Dr. Johannes: Once I left academia, I also wondered if I could ever get back ? Would I ever be qualified? Would I ever? I hadn’t been publishing. I hadn’t been doing research, and I wondered if I would be able to come back. Anybody who’s listening has that same question, I guarantee you 100%. Yes. You can always come back.

Dr. Venable: Welcome to the Veterinary Cancer Pioneers Podcast, the show where we delve into the groundbreaking work of veterinary professionals who are dedicated to advancing the field of veterinary oncology. I'm your host, Dr. Rachel Venable, and I'm thrilled to embark on this journey with you. This episode is produced and brought to you by ImpriMed, pioneers in an AI driven precision medicine for veterinary oncology. ImpriMed’s personalized prediction Profile helps you make confident treatment decisions for canine lymphoma and leukemia patients by predicting how your patient will respond to multiple chemotherapy protocol options. Learn more at imprimedicine.com. That is imprimedicine.com.

Dr. Venable: Hello and welcome to the Veterinary Cancer Pioneers podcast. I’m so excited today to have our guest, Dr. Chad Johannes. He’s really worked the spectrum of different oncology jobs. He’s gone from practice to academia. And in fact, right now he’s the Associate Professor and Executive Director of the Veterinary Teaching Hospital at Colorado State. He also developed the oncology program at Iowa State. Before that, he was even a medical director at Aratana Therapeutics, and he helped to coordinate the launch of Palladia with Zoetis. And so really excited to hear how much he’s done on all the different levels and changes. So really has done so much in oncology. And Dr. Johannes, thank you so much for being with us today.

Dr. Johannes: Thank you. Rachel. Thanks for having me. I’m excited to be here and share my experiences.

Dr. Venable: So thank you. And so you have done so many different things that I would love to hear kind of how you’ve gone about all those. But to start, I always like to ask people how they got into veterinary medicine or, essentially, oncology.

Dr. Johannes: Yeah, I guess a long story short, I grew up in a small town Nebraska and raised rabbits. My family showed rabbits for probably most of my elementary school through vet school. I probably knew in high school that I wanted to be a veterinarian, probably early on in vet school. I wanted to be a specialist, didn’t know what route to go to get my internship here at CSU. I really enjoyed specialty medicine and kind of got immersed in that experience as you do as an intern. But I always had this dream of owning my own practice. Back home in Nebraska. So I actually took a year off, and worked in a large primary care practice in Lincoln, Nebraska, thinking that someday I’d want to own my own practice. I knew pretty quickly that I missed that specialty aspect, and a year later went and did my medicine residency at Missouri. At the time, I did internal medicine. That was, the late 90s, and oncology was a fairly new specialty, and there weren’t a lot of oncologists. And so you wondered, would you get a job? It’s kind of strange to think that now when there’s 100 openings, literally on the ACVIM job board, but, at the time, he didn’t know, so I did internal medicine, thought about doing a second oncology one after that, but realized I needed to pay our student loans. So, I did internal medicine, for a bit until I found my way to corporate and launching Palladia, and then I knew I wanted to do oncology only. So I went back and did my oncology residency at North Carolina State.

Dr. Venable: That’s awesome. I know you kind of got a good mix of everything. hearing you showed rabbits. I’m from the Midwest as well, actually. We were just out there and saw the fair and for sure everyone was doing rabbits and their cows. So I just love those classic things. Were you 4-H? just out of curiosity.

Dr. Johannes: Yeah, lots of years of 4-H, and lots of years at county fairs and state fairs and, yeah, it was fun. I don’t miss the heat and it was fun. And you get the initial experience that motivates you to go out and do what you have to do to go to med school.

Dr. Venable: Yeah. I just love those memories. Because again, I shared a lot of those being from the Midwest and just going back, it was pretty nostalgic for me. So love all, love all those things. Now with the launch of Palladia, I guess, how did you… so you were in academia, you’re doing training in private practice. What made you go to industry? Or I guess maybe my real question is for people who maybe are getting tired in clinics or just wanting something different, how did you make that step or what would you recommend for those people?

Dr. Johannes: Yeah, my story is some internal medicine. I worked for two years in the state after I finished my residency as a clinical instructor. Made the jump to private practice in Kansas City, which was great. It was a busy practice. I don’t think I had… if I had not learned those things that really help you manage your life. And keep that balance. I got really burnt out in practice and to the point where I did not want to be a veterinarian, and that scared me because I was only four years out of residency. And so I searched online, and I saw that a pharma company was looking for an internal medicine specialist. I connected with, recruiter, who informed me it was Pfizer at the time. And they were launching two new drugs, which happened to be at the time, Cerenia, and Solensia. And they wanted, internal medicine specialist on board. And so she coached me. I flew to New York, my first time in New York City, for a one hour interview. And, that began my adventure in corporate. And I spent the first two years traveling around the country, probably visiting about 300 practices over the course of two years. I would usually fly out on a Monday and fly back on a Thursday and have 7 or 8 events a week while we were out there. We did a lot of speaking on Lepto vaccine and Cerenia, vomiting, cascade, all those good things. But that was my first, kind of an experience with drug development, with drug launch. I fell in love with serenity. all the initial data was. It was so positive. And then you got it in people’s hands, and you saw how well it was working. And it was just a great experience to have. For about two years, I got really burned out while traveling. Because travel is great in a lot of parts of the country, new places, I’d want to consider living, and the places I would never want to live.

But what it helped me, kind of shaped what I wanted to do. And Pfizer at the time had a need to launch Palladia. They thought it was going to be easier to train a specialist, to be a marketer then, than a marketer, to understand the specialty market. So even though I wasn’t an oncologist, I was an internist. I knew I had an interest in oncology. And I made the move to New York to launch Palladia. So I think that you have an interest in pharma and going that route or going in industry, really talk to those that are there, and get their experience and get their stories and what they what’s been challenging for them. So I think it’s important to know that before you make the jump and then sometimes it’s hard to break into that industry kind of network sometimes. And so connecting with those that are there as well as I found, having a recruiter that had those connections was really helpful actually in both industry I pharma jobs, I had my recruiter make those connections and that helped facilitate things. And then once you’re in and you have that network, then just the natural ebb and flow of where people move, and what positions they take at other, other companies, your network continues to amplify exponentially. And then you have a network where the opportunities become somewhat, endless, on route, you could go within industry, which is really cool. Sometimes breaking in can be difficult and so I think having those connections to those that are there and hearing their experiences, as well as having a recruiter were my avenues.

Dr. Venable: Now a recruiter certainly makes sense. And I feel there’s more and more out there. I always see things on LinkedIn. Right? They always want to connect. Yeah. So there’s a lot of them out there. So that’s a great resource for people. The other thing, hearing your story, it sounds like you really took a lot of bold moves. Pretty brave going from, being in practice what you always imagined doing, not liking it. So taking a huge move in the industry, traveling, moving to New York, would you say that just kind of changing it up really made a big difference for you? Or is that something if people are feeling kind of stuck, maybe they just need to take a step out and change it up?

Dr. Johannes: I was maybe, I’m not a millennial by, date of birth, but maybe I was a little more millennial than my parents, and some of my mentors would have liked me to be, because I maybe moved jobs more frequently than they would have, thought was wise at the time. What I found for me is I had to be someplace that I felt fulfilled, connected, I was continually growing. And if that wasn’t happening, it was hard for me to be engaged. And I had to find something that worked. And I think when I landed at Pfizer, that was the first time that I felt, wow, this is… I love this, this motivates me every day to get up. It’s different from practice, but yet it’s still better medicine and the other side of better medicine.

And it was so informative and educational to see that mad from the other side and understand the business dynamics of it. Understand how academia, industry practice all and that was when I started Pfizer in 06’. That was a time when the corporatization of vet med was happening. So there were a lot of things kind of in motion at the time. And so I just think that having that experience just really changed who I was as a clinician. When I went back to practice, I think it was a different, and hopefully better clinician. I definitely have learned how to balance my life and my time and be more efficient. And, I think for my residents, be more engaged in helping prepare them for what they were going to see down the road.

I remember when I went to, Pfizer in 06’, a lot of my friends were oh, you went to the dark side? And oh, how could you? How do they practice? My mom wondered how I could spend X number of years, and, all my steps of, training that we all go through to not practice. Because in her mind, if I wasn’t practicing, I wasn’t really a veterinarian. But when I left Pfizer in 2010, many of my friends were asking, how did you get your job? What other opportunities are there? I just think that doing you and doing what motivates you, is important. And what my kind of movements, a lot of my career helped me do is give me the background. I think, to be successful where I’m at today gives me a different perspective on things that I would not have had, about. I never thought I’d leave academia. I never thought I would be back, yet I can 100% say the best thing I ever did was leave academia, get all those other experiences, and then come back. You can have a much different perspective. I think more I would have had if I would have just kind of stayed here.

Dr. Venable: So what you said about not wanting to leave academia, I have, now there is a shortage in academia, and you are one of the few that have gone from private practice back to academia. What is it about academia that you like so much?

Dr. Johannes: Yeah, it’s a good question. I think that once I left academia, I also wondered if I could ever get back would I ever be qualified? Would I ever… I hadn’t been publishing, I hadn’t been doing research, and I wondered if I would be able to come back. Anybody who’s listening that has that same question, I guarantee you 100% yes. You can always come back. You may have not been doing bench researching, may have not been doing, publishing a lot of papers. But what you have been doing in your clinical life is hugely valuable experience and is greatly needed in the university. And it’s not a new challenge. It is an ongoing challenge, but it is becoming amplified. The challenge of recruiting and retaining faculty members in academia. And, I think when I went back to Iowa State and, after my time at Aratana, I think what kept me in academia and what interested me in pursuing here, my current role, and leadership is there’s a lot of challenges for the academic environment. And the whole vet industry has changed a lot in the last 20 years, but academia hasn’t. And this is just an and across the board has not clinical academic practice has not kept up with those changes. And now we find ourselves in the spot where if we don’t make some pretty significant changes, we’re going to become a relic. Really not meeting our students' needs, not meeting our residents' needs, and I mean our patients' needs. And so I think what drives me here, as you can see from my CV and all the job changes, I like building things. I like growing things. That’s why I went to Iowa State. They were one of the last better schools that did have an oncology program, didn’t have radiation oncology. They had the resources to invest in it. And so it was a natural fit. It was close to home. What what I find is that we have to think outside the box. We have to be creative on how we’re doing things. So, we're looking at it is not. Yes. The salary gap is there. Depending on the specialty it’s wider for some than others. Universities are not going to consistently ever compete at a private practice level or a corporate practice level on salary. We have to build positions that people want to do. And I think what academia is realizing is trying to ask every clinician to do the traditional three and one teaching, research, clinics.

It’s a rare person that can do all three of those buckets well and enjoys doing them all well. And so tailoring positions that, someone wants to be high tech, high clinical, let’s build them clinical on their roles. If someone wants to do heavy research and teaching, let’s build those roles. And that’s really what we've started to do here at CSU is just build those roles to match the individuals' interests. And so we have, have clinicians that work part time at regional specialty practices here in Colorado, even have shared appointments with some of our corporate partners, building those flexible positions. Also, from a scheduling perspective, and kind of a bit blowing up the traditional model even with academics, a week on clinics. Might be, two days on clinics this week, three days the next month, the following week. Just being flexible in scheduling, all of those levels, are important. And then, yes, we do have to be better about getting salaries closer and narrowing that gap, which I think we are better than we were maybe five years ago. But all of those factors. There’s, there’s the financial part, there’s the quality of life part. There’s balancing those things, not how many people want to sign up for being on all the committees that faculty or sometimes asked to be on, and doing, having research tied to their promotion or tied to their feature, having to go through the tenure process for those pretty intense 5 or 6 years. And so building those positions that allow them to just come do what they want to do, be, clinics, teach students on clinics, teach residents on clinics. We’re finding to be successful at recruiting people back from practice in academia. 

Dr. Venable: Certainly, I think, really highlights some of the advantages of academia. And I do think it’s great that you are being flexible. That’s one of the hardest things, I think for people in general, probably also the people that have been doing this for a long time, they just don’t understand, well, why doesn’t the next generation just do what I did? Right? So you’re talking about your parents' mind the same way. My mom was always so confused because I was in school for so long. She kept being so, are you done? I don’t understand. When are you going to start making money? That was really when I think she was a bit worried about. But I do think this is great that you’re thinking outside the box that you guys are trying to work with people. I know you’ve written about different trends in veterinary oncology or just veterinary medicine over the last 20 years or so. What do you think? Yeah, we just talk about academia, but some of the other impactful trends that you’re seeing that’s affecting us.

Dr. Johannes: Especially. Yeah, with regard to oncology and of the industry, the trends I see, some are very positive, some are concerning. I think the ones that concern me the most is probably just the cost trends. And that’s across the veterinary industry. But in specialty medicine in particular, our annual inflation, for veterinary medicine specialty, that medicine is higher than the consumer index.  And so and that’s been for a number of years. And I think the other thing that’s also challenging for vendor medicine. And I think oncologists, we have to kind of be truthful with ourselves. Outcomes haven’t changed significantly. Or many of the common cancers we treat. Lymphoma, osteosarcoma. Yes, there’s new therapeutics. And yes, there has been some movement, but all that’s been done, hasn’t been a lot of movement in life expectancy with CHOP, with osteosarcoma.

Yeah. The cost of that treatment has gone up significantly. And so there’s more oncologists now. Obviously every year we produce about 35 oncologists. There’s about 600 ACVIM-boarded oncologists in the world now. And so access to care from an ability to have a specialist in your region has increased. Yet the cost escalation has narrowed the access to care. For those that are able to afford that care. And so I think that the challenge for specialty medicine, particularly oncology, is how do we continue to increase access to care and balance out with all the financial, kind of obligations and pressures that we all have from a practice standpoint and balance out. I think that’s probably the biggest challenge facing vendor technology now.

Dr. Venable: I agree, I do think it’s a huge challenge. I think you’re always trying to encourage people to get pet insurance. I’m not really sure why that hasn’t taken off as much as it has. I’m not a business, so I don’t really know. Do you know? Have you heard anything about why there’s not a better uptake? I can’t think of the word, but why aren't more people getting pet insurance?

Dr. Johannes: Yeah, I think that’s one of our interesting things to watch over the last ten years. I remember 1 to 10 years ago when, as it were written, we had the local antibodies for lymphoma at the time, which and I’m not being successful, but at the time our thought was, okay, how do we get this was going to be an add on to the current therapy. So it’s going to be an additional cost. How do we get clients for that. And can we know it’s not going to have immediate effects, but can we get more people, at the puppy stage of insurance, those kinds of things, and have a lot of conversations with the big players in pet insurance. And, many of them kind of develop their own sales force. In essence, they had sales reps that were going out trying to promote primary care doctors, particularly having those conversations when new puppies come in, this is the advantage of having it. And I don’t have a good explanation for why, especially compared to Europe, where the insured rates are much higher. Why in the US it’s been a struggle. It’s a lot less than 5% of dogs and cats are insured. So we are very largely a self-pay industry. And it’s tough. I know on the flip side, premiums have gone up significantly. And so I don’t know if the barrier has been… is there hesitation? Because if the uptake grew and a large number of dogs and cats became insured, would the human model come into play where we had to get permission to do every diagnostic and, a lot of administrative costs come back to the hospital? Is there hesitation from that regard? I don’t know, but I think that is impacting especially medicine in that so many dogs are not dogs and cats are not insured, which then definitely changes that dynamic when treatment is needed.

Dr. Venable: You mentioned that the price is especially, specialty care has gone up quite a bit, especially compared to the consumer index. In an article you wrote recently, you had mentioned, I think, at 149% that it’s increased over the last, I think, two decades or so. What are your opinions? Why do you think that’s happening? Or are there other industries like human health that that’s happening?

Dr. Johannes: Well, I think the difference for us in human health is that the way Medicare or Medicaid is structured, it kind of keeps insurance. There may be a price here, but then with the ultimate, the write off the goes to the insurance company when they negotiate their, their actual costs, are different. On the human side the margins are very narrow, 1 to 3%, profit margin on the human side. So it’s a volume. Again, much of that is driven by Medicare, Medicaid, those kinds of insurance payer negotiations. On the veterinary side, I think part of the challenge has been that our margins are even higher because we don’t have those insurance, Medicare, Medicaid, things holding kind of a lid on prices to a certain extent. And so we’ve had more flexibility to increase prices. But sometimes I wonder, have we increased them too much? In general. And, I think that’s the dynamic we face is, are going to be some plateauing and flattening of prices. I think that’s inevitable, especially the way that the economy is trending back down currently. And we’re seeing that. So it’s going, kind of trending back down just a little bit. I think things are going to be rising. We also had the COVID effect, post COVID, the jump in caseload. And now we’re kind of sizing after that. So I think there’s a lot of things moving in there in the industry. And the specialty dynamics are, in oncology. I think the other challenge is before we had any drugs that had gone through the either FDA or USDA process for approval in our species, we were using human generics, which for the most part were pretty inexpensive. Sometimes there were manufacturing shortages, etc. that would drive up the cost, but in general pretty inexpensive generics that then we could mark up, and still make a pretty good profit on, as more drugs come out and design for our species. That’s great. But there’s an investment the companies make in bringing those to market, and they have to recoup those. And so those drugs are no longer generic priced. And so veterinarians and veterinary industry have had to learn how to price those. I’ll be putting the standard 3x, 4x markup market to work when that drug is, not generic priced. And so kind of being willing to margin price or being willing to be flexible on pricing is still realizing that you’re going to make a significant profit on it. It’s just not your traditional 3x. And I think sometimes it’s been challenging for, the specialty markets to adjust to some of those approved or licensed drugs, which is particularly challenging for oncologists when a new drug at the time, Palladia comes out, or Tanovea, Gilvetmab, we have those new therapeutics coming out, but depending on where they’re priced and how frequent we have to give them, especially if they’re an add on, I think that’s what we’re seeing, that, it’s interesting.

I remember when I was doing market research for Aratana that ten years ago, kind of the cap that many clients that were specialty clients said they would spend on their pet was $15,000. The survey I did for ACVIM last year of our ACVIM oncology colleagues, I think we had 125 respondents. I asked what kind of the ballpark cap that clients would spend, and the most common response was 10 to 15,000. So my concern is that clients' kind of cap on what they’re willing to spend in a specialty market hasn’t changed, but the cost of our treatments has significantly changed. And so any new therapeutic that comes out, that’s an add on to what we’re already doing is going to be a challenge unless it can reduce the amount of chemo or other treatments that we need to give or replace those treatments, it’s going to be hard to slot in, and add on to our current, kind of expensive treatment.

Dr. Venable: I’ve also seen some of the frustration with the always a certain markup. you mentioned the three times markup. And I think I think it does take some education. I feel there is sort of this mental block where a lot of that clinics feel they have, no matter what, they have to mark it up that much, because I’ve ran into that with certain diagnostics that are a lot more expensive. It’s no, we don’t. If we mark it up three times, no one’s gonna be able to do it. But we could still with what it’s involved, you, you don’t need to markup that much and you can still make a profit. And so I do really feel it’s just education across the board. Is that what you think or do you think there’s other ways to help change sort of this paradigm?

Dr. Johannes: Yeah, I think I think it probably will be from multiple angles. I think there’s also from the industry side. Yes, the company has made this much investment in a drug. And this is what their pricing research shows that they probably need the price of that. But I think they also have to take a deep look at the market and really talk to oncologists and say, okay, our client’s going to spend this is the efficacy that it’s providing. And the side effect profile, is that really going to bring the value that you think your drug is going to bring to the market? I think being realistic and receptive to that feedback is important. And then from the oncologist perspective, I think it’s important for us to work with our management if we’re not the ones making the decisions and really be proactive with our management and helping them understand.

And also oncology, it’s not a one time visit usually, right? These clients are coming in for multiple treatments. Multiple. So yeah, I kind of look at the big picture. What’s the cost of that client going has been over the lifetime of that bigger cat versus that one individual treatment. And why it’s important to price it so that yes, we’re still covering expenses and we're generating revenue and profit. And we’re also setting a client up that they are going to be able to afford that within a self-pay system. So I think it takes really all players to be successful, but also takes a lot of work, a lot of communication. And I think that sometimes the challenge when a new drug comes out is that not everybody has the time to navigate those within their practice. And so things fall by the wayside and then they don’t get incorporated or maybe used as much as they otherwise could and anytime there are new drugs out there, if it’s not quickly uptaken within the first 1 or 2 years, it’s hard to get it to move.

Dr. Venable: Yeah, I agree. And the other thing I think a lot of people don’t really know is how much does it typically cost to get a drug to the market, I think often we just don’t realize how much investment these companies have had to make. But what would you see? On average, they’re usually having to spend.

Dr. Johannes: Yeah, the average. There’s not a lot of literature on this because, depending on the size of the company, they may not need to disclose these, but probably, for an FDA drug, you’re probably looking at 20 to 25 million range. These days, USDA may be a little, a little less, but it’s a significant investment. And some of that depends on… also depending on some of the immunotherapeutics, the manufacturing process can be a little more involved and a little more expensive. And so the API or the, the drug production costs, can be high as well. And so all of those things factor into that price. And then I think, we talk about access to care. And I think that one thing both oncologists and then companies are developing drugs, we don’t have numbers, but we know that most dogs that have cancer never see an oncologist. So how do we pair and have our primary care colleagues comfortable and have them armed with tools to treat some of these commonly seen cancers that aren’t going to find their way to an oncologist?

And that’s always hard to do, usually in oncology worlds, minimal side effects and high efficacy don’t go together. And so that’s the challenge. How do you find that balance with the drug that has reasonable efficacy towards whatever cancer we’re looking at, manageable side effects and a cost, pricing profile that’s going to be workable in primary care I think that's the trifecta. If you want a blockbuster drug in the ecology is getting a, a drug for a common cancer that has reasonable side effects, profile reasonable efficacy at a reasonable price. I’m not sure it can be done, but that's what that would be, I think to truly increase access to care. I think that’s what’s needed.

Dr. Venable: So even more of the products and treatments out there, do you have any other thoughts on how to help increase access to care or or working with general practitioners?

Dr. Johannes: Yeah, I think the more we can continue, it’s kind of what we’ve always done, only maybe doing it more effectively as far as having those relationships. Thinking through and actually helping our primary care colleagues also know that hey, if a dog can’t come for lymphoma treatment and get CHOP with us, what could you do in your practice? Can you do CCNU? Can you do Laverdia? Can you do… What can you do here? And these are things that you readily can do and manage. And give them the short course on side effects and dosing and, and these are the things, is our monitoring schedule and help them understand these are things you can do in practice and you can do it readily. And now we know palladia dosing. We know palladia side effects. The primary care doctors are using palladia. But I don’t think many are and so helping give them but comfort them. The confidence to be able to use it I think is the best thing we can do to truly increase access to oncology care for the majority of our pets.

Dr. Venable: I certainly agree that a lot of what I do with my consulting work is trying to help, because there’s so many clients, even financial, but sometimes it’s distance or they just can’t get in there. There’s so many barriers really. And so I do think trying to help those vets that are interested and, I, I feel the ones that especially are positioned far from a major metropolitan area, they just have to be more willing to do things, not just oncology, but I’m sure some of the surgeries they end up doing and things would be things that I probably wouldn’t want to do if I was a general vet out there. But I definitely agree. I feel there’s got to be a balance, to try to help because I also feel and you tell me your thoughts, that the pet is no longer just a pet. right? They’re not in the backyard that we, the kids, play with at random. Most people see them as family members, or at least clearly the people that I interact with. They see them as family members. And so they’re wanting more of that pediatric type care that they see that children get. Is that what you guys are seeing and kind of experiencing at academia as well?

Dr. Johannes: Yeah, absolutely. I mean, I think that’s really oncology in general. So we’re seeing more cancers than we did 20 years ago, but we’re definitely treating a lot more dogs than we did 20 years ago. Pets are family and pets are living longer because we have a lot better preventative care. And so they’re living longer, healthier lives, which is great. And they’re living long enough to develop cancer. We also have a lot of breeds that are popular that are unfortunately prone to develop cancer, right? And so for many reasons, we see a lot of cancer. Then when we do, clients have the expectation from a diagnostic and a treatment perspective. Hey, I want to be able to do what happens to me. CT gets a CT, needs radiation treatment, gets radiation treatment. And so that is why I think we’ve seen the kind of explosive growth of oncologists in our ecology, specialty market and industry that we have in the last two decades. And then I think the question I have is, and it’s interesting, I remember when I launched Palladia, it was 2009. And so I spent most of 2008 tracking all the oncologists in the country. And, at that time, there were 225 oncologists. Now there’s 600 and mapping them out so I could show corporate leadership. Here's all the oncologists are here’s the growth plan for 1990, when kind of the specialty started through oh nine. And here’s a growth trend. And I remember pretty distinctly it was a 13% annual growth rate. And I’m hey, if this is your 401k, one could be happy. These are all good trends. And 2009, I wondered, is this sustainable? Is this truly a sustainable path? 16 years later, I put the same graphic up there that the annual growth rate of oncologists is 11%. There are 600 oncologists and there’s 100 job openings. So obviously that need is still unmet. But I think we are at an important time with the costs and the pricing, and case and access to care that we’re going to have to see some adjustments in, we’re going to have to kind of make some adjustments ourselves to kind of move forward for the specialty.

Dr. Venable: I totally agree. It is interesting how just the market is outpacing us, even though, as you said, we’re growing. It’s just not enough. So I do think that's an important area that we all really need to focus and lean into. But one of the things I wanted to ask you is you’ve had a lot of leadership positions, medical director at Aratana and now, executive director at Colorado State, which is huge. So what would you recommend for veterinarians? I feel we don’t get a lot of leadership training generally. There's so much to learn in medicine. So what do you recommend for people as far as how to grow their leadership skills and how to get into leadership roles?

Dr. Johannes: Yeah, I think for me, probably my time at Pfizer and just being immersed in and surrounded by leaders and being able to observe and grow was the best opportunity I had. Coming from a very clinical background where all I needed were clinics and then being immersed. When I was at Pfizer, I was actually in the marketing side. And, so I was on the marketing team. I was maybe two veterinarians on the marketing team at the time. And so, being surrounded by a lot of business minded people that knew the veterinary industry really well, because that’s what they did. And seeing that through the business lens was very eye opening. And I think seeing that leadership and how they ran a company really helped me to forge my leadership. I think I also learned a lot about, through launching Palladia, I learned a lot about communications. I learned a lot about managing politics there. As you can imagine, when you roll out a new drug, there’s a lot of politics, and you have to navigate those in order for the drugs to be successful because there’s. “Okay, do you only give this to oncologists? Do you give it to internists? Do you? If you only give it to oncologists, how much are they going to get? Who’s going to get it?” Navigating all of those things. So you don’t alienate your customers. Taught me a lot about and what I do today about navigating internal politics and external politics and dynamics and how one decision’s going to impact another. And I think, it just kind of mold you into who you are. So I think surround yourself with people who are excellent. Whether that’s your leadership. I’ve always admired, if I’m learning something every day from my leadership, that’s the environment I want to be in. When I look to hire people. And I surround yourselves with excellent people. Don’t micromanage them. Let them be them. Guide them and let them be them is kind of my motto. And, I think it just kind of morphs you into what kind of leader you are and will become. I think it's hard for me to say, take one, take its course or read my book. I think it’s a combination of things and always being open, receptive to feedback from your team and back from your leadership, but also learning. as much as you can have those experiences. Recently we have a partnership with the University of Colorado Medical school, and they have an Institute of Health, Quality, Safety and Efficiency. And so we’re learning a lot from them over the past several decades of health, quality, safety. And, improvements have gone on the human side. How we can adapt that to the better side. I went to a four day leadership course, foundations and Healthcare leadership, they provide. And for me, it was the most professionally rewarding opportunity I had. And it was all healthcare based. And so much of it is largely based on human medicine, so much of it transcends what we do. And, they were so receptive to it. It's interesting to be surrounded by endocrinologists, dentists, primary care doctors, ER doctors. And we all have similar challenges and different species. Different financial structures that may have the same challenges. And so for me doing those things, finding those things that are truly, kind of adapted to where you are in your life and can be rewarding. It is kind of where I try to focus my time energy.

Dr. Venable: That sounds really interesting. That sounds like a great course. And I love how you’re always open to learning new things and changing, because that’s hard. And I think a lot of people, as you get older, you almost feel so busy that you don’t want to learn new things. But I do think it is crucial to keep learning and be open to change, which I think it’s fantastic. Your career certainly shows that you are definitely open to all those and kind of speaking of something new and change, are there any emerging technology or research, anything on the cusp that you’re excited about?

Dr. Johannes: Yeah. Oncology and probably, not just oncology kind of across vet med, but I think it’s going to be interesting to see where AI takes us. I think, from a clinical perspective. How we integrate AI into medical records and efficiencies and those kinds of things, and maybe even diagnostic decision making, those things that, there’s a lot to be, to uncover there. But, I think that that’s going to be interesting, I think from a college’s specialty side, some of the AI technologies and diagnostics are interesting on some of the diagnostic companies ability to do. I read, cytology slides, etc. some of those things that are out there, and on the horizon, I think our interest certainly is going to increase that access to care. Can we get better, more efficient, cost effective diagnostics in-house for primary care doctors so we, they can treat those cases that wouldn’t otherwise come to us in-house and or can get them to us, more efficiently at an earlier stage. Or we could treat it. I think that on the dynamic diagnostics front, there was a time when the therapeutic front was leading the diagnostic front. And we had a lot of new therapies on the horizon. I think now diagnostics are kind of surpassing therapeutics. I think that some of the diagnostics stuff, we don’t exactly know what to do with it yet, how it should be driving, therapeutic decisions. And when it drives therapeutics, that might be some of the human generics. What truly is the PK, PD, of those drugs? Do we really have enough information that we know how to dose them correctly and understand their side effects, profile, all those things? It’s exciting to have those opportunities and options available. But I think the diagnostic front is probably ahead of the therapeutic front, now in kind of the new horizon. But that said, I think there’s a lot of new and interesting therapeutics.

I think that immunotherapeutics are probably, we saw it on the human side. I think what we haven’t had in veterinary medicine that human oncology had, I remember being, in 2009, we launched Palladia, Sutent on the human side at Pfizer was fairly new on the market. And I remember within Pfizer the question was even on human oncology, is it too fragmented? Because you have to get indications for particular types of cancer. Oftentimes there are multiple treatment arms. If other approved drugs are there. And so is there a market in human oncology. And 15 years later, we know that human oncology is driving much of pharma, right? But what we haven’t had in bat med that they’ve had in human oncology is some of those true blockbuster drugs sunitinib, as a small molecule drug, Rituximab lymphoma, Keytruda. Rp1. So truly blood pressure. And we have we have Gilvetmab we just some have a lot of data on it yet. So we’ve had some of those. We just haven’t had the data yet. That shows that, hey, these are really going to transform how we treat certain cancers and the outcomes that we have. And I think if we can get one of those in veterinary oncology, then that will change the dynamics as well. But I think it is exciting in veterinary oncology that we do have small biotech. We have larger kinds of our traditional, pharma companies all engaged in their therapeutic development. We have large diagnostic companies that are bringing new things into the oncology space. So that is exciting. Because if companies are bringing things to market and looking into oncology Market, that says that they see potential in the market, which is always, always a good thing.

Dr. Venable: We are in an exciting time in oncology, there’s so much going on where I feel even when I first started going into it, there wasn’t a whole lot compared to some of the other specialties. So we’re definitely in an exciting area now. And, I just really love this conversation. I feel we’ve covered so many things from the different types of practice. And, academia, private practice, industry, and just all the different trends of things that are going on, access to care management. And so as we start to wrap up, I always like to ask people, who do you think would be a good guest for this show?

Dr. Johannes: Absolutely. I’m not sure exactly who you’ve had in the past. But some names come to mind for me. I don’t know. You’ve had Cheryl London on, MK Klein, and Nicole Ehrhart. I think all I see is really transformational, within, various aspects, Cheryl, from, all the research and drug development that she’s done. MK, one of the first, colleagues, especially practice owners and just, her tremendous experience there being, dual boarded and all those things. And then, Nicole, from a surgical oncology perspective, being one of the early pioneers in surgical oncology, I think all of them help tremendous experiences that would be great to share.

Dr. Venable: Those would certainly be all great gusts. Dr. Johannes, I just want to thank you so much for taking time to just share your expertise today. And thank you again for being part of this show.

Dr. Johannes: Absolutely. Thanks for having me.

Dr. Venable: Well, that's it for this episode of the Veterinary Cancer Pioneers podcast. If you enjoyed this episode and gained valuable insight, we would be so grateful if you could share our podcast with your friends and colleagues. And it would be even more wonderful if you want to give us a five-star rating, positive review, or any kind of feedback on Apple Podcasts or wherever you listen. The Veterinary Cancer Pioneers Podcast is presented to you by ImpriMed.