly complex, if not daunting, goal for a startup. Who were the key stakeholders in achieving success?

You are right, this was a daunting challenge. I think I was foolish enough not to think it would be this daunting when I was in medical school. If I knew then how much work it would take, I’m pretty sure I would have chosen something different. In a way that ignorance was bliss. That lack of knowledge allowed me to continue on with this lofty goal. The number one stakeholder we interact with is government regulatory agencies, usually FDA counterparts. We also work a lot with research-based or university hospitals, where our patients in developing countries often get care. We do not get a lot of direct contact with patients. They are a stakeholder but not a direct one for our company. This changes with geography and private vs. public insurance subsidization. In locations where payments are typically out-of-pocket, we deal more directly with physicians and patients as our direct clients. We only have one or two countries like that. The former is the more common model.

This company was formed back in 2006. How many drugs have you registered and provided to patients?

There’s a common list of products in cancer. Old chemotherapies focus on trying to kill the cancer before we actually kill the patient. That’s one kind of medicine that we’ve registered. And more recently, we’ve done a lot of targeted therapies, like tyrosine-kinase inhibitors, such as Gleevec. There are even newer ones that we’ve registered and delivered that are biologics such as Rituximab. And this is just in cancer.

Overall, I’m not sure how many - maybe over a hundred. What’s more fun for me is to think of the different categories of products than the number of medicines we’ve distributed.

In reaching patients, our goal is to reach a billion people. I’m not saying we’ve done so successfully. Currently, we have gone over 200 million people, and we continue to go to new countries. Ultimately, our goal is to impact a billion people.

It’s clear that you’re involved in the drug development process. How does your medical and pharmacy background play a role in your startup venture?

It was invaluable. It gave me confidence to sit down with any physician or physician group, any MOH (Ministry Of Health) official, and to approach every decision from a clinical perspective, in addition to, and rather than purely from a business perspective.

So like I said in the beginning, we definitely are for profit, but with everything, the starting point is always either clinical or scientific. Having that background––I cannot value my medical education highly enough. And by the way, I worked very hard to actually obtain it, because after pharmacy school, I worked in a biotech company. I could have continued with a very nice path. But I just didn’t feel complete without a medical education. For anyone who’s interested in healthcare, irrespective of how you use your MD degree, there is nothing that’s more valuable than getting the education, understanding the perspective of healthcare personnel, and, more importantly, the troubles and the agonies and the suffering of the patients, so you can actually become successful. And I don’t mean to sound sappy, but it’s really true.

You mentioned that you did not pursue a residency. Could you talk through that decision?

That’s true. Probably one of the most difficult decisions of my life. To this day, I think about that decision, and oddly enough, there isn’t a single month where I don’t have some kind of dream, whether good or nightmare, about having not applied to residency. Or, I missed my Board, or I missed my application deadline, or I did not match. Even though that’s ten years in the rearview mirror, I still have nightmares about it. I would say, equal to the medical education––and, in fact, to activate your medical education––you absolutely must do a residency. You have a 10,000 level higher understanding of medicine and everything that goes into medicine if you do a residency. It’s really the very very rare circumstances where one should not go to residency, and the decision should be so immensely tough that you truly have nightmares about it the rest of your life like I do right now.

I’m not saying I regret it, but I’m saying that it was a very difficult decision at the time and what I’m describing as the “extreme situation” was my case. We put a business plan together, we spoke to investors, we asked for a handsome amount of money––or what we thought at the time was a handsome amount of money, double digit million dollars––to start up the company, and somehow, enough people were fooled to invest in the company. So by then, you’re committed to the vision, you can’t bail out. But I’ll tell you, to this day, I think about that.

To anyone that reads this, I cannot recommend, insist, advise highly enough on doing your residency. You just understand the world of medicine so much differently.

So besides that, do you have any other general advice for future medical professionals?

There are many ways to answer that question. I hate to be the person that gives those deep philosophical answers, right? So to keep it practical, there is nothing more important than actually doing work everyday versus thinking that something is going to happen in a single second that is going to open all the doors for you. What you find out in life is that showing up everyday in the path that you want to go to ultimately opens all the doors for you. And you just never know which step, or during which day, that door opened. So you actually have to be there everyday. So you really have to show up everyday.

Now, something more concrete to medicine, I would say everybody should somehow engage in entrepreneurial activities. The world of medicine, the world of business, the world of professional work is changing whether you're an engineer, a pharmacist, a doctor - even 10 years ago, all of those fields were different than today. And to think that you are going to go to any of those professional schools, and practice like people who went to school as recently as 1995, and 2000, and 2005 is just sure fallacy. That’s just not going to happen. So you need to have additional skills, not just to survive, but to lead and to have an impact and to get the satisfaction and sub-satisfaction that most of the very highly respected people that are in medicine usually seek. You need more than what's traditional and from my perspective, all of the people that I know and respect have some sort of entrepreneurial spirit, even if they go into academic medicine. If you think of some of the physicians at MGH that go and start non-profit organizations and certain treatment clinics in Haiti and other countries, that's very entrepreneurial. There are so many more avenues open today than the traditional medical pathway.

Thank you so much for taking the time to speak with us this morning.