Rishi Sikka, M.D.: Hi, I’m Rishi Sikka, one of the co-hosts of Day Zero, and I’m excited today to be joined with Dr. Bea Bakshi, CEO, and co-founder of C the Signs, an AI cancer detection company in the uk working with the NHS and preparing for their US launch. So excited to have Bee here today. Bea I’m so impressed by all the work you’ve. And where you’ve gone with this, perhaps equally as interesting as you being a CEO and co-founder is your personal story and you bring so much of that personal story into your leadership and your approach. I’m of Indian origin, you’re of Indian origin but underneath that particularly for you, there’s the sort of polyglot of cultures and and backgrounds and experiences growing up. I wonder if you could just share that a little bit with our view. About some of that background and experience and how that actually kind maybe even affects maybe even your leadership a little.

Bea Bakshi, M.D.: Yeah, absolutely. And thanks so much Rishi, for having me here today. My, both my parents my mom’s actually from Kenya, Nairobi, my dad’s from Kashmir in India. And they both met actually through a newspaper advert many years ago. And after meeting on a newspaper advert, they got married and then they chose to settle in in London, in the uk. And it was a really interesting mishmash because. Of many different cultures, many different religions actually as well at the time. And then I, as a from first generation immigrant parents ended up going to a Church of England school as a child. So it was one of those things I was embraced with a lot of diversity and a lot of different cultures, ethnicities, and faced very early. Which meant that there was such a colorful collaboration of looking at what is the thread that ties everything together. And it was very much a value-based system that drove me in my upbringing, in how my parents raised me, my brother and my sister. And looking at good work ethics, morality, like looking at how we can serve society and give back to society and more holistically in that way, which really shaped who I was, who I am.

Rishi Sikka, M.D.: And that values-based approach that came from all of these pieces and backgrounds really. It affected your decision to go into medicine? So many people that we talk with on both this program and in general they go into medicine because their parents maybe were in medicine or they had an experience with the healthcare system. You actually went into medicine because of a, of an experience you had in retail and and being mother in retail and I, on the retail side of things, I was wondering if you could share that and how that, prompted your decision to become a.

Bea Bakshi, M.D.: Yeah. In I had a I had a part-time job pretty much from the age of 16 straight through to university and till I started as as my, in my first year as a doctor when I was 24. And when I was 16 in this first job, I I was selling shoes essentially in a store. And it was one of those things that we used to be incentivized to open store credit cards in being able to get patient get customers essentially to take on store credit, buy loads of shoes, and obviously increase the sales of that we could. And I have this one vivid memory where a customer came in and she was looking for some boots and the boots just looked awful on her and it was really clear that they just didn’t suit her. But my manager at the time and very much kind of the retail mentality was very much no, they look great. They’ll go great with your dress, like you should get them they make you look great, and things like that. And I remember that, that kind of really striking feeling inside to. Wow. Like I’m working in an industry where the alignment is about making money off the customer and it doesn’t necessarily synchronize with the alignment of deriving that value that the customer might want. Longer term and more holistically. And it was the idea of what motivates that industry and what motivates then me and my pursuit in the United Kingdom, when you choose to go into medicine, you actually have to make that decision at the age of 16 because it’s a very linear career path, even entry of what subjects you do. And then you start medical school at 18. So for me, at that point, and I just, I happened to be good at science at the. Health just naturally. It was a natural attraction for me because the NHS in the United Kingdom and the National Health Service was something that was based on point of need. And when the patient won, you won. And it was driven by outcomes and it was driven in a very purposeful way that we weren’t talking about profit margins and we weren’t talking about, one person winning and maybe one person losing. Like everyone wins in the system when a patient wins and you can improve outcomes. And that kind of value-driven way of like access that point of need. And taking out the inequalities there as well was something that was very attractive and very motivating, but also really nicely aligned to my own personal value base.

Rishi Sikka, M.D.: I, I love that story because it ties in your background from your values, and I love that statement you said, when. Patient one you want. And I know you bring that perspective into your work, prior to you, founding the company like many physicians, my, myself included, there are patients you remember and there are patients in some ways that haunt your dreams for forever as well. And you had two or three patients not to put words in your mouth or to project that haunted your dreams, but that you still remember to this. And we’re really critical in terms of you taking that next step to deciding you want to build a company. And I was hoping you could share that story with our viewers too.

Bea Bakshi, M.D.: My very first patient that when I started out as a house officer, and it’s one of those things. The transition from medical school to day one as being a doctor is something that is daunting, I think, to every single physician. And often really weirdly, it’s about kind of paperwork and kit boards and like making sure you’ve got enough pens for ward rounds, really bizarrely. And it was the kind of naivety of all of that and making sure I’m prepared to then actually walking into a patient’s room and that. All of a sudden, everything changes. And within that 15 minutes when you’re at the bedside with the entire clinical team, and this was on a colorectal ward, you are straightaway pulled into that patient’s life, that patient’s story. And this particular patient was around a 45 year old woman with ovarian cancer. Who essentially said three weeks ago she was dancing at her kind of niece’s wedding, and now was completely bedridden with metastatic ovarian cancer. That was just picked up late. And I vividly remember having her hand on like her holy book, her son there, who was a dental student at the time and went to the same university as myself. And that connection of wow, this could be my. In this situation and that kind of really haunting reality. But coming out of that room and every kind of healthcare professional ran me and my consultant at the time it just very much feeling like it was just a sad case, like for this one lady. And this one scenario. And then fast forward when I was on an oncology ward doing my looking after cancer patients, having one patient that I then cared. On a more personal level over months and months, and then just after one bout of radiotherapy. This patient had a tracheostomy, they had a head and neck cancer and just happened to be walking towards me from his bedside and all of a sudden just bled out from his tracheostomy site. And it was one of those really violently horrific things that you see where the hardest thing I think as a doctor is when you physically can’t do anything. And at the time I remember like bringing the crash trolley and trying to see what we can do to resuscitate this patient and a senior just tapping me on the hand and. We need to just get some morphine for this patient just because of it. It was too far gone and they had hemorrhaged, like over a litter by this time. And there wasn’t really much we could do. And then the last one where I think up until then, it was very much these are just sad stories. And then being in er and actually losing a patient where they came in, diagnosed him with metastatic pancreatic cancer. And again, unlike previous stories of why did I get cancer or it’s so sad. The complications around it, this particular patient really challenged me and was just like I did all the right things. I saw my physician. I kept going back. I told them something was wrong, and actually the system failed me and it was the first time that I think that challenge and that changing questioning made me question to say. Actually, is it the system failing these patients that are being picked up late and dying from cancer? Or is it the case that cancer is just a sad eventuality of a disease that we just don’t know about much about? And that really led me to the discovery of actually what are the stats and statistics behind cancer and actually how do we perform as a country and more globally from that per.

Rishi Sikka, M.D.: Incredible story. And thank you for sharing that and your candor and your the passion you bring from that. So you go from having a values space. The decision to enter medicine and realizing that the patient wasn’t winning, so we weren’t winning seeing the problem. And then you found out that there’s really no solution out there. And it’s not happening. And you decide then that you’re gonna build after so much work, so much research to build your own company. Tell us a little bit about that piece and then what does C the Signs do? What does. What does your software do and what has that?

Bea Bakshi, M.D.: Yeah, so after that experience, it. Challenged me to say what is the data? And having looked at it, cancer’s the second leading cause of death. Globally it counts for one in six deaths and both kind of in the US and the uk. It’s the second leading cause of death as well. And when you break that down to say, why are most people dying from cancer? It’s actually down to a late stage. Detection. And there’s essentially, if you diagnose patients in the early stages pretty much nearly a hundred percent of patients will survive over five years with their cancer and many will actually survive 10 years or more from their cancer. So for me, it was one of those things that, again, it just didn’t sit with me, the fact that, all of these patients who have been picked up late and been diagnosed in the later stages. And that’s really where, see, the signs was born. It really struck me at the time to say in the age where we have such advancements in technology and AI and big data. Why at the point where a healthcare professional meets a patient, where we just relying on human beings because doctors are human beings and we are fallible and relying on the clinical experience of a human being at that point in time to essentially identify one of the most complex diseases out there reliably and accurately. And with over kind of thousands of papers that get published, every week, every month, whatever. Again, like human beings just don’t have the capacity to like, retain and absorb that much data. So it was this opportunity to say, actually, if we can make data accessible and available at point of care, we can consider risk stratifying patients at that first touchpoint to. Is this patient at risk of cancer? If so, what cancer and what do I need to do next to make sure we can diagnose this patient as early as possible? And that’s really what see the sign does for healthcare professionals essentially.

Rishi Sikka, M.D.: So you are in the UK right now. You are in the nhs. Tell us. The deployment where you’re at, some of the results and the performance that you can share to.

Bea Bakshi, M.D.: Yeah, so super exciting. We’ve had really great traction and impact in the n h. We’re servicing about 15% of primary healthcare in the n h s, and we pretty much focus on primary healthcare just because we’re trying to capture where patients will present first within the healthcare system. And primary care is always the root in we’ve seen fantastic results. We’ve diagnosed over 10,000 patients with cancer already through our platform, over 50 different types of cancers that we’ve diagnosed through that. And that’s from really complex cancers like ovarian head and. Brain pancreatic cancers, we’ve even diagnosed children with cancer through our platform that we’ve been able to pick up. So it’s been really gratifying to see the results and actually see the results very early on because it’s a software based approach. And as you can imagine, as patients come through, every patient can literally be risk assessed and re stratified. We can start actually seeing the impact the system. On identifying patients at risk of cancer and then diagnosing these patients with cancer rapidly. We’ve also been able to see great data when it comes to the sensitivity of the platform, which is basically around 99% and the tumor accuracy of the platform as well, which is around 96%, which means that. When we predict which cancer types the patient has, we’re pretty accurate in being able to recommend the most effective route to diagnosis. So we’ve been able to be very cost effective also in the approach to early diagnosis by using resources effectively rather than saying, actually, if you scan a hundred people, yes, you might find cancer, but how do you consider scanning the right hundred people to find those cancers?

Rishi Sikka, M.D.: That’s an incredible value proposition there, that you’re not just facilitating diagnosis. You’re not just facilitating early diagnosis, but doing so in, in an effective and efficient way, which is just so paramount. Whatever health system you’re in. We’ve had a couple founder CEOs on day zero who have come from a an international market and then are coming to the US and it always seems like they’re gonna hold on for their, like they’re on the rollercoaster because it is so different. Tell us a little bit about some of your first impressions or more recent impressions and thoughts as you prepare. Moving from a what is essentially a single payer to the US market. So observations and perspectives or challenges that you’re seeing.

Bea Bakshi, M.D.: I guess the biggest thing coming from a system that’s based on like point of need we’re moving to a system which is based on point of coverage, right? What coverage do you have will determine what access you get rather than actually your need. And I think it’s amazing to see what the Affordable Care Act has done in in, in the United States since that was introduced. Fundamentally, going back to my values is that healthcare is a fundamental human right and. To survival from cancer is a fundamental human right. So then when you look at the stats across cancer care in the us, especially when you look at those patients with, who don’t have the same coverage as say, a private insurance or Medicaid background or those who are either at, paying out-of-pocket, et cetera, that those patients will have poorer outcomes. Whilst we know that, the number one cause of, bankruptcy and things like that is medical. Actually the main reason for that is actually cancer related, oncology related costs. And there’s a lot of data out there by a lot of the cancer institutions to show that patients will be rationalizing their chemotherapy. So if it’s once a week, they’ll take it once a month because they can’t afford to take it once a week and things like that. When it comes to thinking about how we approach cancer, number one is looking at how do we get rid of financial toxicity.

Rishi Sikka, M.D.: The other layer of complexity that. Probably, dealing with, in addition to entering a new market is just this macroeconomic environment we’re in of inflation, of the possibility of a recession or perhaps we’re in a recession. There’s now in the past two weeks, two, three weeks, banking instability. How is that affecting your leadership or how you’re thinking about a US entry or even how it’s affecting you in the uk, if at all.

Bea Bakshi, M.D.: It’s a good question, and I think it’s one of those things that it’s it’s just normal. I feel like in the last five years running a company in, in, we had Covid, we had the Ukrainian the war in Ukraine. And many of my team members are Ukrainian. We have developers out there. Uncertainty and obstacle after obstacle is something that now has just become a normality of. Founder life that I think for me it’s just something that we have to be prepared. We have to be resilient, and we always have to be very aware of every step we take. But again, risk is something that comes part and parcel, I think is one of those things that we’re looking very closely at. Markets. We are shortly, we’re gonna be fundraising our next round soon so that again, it. Lots of nuances, especially as I have to, as someone, who is a person of color fundraising, in this environment, which we know already is that like less than 2% of women of color get fundraising, right? And this was like pre risk, pre this type of financial environment. So again, all of these risks and things, I feel like it’s almost been like from day one that you are battling away. So I feel like it’s just yeah, it’s, it just feels normal now.

Rishi Sikka, M.D.: What has changed about your leadership approach or your style as you’ve actually made that tr transition from being from physician to ceo?

Bea Bakshi, M.D.: I think the biggest difference is that in medicine, I feel like it’s very textbook, it’s very formulaic what we do in the sense of like a patient comes in, depending on the combination of symptoms they might have, you know exactly what you’re gonna do, the order of what you’re gonna do in the sequence of events, whereas, Every single day is like a brand new day in, in startup world, and even what we are trying to build and create at C the Signs doesn’t exist. So there isn’t a rule book or a template or even something I could put on my vision board to say, I wanna be like that and I wanna do that or get to that place. It’s one of those things that when you are aware of. Uncertainty and uncertainty is literally driving everything. And as new technologies come through, it’s okay, can this technology be used? How will it impact us? Is it something that can help us get there to our purpose and our mission? But it’s the It’s almost an excitement as well of the unknown and taking a journey down a path, which is the unknown as opposed to when you go into clinic and it’s a very predictable day. Sometimes even within the context of the unpredictability of you dunno what patient you’re gonna see. So I think there’s an excitement, but also there is a change of expectation because in the classroom and in the clinic, you can practice for an. And you’ll be perfect in real life. That’s how medicine works, right? You practice at a recess such situation, and then you’ll be very good when a recess comes through. It doesn’t work like that in in, in startup world.

Rishi Sikka, M.D.: You’ve got some very powerful reminders for all of us of the reality and the challenges that that founders face in, in that regard, you’ve accomplished so much. You’re having such tremendous impact and. Hopefully you’ll, you will have more. What advice would you give to a physician who’s listening to this podcast and they’re thinking about starting a company, or they have an idea and they’re gonna take that step. What advice or guidance might you give to them?

Bea Bakshi, M.D.: Just do it. Just do it. I think one of the things that I’ve seen a lot of physicians do is they feel that they need to Go get do a course or get a degree in digital health or things like that in order to be proficient in it. And I see, obviously there are so many courses through that, but as physicians, you don’t realize how many of your skills already are completely transferrable. Like the fact that you can do pattern recognition very well, you can adapt very well to uncertainty in what’s coming through the door and things like. You have great problem solving skills as well as a result of that. Like you don’t need to go out and do a course in whether it’s digital health or it’s health innovation and things like that. I of feel like your skills are transferrable enough that if you had an idea, you would know how to implement it and think about it in just a, kind of an approach to test it out. I feel like physicians feel like they need to be proficient with a certificate sometimes, and actually you don’t really need to. And yeah, just get out there and do it really.

Rishi Sikka, M.D.: That is incredible advice, and if I could express something, is that, you are o obviously not just a values-based leader, but a leader driven by mission. By connection and, for all that you’re doing and for all that you will do on behalf of your organization. I’m rooting for you. We are all rooting because if you win to go to, to paraphrase your phrase, if you win, the patient is winning. We are all gonna win. And in the field of cancer and cancer detection, that is so critically important. Dr. Bea Bakshi, CEO o co-founder of C the Signs. So grateful to have you here on Day Zero. Thank you for all you’re doing and awesome luck and success in the time ahead. I’m rooting.

Bea Bakshi, M.D.: Thank you so much, Rishi. Thank you.