Podcast #2 – Siva Nadarajah | JOGO Health

Video interview with Co-Founder and President of JOGO Health, a Digital Health firm that helps treat chronic pain and movement disorders by tapping into the neuroplasticity of the brain.

Our discussion covered multiple trends and topics within the Life Sciences industry, including neuroplasticity, digital therapeutics, advances in AI, access and affordability and payment structures in healthcare.

Transcript

[00:00:00] Alan Kotun: Welcome, everyone. Welcome. We have a wonderful guest today at the Life Sciences Trends podcast this is episode two, and I’m glad to welcome Mr. Siva, who has a very extensive wealth of experience within Life Sciences. He’s on his second venture, not his first. And in order to make sure I don’t give him a disservice, can you please introduce yourself for the listeners today?

[00:00:26] Siva Nadarajah: Thank you Alan, thanks again for the opportunity. My name is Siva Nadarajah. I’ve been in the Life Sciences industry for almost 25 years now. Mostly I worked in pharmaceutical companies, helping pharma in the launch of drugs and also medical devices.

So I did not work directly for pharma companies, but I worked for a company which helped pharma companies and medical device companies launch drugs. I was in the launch teams of [00:01:00] Botox. I was in the launch teams of Viagra. I was in the launch team of Lyrica, some of the largest drugs that you would normally see.

And in 2010, I quit my last job and I started my first venture. It was an AI-based drug and vaccine safety monitoring software that was needed at that time for various compliance reasons for US based companies, and that product grew very well, that company. And we got acquired by IQVIA, one of the largest clinical research companies in the world with some 80,000-90,000 employees now, and they make $12-13 million in revenue.

So my company was acquired by IQVIA and I led IQVIA’s AI business within the safety portfolio. And [00:02:00] interestingly that software that we developed and sold to IQVIA is currently used by some of the largest pharmaceutical and vaccine manufacturers like Moderna to monitor the vaccine safety in this pandemic.

Then I was at IQVIA for almost six years, and I met these researchers from NYU who had developed JOGO, which is essentially a sensor-based technology which can rewire your central nervous system to recover from stroke, chronic pain, and various neuromuscular conditions.

And I became an investor in the company originally. Then I just, before the pandemic, I quit my last job. Started and joined the company as a co-founder to take it to commercial. So that’s my background Alan.

[00:02:54] Alan Kotun: Wonderful, wonderful. And, just very curious and excited to learn a bit more about [00:03:00] before progressing / going into some of these ventures, as someone who has founded not just one, but two firms within this field so far. Definitely strike me as an entrepreneurial person. Can you explain a bit more of the thought process that went inside and what led you to have found that the first venture which looked at the safety side of therapies?

[00:03:26] Siva Nadarajah: Yeah, it’s always difficult to leave a comfortable corporate job and start a company, right? Because you lose your paycheck from day one. Nobody pays you from day one to start a company.

But it was an interesting journey because I found a problem that existed in the industry. Actually, I was even teaching this to my management at that time, and said “Hey, let’s go build this”. There was a need.

A little bit of background why that company was started. [00:04:00] Right, if you remember the previous pandemic supposed to be the pandemic, the H1N1 virus (influenza A virus subtype H1N1). So during that pandemic there were some drugs that were developed and apparently nobody monitored the side effects of these drugs at that time.

It’s not that those drugs were not safe, but apparently there were some side effects that were reported by these. Later on they found out in 2008, whereas the H1N1 virus was in 2002 or 2004, I think. So there was this mass amount of data that got collected over a period of time and they had no way to find, go back and look at who actually had side effects in these drugs, right?

It was impossible for human beings to look at data that was in billions of records, right? So there was a need for a software to go back and look at all the side effects. And AI was not even a term at that time. You know, there was of course AI as a concept existed, but nobody called it [00:05:00] AI, if you remember, in 2010.

It was natural language processing, machine learning and deep learning, those were some of the terms that were used. So I thought there was a need and I thought I will start this company by, you know, overnight. One day I decided to quit my job and launch this company with no money, thinking that somebody will fund me, but nobody funded me in the beginning.

So it was a struggle for 18 months, then finally we found a great co-founder. He was able to help me through the journey at that point and then we eventually found traction and revenue and we actually did not even need venture funding. At that time we got acquired, before we even really took venture funding.

So yeah, it is always, you know, 50 50 chance of whether your entrepreneurial journey will be successful. I was lucky. So my second one [00:06:00] wasn’t that difficult. Because once you launch your first one, it’s easy to attract investors for second, and also, you yourself can fund the company. So with my first one, was really a struggle.

[00:06:11] Alan Kotun: It is interesting. I think, as with many things, the very first initial stages can be a bit more of a harder process whether that’s starting a new venture or even within medical research sometimes diving into a new therapy area, for example.

It can be a bit harder to get the traction off the ground in those initial phases. But once that momentum builds up and there’s more evidence that things can be done, it’s a lot easier to get the process snowballing.

I really find it fascinating the work that you did there in terms of applying AI because I know and understand that AI is often used as quite big buzz word because it is a fascinating technology in terms of use cases within Life Sciences and Healthcare, but [00:07:00] also across various different fields.

But I really do see AI as something which is a tool that can be used not just within the initial phases of let’s say R&D, in research, drug discovery, drug development, but also both within that spectrum, beyond that spectrum in terms of after a drug has already been developed.

But in the case that you just mentioned, being able to sift through large volumes of data to find out information, which pertains to safety, which if we were to do mechanically, manually would be rather time consuming and maybe not the most possible or viable in simple terms.

Shifting a bit from that first venture to JOGO Health. I’m really interested about the capabilities of JOGO and how this is [00:08:00] impacting digital health. Could you please explain, in simple terms, what JOGO Health is, it’s main product is and some of the disease areas that is targeting?

[00:08:12] Siva Nadarajah: Sure. So JOGO originated at, NYU, New York University here, and it was developed by a well-known neurologist and physical medicine and rehabilitation doctor called Joseph Rodney. He’s late. Joseph Rodney. He was 94 years he passed.

He worked with an engineer called Gordon Silverman, Dr. Gordon Silverman, and that’s where the name comes from. JOGO, JO-seph and GO-rdon, JOGO we named the company.

So Gordon Silverman is famously known for creating the world’s first automated toll booth systems in New York City. So basically a [00:09:00] sensor-based technology in the 1950s to collect toll automatically, from the highways.

So he was a sensor-based guy from the early pioneers in sensor-based technology. So the both of them developed JOGO, using a foundational science called neuroplasticity.

Neuroplasticity is your brain can be rewired. So a great example of neuroplasticity is, since you’re in London, the London taxi drivers. London taxi drivers, they have to memorise the map before they get a license, right?

No other country does that. They have to memorise the entire map. So Harvard Medical School did a study on London taxi drivers, and they actually did Functional MRI (fMRI) scans on the London taxi drivers, and they found that the area of the brain, which stores the spatial information, which is the map, is larger [00:10:00] than in regular human beings in all the land and taxi drivers.

So that kind of shows the brain can be rewired by training. Our brain changes every day, but, you know, if you specifically focus on certain tasks, then that part of the brain can be rewired, which is neuroplasticity.

So what JOGO does is it uses a sensor. It’s a variable sensor that reads the electricity from the muscle. The electromyography, that’s the muscle, our body produces electricity and it feeds it back to the brain. And we have machine learning algorithms and all these buzzwords I don’t want to use, but basically it tells the brain to rewire.

So let’s take an example of a stroke patient, right? So if someone, God forbid, had a stroke, you get a blood clot in the brain and that part of the brain, which now controls your muscles or your upper extremities, [00:11:00] your hand, or a leg, now cannot operate. Now that’s why people get paralysis, right? There’s a blood clot, there’s an accident in the brain.

Your brain, and those two neurons which are actually working, connected to work with the muscles, can be rerouted by training the brain, right? So what we do is, we put the sensor on the hand or leg, wherever it’s impacted. And we have an app which runs on a tablet PC, where the patient has to look at.

And it trains the brain using certain protocol exercises that we have patented. And that’s what photo IP is. Which basically trains the brain and people get controlled back right after a lot of exercise. It’s not like- it doesn’t happen overnight.

You need to do very much like how do London taxi drivers memorize the map? It doesn’t happen overnight right? They have to take a lot of steps to do that.

So typically after about four weeks or say six weeks, we see [00:12:00] great results from patients who had stroke, in recovering from this. The second piece of JOGO is actually working with chronic pain.

Chronic pain being, let’s say someone had a back pain or they fell and they had a back injury. You go through physical therapy. Sometimes you go through surgery and when you fix a pathological problem in the body, right? But you see two thirds of the patients still have pain. There’s no underlying pathological reasons, but they still have pain.

It’s called non-specific lower back pain. That’s what triggers the opioid crisis in the United States, and probably in the UK it triggers all kinds of other addictions. So it’s a brain related pain.

So take a chronic pain, for example, chronic, lower back, any chronic pain. So it’s a neural [00:13:00] signaling problem. The brain has become too sensitive or there’s residual memory in the brain about the pain. So the brain is not gonna let go, right?

Then that creates muscle tension in the body, right? And the muscle tension is a vicious cycle that feeds it back to the brain and there’s anxiety build up. So there is a pain, anxiety, muscle tension build-up. In chronic pain, chronic lower back pain, cancer pain, you take any other chronic pain, right?

So what JOGO does is you put these sensors again in this body depending on which muscle you’re working on, and we reduce the muscle tension by telling the brain to reduce the muscle tension.

We give relaxation exercises to the brain and the brain naturally relaxes the muscles. Right? And we have in studies at Harvard Medical School, Here that this can reduce pain better than opioids.

So we did a study and it’s permanent. You don’t need to use it every day. [00:14:00] It’s permanent. Once you do it, it’s done. So chronic pain, chronic migraine, tension type headache, chronic pelvic pain, fibromyalgia pain, all these can be treated. So it’s actually the opposite of what you do with stroke really.

Stroke, you are trying to recruit the muscles, you bring the muscles back. And here in the pain you are letting the brain forget about the tension in the brain and in the muscles and let it go, right? So it’s a very new science when it comes to this new, not a, it’s not a new science, the old science, but now resurrected.

This has been studied for 40-50 years, this whole science. That you can actually train your central nervous system through this feedback process.

 And a lot of different applications came in, it falls in the, something called electromyography biofeedback that’s been set. But you know, what we do here is, very unique how we create these, protocols and the treatment can be provided remotely so the patient don’t [00:15:00] have come to clinics.

So this whole app. It’s an app you download and there’s a sensor we ship it to the patients and they do it at home with some support from the clinicians.

So that’s basically how, those are some of the conditions we treat. So the other conditions we treat with JOGO, we talked about stroke, we talked about chronic pain.

The third one is pelvic floor disorders, right? So especially women who develop urinary incontinence postpartum. So you know, during a childbirth there is trauma and now the brain and the pelvic muscles have forgotten how to work together. Now this connection is gone. So they develop incontinence, they can’t control bladder.

It happens with men as well when they age, and also men who go through prostate surgery, when the brain and the muscles are now not talking to each other. So we can re-educate that process back again by putting the sensors in the pelvic area and re-educate the brain, so we can treat incontinence in both men and women, [00:16:00] right? So that’s also something that we do with JOGO.

So the last one we are working on right now is Parkinson’s (disease). JOGO doesn’t treat Parkinson’s. JOGO can actually help the brain relax and stop the tremors so we can help the brain stop the tremors. So we are seeing some really good results. Sometimes in some cases 90% reduction average, 70% reduction in tremors in patients.

So we’ve actually worked with a UK Parkinson’s group. Those are one of our first partners based in the UK. We did a small trial recently and it showed that JOGO we can reduce tremors and by reducing tremors. We are actually improving sleep in Parkinson’s patients, which is one of the major issues with many Parkinson’s patients.

They can’t sleep because they have tremor and that leads to anxiety and it’s again, a whole cycle. Right. So those are big four areas that we are working on. Stroke, chronic pain, including migraine and pelvic floor disorders like incontinence and then Parkinson’s.

[00:17:02] Alan Kotun: Fascinating. And, just touching upon some of those therapy areas that you mentioned.

Starting with stroke, for example. I’ve heard (that globally) every two seconds someone is suffering from a stroke. So stroke is absolutely massive. And, having parts of the brain, which are essentially being damaged due to lack of oxygen and being able from the sound of things to redirect your neural networks to reach a part of the brain which the body was struggling to reach through a different path, I think that’s a massive application, that is going to have tremendous impact.

[00:17:41] Siva Nadarajah: Yeah, yeah. I would recommend people to watch this TED video, which is on our website, which explains how fascinating. We are just scratching the surface at this point with brain science. Because until the fMRI scans came in, we [00:18:00] never knew how powerful the brain can be, and how powerful the brain rewiring can be, right? Neuroplasticity.

We always understood neuroplasticity naturally, right? That the brain can be changed. You know, tennis, if you start practicing for 10,000 hours, you actually get a good swing and then, 10,000 hours- I forgot what the number was, but now we can see in the brain actual structural changes.

Well, the short term, memories and things that we do, they are stored. Let’s say you go play tennis one day and you think you got your service right. But you go two days later, you are like awful, right? That is because the chemical changes are the ones that happen in the brain, not the structural changes.

But in neuroplasticity the more you practice, you actually can change structurally the brain, right? So that is, you know, in tennis, the same thing can be done with stroke patients. [00:19:00] Where we actually train the brain through this process.

So we are just scratching the surfaces. And I was fascinated, some of the neurology textbooks are just getting expanded on neuroplasticity and the whole process of feedback.

It’s just a small chapter in neuroplasticity books, until recently when students study medicine.

[00:19:25] Alan Kotun: It’s an important fact and, like you said, the fact that things are really just getting started in terms of what we’re learning about neuroplasticity just makes things even more exciting.

I personally find it really interesting that you mentioned how in the case of stroke it’s trying to rebuild some of those connections where you can also engineer the reverse in terms of chronic pain. Where we are basically trying to release some of those connections to part of the brain, which are linked to feelings which we want to dissociate from.

And [00:20:00] I think the whole chronic pain use case in my eyes is quite a massive thing because it’s not only treating this chronic pain, but it’s also providing an alternative solution to opioids, as you mentioned.

And working within the whole professional services and consulting field, I’ve worked with some biotechs, for example, people looking to essentially, create non-opioid pain relief alternatives because it is a massive-

[00:20:29] Siva Nadarajah: One in five. Alan, one in five adults in the world suffer from chronic pain. And, and we’ve talked to doctors, there’s nothing else they could provide.

And it’s like what do you do? Right? You can’t prescribe opioids and in the UK, even Gabapentin, right? That’s getting phased out in 2025, I think. They saw that it’s not doing anything to the patient, it’s just placebo effect. So it’s not treating the root cause. So there is nothing out there for these [00:21:00] patients.

We feel that chronic pain is a big area that we will focus on. We are seeing great results. We did a clinical study, a RCT at Brigham’s and Women’s at Harvard Medical School. Fantastic results.

[00:21:14] Alan Kotun: I know you mentioned previously that with some of these patients and use cases, it’s not like an overnight thing, but with example you gave with stroke being able to have massive results in four to six weeks. I think that is, in my opinion, quite fast.

[00:21:30] Siva Nadarajah: I’ll give you a story, Alan. Stroke patient stories are what encourage me every day to wake up in the morning and run for this job.

So there was a UCLA professor, right? One of the famous professors at UCLA had a stroke during the pandemic.

And UCLA has one of the best- you’ve seen California, LA right? UCLA. They had one of the best rehab and he went through the regular rehabilitation. [00:22:00] You know, his ADLs were fine, but he still lost the ability to write, right? Because his hands were gone like this, and he was paralyzed here.

And he also could not walk. So, you know, basically the rehab said, that’s it, that’s the maximum we could do. And, you know, go, go home. And that’s, that’s the end of your teaching career. Right? And he cannot write . So he found out about us and he called us and we worked with his physical therapist who was helping him.

And shipped a JOGO kit, this just happened a month ago. And after six weeks, he opens up, right? His hands opened up and he’s now back in school teaching. This famous UCLA professor. So it’s life changing when it comes to stroke, right? When patients don’t have anything else. As I said, we are just scratching the surface.

Not every stroke patient is a candidate for JOGO. [00:23:00] Because if someone has lost the ability to see if they’ve become blind, right? JOGO doesn’t work because you need to look at the screen. So that is an important factor. The feedback goes through visually to the brain.

So that’s important, because if you’re working on other ways, maybe through sound or whatever, right. But right now it’s a stroke every, I think every 40 seconds in the United States, someone has a stroke, every 40 seconds.

[00:23:29] Alan Kotun: Every 40 seconds. And honestly, like you said, I think use cases like that and case studies where you are actually seeing this tangible, massive impact on people’s lives really showcases how genuinely impactful these technologies are.

Having someone in that example, who is a lecturer who in one scenario without JOGO, without any way to improve after stroke and be able to write would literally have to [00:24:00] end his lecturing career. To now with JOGO Health being able to go back to his career and not have to make a massive lifestyle change is really impactful.

It also reminds me of another story I think I’ve heard to you share in the past. Where I think one of your friend’s daughter had cerebral palsy and essentially JOGO Health was used in that scenario as well. Are you able to share that example?

[00:24:33] Siva Nadarajah: Can you repeat Alan? Which one?

[00:24:36] Alan Kotun: Yes, no worries. I believe one of your friends, their daughter has cerebral palsy and with JOGO Health was able to, essentially, bring it to the stage where she was able to by herself, walk to the restroom.

[00:24:52] Siva Nadarajah: Oh, yeah. It’s-. So, this is a cerebral palsy child, right?

[00:25:00] So cerebral palsy essentially is a, is a pediatric stroke that happens during the child’s birth. Oxygen doesn’t go to the brain and the brain gets damaged and you get cerebral palsy, right? Mostly it happens during the child’s birth, some of them at birth or even pre-birth also. This child, she was 13 years old when we treated her and she could not walk to the bathroom.

So her dad carries her to the bathroom. Remember, imagine a child a 13 year old teenager, dad carrying her to the bathroom. So their goal was basically, can this child at least walk to the bathroom by herself? You know, we cannot completely cure cerebral palsy with JOGO. (But,) we can make great improvements actually.

So she had the same issues, spasticity. One of the biggest things she had was you know, the face drops and in the chin drops, for [00:26:00] the cerebral palsy children. That’s one. Second is the foot drop where they cannot walk. Right. They need help. So we worked on both of them. And this also gets six to eight weeks, I think, treatment.

And she, her chin went up and she started walking with some support. And for the first time she walked to the bathroom, right? So the dad doesn’t have to carry her. So these are amazing stories of children.

And there was another child, I even had a video. For four years, he could not walk. He was an intellectually bright child, four year old. He walked for the first time with the walker. But still, his legs would just topple before. But now he could stand and walk with the walker.

The joy in his face was like, you wake up and “okay mission accomplished”, for my company, [00:27:00] when you see these children.

[00:27:03] Alan Kotun: That’s the thing it is really impact almost on a stereotypical biblical scale where, the lame can walk almost in a way. And, It reminds me of some of the use cases of gene therapies in some rare diseases, for example, where in some cases you can have a patient who is blind who now with this treatment can literally see.

And you can imagine, like you said, seeing the smile on that person’s face, seeing the impact that you’ve brought to the life is really hard to even capture.

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