Episode #88
Dr. Andrew Holman | CEO of Inmedix | Innovative Diagnostics in Rheumatology & The Power of Stress Management
Dr. Andrew Holman is a rheumatologist and the CEO of Seattle-based Inmedix, which recently received FDA clearance for the first cloud-based heart rate variability (HRV) diagnostic platform. Dr. Holman shares how a “detective” mindset led him from early interests in orthopedics and cardiology into rheumatology, fibromyalgia research, and ultimately entrepreneurship. He explains how chronic stress, the autonomic nervous system, and conditions like sleep apnea and restless leg syndrome can influence cardiovascular risk and autoimmune disease outcomes, and why measuring stress biology with medical-grade precision matters. Dr. Holman also offers hard-earned advice for physician-innovators, reflects on pivotal study results, and shares what he hopes to be remembered for: never dismissing patients in distress. Guest links: https://www.inmedix.com | https://www.linkedin.com/company/inmedix-inc Charity supported: Save the Children Interested in being a guest on the show or have feedback to share? Email us at theleadingdifference@velentium.com . PRODUCTION CREDITS Host & Editor: Lindsey Dinneen Producer: Velentium Medical EPISODE TRANSCRIPT Episode 088 - Andrew Holman [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello, and welcome back to another episode of The Leading Difference podcast. I'm your host, Lindsey, and today I'm delighted to be welcoming as my guest Dr. Andrew Holman. Dr. Holman is a rheumatologist and the CEO of Inmedix, a Seattle-based medical diagnostics company that recently received FDA clearance for the first cloud-based heart rate variability diagnostic platform. He has 25 years of clinical experience with 16 peer-reviewed papers and clinical trials demonstrating that measuring stress biology with medical grade precision can improve success rates in autoimmune diseases. All right. Andrew, welcome to the show. I'm so glad you're here today. [00:01:30] Andrew Holman: Yes, happy to be here. Thank you for inviting me. [00:01:33] Lindsey Dinneen: Course, of course. Well, I would love, if you wouldn't mind starting out telling us a little bit about who you are, what your background is, and what led you to medtech. [00:01:44] Andrew Holman: Sure. Well, I'm a, a guy from Seattle, Washington. Grew up here, but trained everywhere else, became a rheumatologist. We study autoimmune diseases, lupus, rheumatoid arthritis. I also was very interested in fibromyalgia and pain. We're the immunologists of medicine. So, I started my practice, golly, a while ago. 1992, I finished my prac- my training, and I was the main rheumatologist at a large suburban hospital at the southern end of Seattle. So hometown, circle back to the hometown. I went into rheumatology because you have many choices when you do internal medicine. You can go be a specialist in many things. But I like the puzzles. The immunology has grown and it's a, it's a particularly sort of detective-oriented specialty. So, I didn't set out to be an entrepreneur. That came 25 years later. I was an in-the-trenches doc trying to help the person in front of me with these devastating diseases that are crippling diseases, usually of young women mostly. [00:02:45] Lindsey Dinneen: Yeah. Okay, and I'm sure there's, there's much more we're gonna dive into, but one thing that really stood out really fast was you, you kind of called yourself a detective, which I really love that term. And so I'm curious, is that something that you always thought you wanted to specialize in, in medicine, or was this, you know, detectiving to come later? Was this something that, you know, you ended up learning more about while in med school and thought, "Oh, this sounds really cool. I could put really two interesting passions together"? [00:03:19] Andrew Holman: Yeah, it was-- you know, things just sort of come into play sometime. For those who are not in medicine, they may not realize it takes about ten years to go to college, med school, re- internship, residency, fellowship, you know, and then you, then you finally get to go be a doctor, and you have to go learn how to be a doctor s- a little more. The patients teach you a lot more than people realize. So I was gonna be an orthopedist. I liked orthopedics. I liked architecture, bones, joints. I thought it was a lot of fun. I just had very little aptitude for what they do. I, I don't-- I, I'm not very g- a good carpenter. I just, you know, I didn't-- just wasn't gonna be a great orthopedist. So then I thought, "I really love cardiology." Rhythm disturbances, all kinds of things. In the 1980s, when I was in medical school , all the new stents and procedures and non- less invasive things than bypass surgery were all coming up. Joint valve replacement. You know, it's really exciting. But I never... and I never took a, a f- a course in rheumatology until I was actually an intern in internal medicine program in Denver, all set to be a cardiologist. And there were 12 of us in the, in the program per year, and s- five of us became rheumatologists because of this one doctor who took us out, a guy named Daryl McCarter. Prob- maybe people who know him, he's retired recently. He would bring us in the office, and we'd see every other patient with him because in between the patients, he would give us an X-ray, say, "I want you to look at this. There's a clue here. See if you can find it." Or, "I want you to look at this pathology slide," or something. "There's a secret, you know, to figure this one out." And I go, "Wow, this is really fun stuff." And once you figured it out, we weren't as good at treating it yet, but we were getting better. We were getting better. So it was the cutting edge and very fertile ground for discovery. So, rheumatologists are called the consult of last resort for a reason. There aren't very many of us. You've usually seen everybody else first, and by the time they-- you see us, we're pretty good at figuring out the rare diseases that are not in other people's board exam. But we're also pretty good at figuring out the common disease that presents in a very strange way, you know? And, and that's what our strength is. So we may... Everybody who sees us who gets diagnosed may not have a rheumatology answer, but we try to get them an answer. And now we're really in the golden age of rheumatology in the last 20 years of really making a difference for so many people. The downside, we don't make a difference for enough people, you know? We, we... That's the problem. So we've got these very motivated doctors out there, eager, and we just need, you know, more. And that's why I became an entrepreneur, because I learned more neurology than I was supposed to know and more sleep physiology than I was supposed to know. You just follow the breadcrumbs, you know? [00:06:17] Lindsey Dinneen: Yeah. Okay, so I know you didn't start out wanting to, or maybe even being interested in being an entrepreneur, but that is the path that you chose, and I would love to hear about that, the company, and what you're all doing. And then also would love to hear about your journey into deciding that this is the next right step for me. [00:06:38] Andrew Holman: Yeah. Well, thanks for asking it. It is a little unusual. So I was actually studying and trying to help patients with fibromyalgia about 30 years ago. And fibromyalgia patients terribly dismissed till they're all making this up. There's not 10 million people that can make anything up and be consistent. I mean, they all say the same thing. So I thought that was nonsense, and I was really thrown into the crowd of, you know, "You're, you're crazy too." And I go, "Well, I'm board certified in crazy." So I w- I was interested in it, and I was irritated that these people were dismissed. And I was around other doctors in Seattle who were similarly that way, which was very, very unusual. It's unusual to find people in the '90s who had an avid interest in that disorder. And so I started doing what rheumatologists are good at, incrementally advancing ideas and therapeutics very carefully, very cautiously. We do a lot of things off-label. When I was-- finished my fellowship in 1992, half the diseases on our board exam had no FDA-approved treatment. We had to do something, right? You couldn't just say, "Well, come back when there's a couple of articles in the New England Journal of Medicine." You, you can't do that, right? People are depending on you. So rheumatologists are particularly good at that, and that's not something most doctors want to do. Most doctors find that very uncomfortable. They're very, very careful people. And, and rheumatologists are careful too, but we take this mission seriously that we need to do something for you. So basically, I was looking at off-label ideas and work on fibromyalgia, and I'll share this with your audience. I was actually pulled up-- pulled in by some senior doctors who said, "We wanna talk with you." And I'd been there about three years as a new doctor. Oh, you know, seem to be doing a good job. Maybe they wanna pat me on the back or something. No, not that. It was actually an intervention, which I had never... I mean, I had no familiarity with what an intervention was. And they said, "Look, we like you. You're a great doc, but you're gonna ruin your reputation if you believe all these people, mostly women And you really need to not take it so seriously or write prescriptions for this c-- this and that." I said, "Well, thank you very much." That's polite. That's not what I was thinking. And I, I... But it prompted me to pull all the charts and say, "You know, I think I'm making some progress here with some ideas here, and let me see if I'm getting fooled and just seeing the people who get better to come back. Let me really honestly look at my performance." And so I pulled about 200 charts. It was my first abstract at the national meeting. And you know what? We were making progress. That had morphed into more progress, following the breadcrumbs, looking at neurology, looking at the autonomic nervous system. So that was about a five-year process. Y-you know, I didn't lose my reputation, obviously. I lecture around the world now. But it led to being very careful about getting clinical evidence if I had a hypothesis. And so we were using the office, and we actually finally did a double-blind prospective study where I bought all the drug myself, had it reformulated, little capsules that, you know, and, and worked with the FDA to get permission to do the study. And that study in fibromyalgia to this day has the highest response rate of any fibromyalgia study for pain that's ever been done. Now, we don't use that treatment anymore. It's 20 years later, we have other things to do. But it did prompt Pharmacia, got bought by Pfizer, I believe, and Boehringer Ingelheim, which co-marketed the drug I was using and reporting on, to pay me $10 million for the patents that I had filed, utility patents. I didn't own the drug. I didn't use it for Parkinson's disease, but I thought there was use in fibromyalgia. So before I told the world, I filed utility patents, and they wanted to exploit that discovery. So did two other pharmaceutical companies, and they had to pay for the privilege of doing it. So at 46, I retired. So I didn't intend to do that, but I do come from a family of lawyers and judges, and so the idea of having a utility patent on a n- a new innovative idea was not a foreign concept to me. [00:10:40] Lindsey Dinneen: Yeah. [00:10:41] Andrew Holman: That is something I teach all young doctors. [00:10:46] Lindsey Dinneen: That is awesome, and I, I was thinking, okay, this is a great segue because first of all, that's an incredible story. Secondly, I, I would be very curious to know exactly that, what is your advice for some of these incredible physicians, great ideas, that are potentially going to end up becoming an entrepreneur just because that's the path that, that is sort of presented to them? What is some of your advice for that? 'Cause that can't just be... you, you had the privilege at least of, of, of knowing and having some background in that, the legal aspects of IP protection and whatnot, but what are some of the things that you tell people? [00:11:22] Andrew Holman: Well, a couple things I would say and I have these conversations often 'cause I really like the younger people coming along. I say, first of all, don't define yourself as an ent- as being an entrepreneur. Make sure you have other things in your life that are more important to you. Now, the investors are not gonna like to hear that. They, they want you to live and die on your, on your company, right? But I'm saying, you know, you don't have to tell the VCs, but have other things that matter more in your life. You still gotta work really hard because you may, you may find that it's really a slog, and it's very long, and it's very hard. But, you know, make sure that, that, that what you-- though is important, your family, you know, your integrity the scientific problem at hand, the patients, you know, they're number one. Make sure we don't lose sight of all that, and do a few things. Go for a walk. Do something for yourself. Something. I do this twenty-four seven for the last 10 years, you know, every day 'cause I love doing it. It does wear you out, though. Even if you make-- even if you're successful with milestones, it does wear you out. But that's what I tell them. I say, "You know, make sure that you take care of yourself a little bit, too." It's kinda like a analogy. What do you do for a pregnant woman who has a, who has a, a lupus? Lupus is terribly dangerous for the fetus and for the mom. Though the worst thing you do to-- for the baby is not take care of the mom. Take care of mom, [00:12:44] Lindsey Dinneen: Mm-hmm. [00:12:45] Andrew Holman: then get the baby delivered. So, you know, everybody's talking about the baby, but take care of mom. That's the most important thing you do for that baby. So that's kinda what I would say. [00:12:54] Lindsey Dinneen: Yeah. Yeah, that's great. I appreciate that. Yeah, that, that makes a lot of sense too. We've been talking, actually it's been a, a bit of a theme too lately in some of the conversations that I've been having with folks, especially leaders, to talk about that identity component and, and be aware that your job isn't the only thing that defines you or needs to. There's a lot more to your life. There's a lot more to who you are. And so also, you know, our identities change over time and how you refer to yourself and th- those are, those are good things. That's growth, that's movement. So, being comfortable with who you are outside of your career. Yeah. [00:13:33] Andrew Holman: The other thing too is, you know, people used to joke 20 years ago that participation mem- medals were like a farce and what. That's the l- that's the last thing I would say to anybody. Give yourself a pat on the back for going out there trying to attack the castle, you know. Give yourself some credit there because a lot of people just wouldn't do it. My middle daughter was a hundred-meter hurdler at Boise State. She's a Division I athlete. There's a lot of sprinters out there that don't wanna get anywhere near that hurdle 'cause it really hurts when you hit it, right? And so half of that was not-- was being brave. So be brave, be brave, you know. My other daughter was a Division I athlete at Rice. She was a h- she was a volleyball player. Yeah. So, yeah. So I, I, I, I watch other people, see how they persevere and, you know, okay, gotta pick yourself up. Gotta go. Gotta get up this morning. Gotta go. [00:14:23] Lindsey Dinneen: That's right. That-- Yeah. [00:14:25] Andrew Holman: Then remember, people are depending on you, not just your investors. I take that so seriously. But the s- the people who have decided that they're gonna hook their wagon to you. [00:14:34] Lindsey Dinneen: Yeah. [00:14:35] Andrew Holman: You know, that's a lot of responsibility. [00:14:37] Lindsey Dinneen: It is. Yeah. [00:14:38] Andrew Holman: Give yourself a little credit that you're stepping up. [00:14:41] Lindsey Dinneen: Yes. Great advice. Yeah. Okay, so all right. So let's talk about your company now. So now you're an entrepreneur, in addition to obviously the rest of who, what makes you, you. But and I know that you're also a clinical professor, and I would love to hear about both of those things if you don't mind sharing. [00:14:59] Andrew Holman: Yeah, sure. So, technically I'm an associate clinical professor at the University of Washington. A, a lot of private docs do, and they participate in helping teach the y-young residents and fellows and so forth. So it's a joy to me. I, I think my job is a job of teaching. I'm constantly talk... I'm not-- I don't see patients anymore, although I do maintain my license in malpractice 'cause I get, I get contacted for the fibromyalgia work I did. So it's, my email's on the papers, right? So I, I don't wanna let that go. People need help. But basically, we're constantly teaching patients, you know. Now, we're listening, hopefully do better and better at that, but then I have to make a case. You know, I'd, the-- I'd like you to try this or that. Why do I wanna do that and so forth. We're constantly, you know... We don't-- It, it sounds too trite to call it selling something. We're not doing that. We're in there with you. We're collaborating. But I have to be, I have to have a reason and be persuasive and all that, so that, that academic teaching part's kind of fun. Now, sometimes I go into the lion's den. I will tell you, it's a little nerve-wracking to give rheumatology grand rounds at Harvard. Yeah, yeah, okay. You know, and the University of Washington, they're a little friendlier. It's my hometown. But Guy's Hospital in London and the Hospital for Special Surgeries, I... My first rheumatology grand rounds came at the HSS in 2009. I get there, I completely bomb. All these famous people are in the front row. I'm... They're, they're just not buying any of this thing we call immunoautonomics and how stress affects the immune system. I'm quoting the NIH. I'm doing everything I... I know how to do it, right? Pathology slides, I'm there. Then I find out the way they pick the speakers is the fellows get to find something interesting, and they pick the speakers, not the not the high mucky-mucks. So the only reason I was there is because the fellows, the young folks, thought, "This is an interesting topic. We'd like to hear more." And it turns out they were 15 years ahead of the rest of the world, because this is the most fascinating topic of how the immune system affects the autonomic nervous system affects the immune system, so it inflames it. [00:17:03] Lindsey Dinneen: Yeah. Oh my gosh. Actually, that is one thing I wanted to talk about, 'cause I, I noticed on your LinkedIn profile there was, you know, a reference to how much stress affects cardiovascular health maybe particularly chronic stress. And I would just love to hear more about that and, and maybe some ways... I know there's like, y- of course you always get your standard, "Here are some th
