WEBVTT - Targeting Pain (Sponsored Content) 0:00:00.520 --> 0:00:03.720 Since you're a subscriber to this Bloomberg podcast, we thought 0:00:03.720 --> 0:00:07.320 you'd be interested in a sponsored podcast called Targeting the 0:00:07.360 --> 0:00:12.400 Toughest Diseases, produced by Vertex Pharmaceuticals and Bloomberg Media Studios. 0:00:13.039 --> 0:00:17.599 It explores the innovative tools, methods, and unique philosophy Vertex 0:00:17.640 --> 0:00:21.159 Pharmaceuticals is using to search for treatments for some of 0:00:21.280 --> 0:00:30.200 humanity's most challenging diseases. Here's a recent episode. 0:00:28.600 --> 0:00:31.680 That's Damian Sanchez or if you are a jazz fan 0:00:31.800 --> 0:00:34.800 living in Miami, Damian j Well. 0:00:34.840 --> 0:00:37.320 I play all types of music, but yes, my passion 0:00:37.440 --> 0:00:41.920 lies in the jazz genre. The history of jazz inspires 0:00:41.920 --> 0:00:45.400 me to create. I get very passionate about talking about 0:00:45.400 --> 0:00:48.280 the history of jazz from its very beginnings until today. 0:00:49.479 --> 0:00:51.640 His passion started when he was twelve years old. 0:00:52.280 --> 0:00:54.760 I saw a picture in a magazine that changed my life. 0:00:54.760 --> 0:00:56.600 When I was young. It was a picture of a 0:00:56.640 --> 0:01:00.440 young man who was holding every single woodwind could play 0:01:00.480 --> 0:01:02.880 them all, and so I wanted to be like that kid. 0:01:03.360 --> 0:01:06.919 Damien started with the obo, then the flute, the alto, sacks, 0:01:06.959 --> 0:01:09.000 the clarinet, and even the bassoon. 0:01:09.920 --> 0:01:12.880 I also play guitar. I also play piano, and I 0:01:12.920 --> 0:01:17.040 also play various percussion instruments, mainly Latin percussion stuff because 0:01:17.080 --> 0:01:19.840 it's part of my project to perform Latin jazz. 0:01:22.640 --> 0:01:24.959 But on a day that should have been a musical celebration, 0:01:25.800 --> 0:01:27.640 Damien's life took a terrible turn. 0:01:29.640 --> 0:01:29.959 Hi. 0:01:30.200 --> 0:01:33.559 I'm Jordan Gospore, a member of the University of Southern 0:01:33.600 --> 0:01:38.000 California Center for Health Journalism. This is Targeting the Toughest 0:01:38.000 --> 0:01:43.080 Diseases a podcast produced by Bloomberg Media Studios and Vertex Pharmaceuticals. 0:01:44.319 --> 0:01:47.199 In this series, we look at some of humanity's most 0:01:47.360 --> 0:01:51.800 challenging diseases and how Vertex, a Boston based biotech company, 0:01:52.280 --> 0:01:56.440 is using innovative tools, methods, and a unique philosophy to 0:01:56.480 --> 0:02:03.960 search for treatments and cheers. Today we're looking at a 0:02:03.960 --> 0:02:08.200 cute pain. You might think pain is just a sign 0:02:08.280 --> 0:02:11.359 that something else is wrong in your body, but Vertex 0:02:11.440 --> 0:02:15.160 is looking at pain as its own unique condition. They're 0:02:15.200 --> 0:02:16.840 researching it as a disease. 0:02:20.760 --> 0:02:25.560 It's December twenty twenty two. I just finished about a 0:02:25.680 --> 0:02:29.280 month of rehearsals with a symphony, A very specific symphony 0:02:30.520 --> 0:02:36.880 made up of nonprofit organizations sponsoring young musicians and professional 0:02:36.960 --> 0:02:40.720 musicians here that play classical music that is of unheard 0:02:40.760 --> 0:02:42.239 of composers of color. 0:02:43.200 --> 0:02:45.440 This was the day of the inaugural performance. 0:02:46.360 --> 0:02:48.240 I wake up early that day. It was a Saturday. 0:02:48.280 --> 0:02:50.720 We're performing at the Broward Set of the Performing Arts, 0:02:50.760 --> 0:02:54.400 this wonderful hall in Fort Lauderdale, Florida. I live in Miami, 0:02:54.520 --> 0:02:56.280 so I grab my scooter. 0:02:57.919 --> 0:03:01.360 See, Damien doesn't like driving. He's not a guy that 0:03:01.520 --> 0:03:05.359 likes sitting still, and South Florida's traffic can be bad, 0:03:06.360 --> 0:03:09.880 so instead of a car, he uses an electric kickscooter 0:03:10.000 --> 0:03:14.280 and public transit. Getting to Fort Lauderdale means riding his 0:03:14.360 --> 0:03:17.520 scooter to the train station, taking the train up the coast, 0:03:17.880 --> 0:03:20.400 and then using the scooter again to get to the venue. 0:03:21.280 --> 0:03:24.160 I have my English hornant and my obow and my 0:03:24.280 --> 0:03:26.639 music and my backpack on my backstrapped on. I had 0:03:26.639 --> 0:03:27.160 my helmet. 0:03:28.080 --> 0:03:30.280 He's also wearing a brand new tuxedo. 0:03:31.760 --> 0:03:34.120 And I remember looking to the left and looking to 0:03:34.120 --> 0:03:38.320 the right and saying, ha ha ah, traffic sucks. 0:03:40.680 --> 0:03:43.440 Damien was in the bike lane going down a steep 0:03:43.520 --> 0:03:46.880 hill when a driver apparently attempting to get out of 0:03:46.880 --> 0:03:51.200 the gridlock, suddenly turned into the bike lane. 0:03:53.600 --> 0:03:55.760 I hit the front of her car with my scooter, 0:03:56.320 --> 0:03:59.240 which I do not let go of, which actually ends 0:03:59.320 --> 0:04:02.280 up flipping over the front of her car. I fly 0:04:02.360 --> 0:04:04.480 into the air and I land on my ribs, which 0:04:04.520 --> 0:04:07.720 get cracked, and my foot, my right foot get caught 0:04:07.800 --> 0:04:12.680 up in the accident, and my tibia and my fibuya 0:04:12.840 --> 0:04:16.360 both are shattered in many many places, and my leg 0:04:16.480 --> 0:04:21.520 is completely discombobulated, disjointed to the side. 0:04:22.960 --> 0:04:27.320 Damien didn't lose consciousness. In fact, he tried to stand up. 0:04:27.880 --> 0:04:30.960 And as soon as I put one ounce of pressure 0:04:31.120 --> 0:04:34.640 on that right foot, then the pain started coming in, 0:04:35.440 --> 0:04:37.720 very very strong. As you can imagine, I have all 0:04:37.720 --> 0:04:40.719 these broken bones in my right leg, and I'm trying 0:04:40.760 --> 0:04:42.960 to walk on it and walk it off like nothing 0:04:42.960 --> 0:04:43.600 ever happened. 0:04:43.839 --> 0:04:48.320 A crowd gathered and someone called for an ambulance. Within minutes, 0:04:48.400 --> 0:04:50.840 he was in the emergency room of a nearby hospital. 0:04:51.880 --> 0:04:54.240 The pain in his leg was unbearable. 0:04:57.440 --> 0:04:59.560 This one guy says, we're gonna give you morphine and 0:04:59.600 --> 0:05:02.640 we're gonna manipulate that leg until they're ready to operate, 0:05:02.720 --> 0:05:05.640 because it needs to be manipulated. I said, I've never 0:05:05.680 --> 0:05:08.680 had any drugs. I don't take drugs. They said, well, 0:05:08.680 --> 0:05:12.120 you're gonna want it. I said okay, and they gave 0:05:12.160 --> 0:05:14.200 it to me through my ivy and I felt like 0:05:14.240 --> 0:05:17.240 I was really drunk. And then he grabbed my foot 0:05:17.279 --> 0:05:24.120 and put it back in place. I ready didn't feel inebriated. 0:05:24.200 --> 0:05:27.279 I was laughing. I was joking, you know. I was 0:05:27.320 --> 0:05:30.760 being very bubbly, which I usually am anyways, but I 0:05:30.839 --> 0:05:31.760 was kind of scared. 0:05:34.040 --> 0:05:37.000 After a few hours, the drugs were off and the 0:05:37.040 --> 0:05:40.320 pain returned. It was time for a second dose. 0:05:41.120 --> 0:05:44.680 I wasn't gonna take anything. I didn't want to get hooked. 0:05:45.600 --> 0:05:49.560 My family has a lineage of substance and alcohol abuse. 0:05:50.279 --> 0:05:53.279 My brother fights it, and my uncles fought it, and 0:05:53.320 --> 0:05:55.200 I've always had that trauma in my brain. 0:05:55.960 --> 0:05:59.960 It's a horrible decision many patients face, choosing between pain 0:06:00.360 --> 0:06:04.039 and the risk of addiction. The doctors tried their best 0:06:04.040 --> 0:06:04.800 to persuade him. 0:06:05.200 --> 0:06:07.280 They were all about it. They were all about it. 0:06:08.360 --> 0:06:10.159 Now you sure, are you sure? You don't want to 0:06:10.200 --> 0:06:12.880 think nothing? What are you going to do? I'm just 0:06:12.880 --> 0:06:13.640 gonna deal with it. 0:06:15.720 --> 0:06:18.400 And that's what many patients do when faced with acute pain. 0:06:18.920 --> 0:06:20.400 They just deal with it. 0:06:21.480 --> 0:06:25.640 I never took any pain medication no matter how bad 0:06:25.680 --> 0:06:28.320 it hurt. But yeah, the first three months were hell Man. 0:06:29.600 --> 0:06:32.880 Pain isn't entirely a bad thing. It's actually an important 0:06:32.880 --> 0:06:36.240 warning system. It's our body's way of telling us something 0:06:36.320 --> 0:06:36.719 is wrong. 0:06:37.839 --> 0:06:40.240 Typically, you expect a broken limb to hurt a lot 0:06:40.279 --> 0:06:43.640 when you injure it gradually get better. It'll be a 0:06:43.760 --> 0:06:47.200 key for a few weeks, but as it heals after 0:06:47.240 --> 0:06:49.840 three months, you would not expect someone to still have 0:06:49.920 --> 0:06:51.360 pain from that broken limb. 0:06:52.279 --> 0:06:54.839 Doctor Norman Buckley is the director of the Michael G. 0:06:55.000 --> 0:06:57.960 Degrout National Pain Center in Hamilton, Canada. 0:06:58.400 --> 0:07:02.640 There certainly are settings where people continue to report pain. 0:07:03.040 --> 0:07:06.360 Then you have to consider what's the reason for that, 0:07:06.839 --> 0:07:07.240 he says. 0:07:07.320 --> 0:07:11.440 Doctors have used medicine to manage pain for centuries. Opium 0:07:11.480 --> 0:07:15.200 in the sixteen hundreds, ether and chloroform in the eighteen hundreds, 0:07:15.680 --> 0:07:20.040 then morphine and even heroin in the nineteen hundreds. More recently, 0:07:20.520 --> 0:07:25.720 insets have been used. Those are nonsterodal anti inflammatory drugs, 0:07:26.320 --> 0:07:29.880 and of course opioids, which can be effective but bring 0:07:29.960 --> 0:07:34.560 tolerability concerns and carry the risk of addiction. Innovation and 0:07:34.640 --> 0:07:38.400 pain management has been slow, in part because pain is 0:07:38.400 --> 0:07:43.880 both common and complex. It affects individual people differently. Those 0:07:43.920 --> 0:07:48.480 differences might be influenced by gender, genetics, and age, as 0:07:48.480 --> 0:07:53.840 well as other factors. Pain represents exactly the kind of 0:07:53.840 --> 0:07:57.640 medical problem Vertex likes to target. There's a long history 0:07:57.640 --> 0:08:01.400 of research to build on, there's new technology available or 0:08:01.640 --> 0:08:05.360 Vertex thinks they can develop it. There's a large unmet need, 0:08:06.000 --> 0:08:09.200 and Vertex thinks it may be possible to make an impact. 0:08:09.520 --> 0:08:13.200 We've picked a set of diseases, cystic fibrosis, type one, diabetes, 0:08:13.760 --> 0:08:16.360 sickle cell disease, also pain. 0:08:17.320 --> 0:08:20.960 That's doctor David Altschuler. He's the chief scientific officer at 0:08:21.040 --> 0:08:24.880 Vertex Pharmaceuticals. What he's really on is a quest for 0:08:25.000 --> 0:08:28.960 something innovative. He's in search of new ways to think 0:08:28.960 --> 0:08:30.440 about old problems. 0:08:31.040 --> 0:08:33.480 The real question in our mind is can we succeed? 0:08:33.760 --> 0:08:34.840 Can we make a difference? 0:08:36.400 --> 0:08:38.079 Pain itself can be a disease. 0:08:38.800 --> 0:08:43.400 That's doctor Paul Negelescu. He's leading Vertex's research in this area. 0:08:43.559 --> 0:08:47.000 So while pain is a symptom of diseases, many diseases, 0:08:47.160 --> 0:08:49.680 it can also be a disease in and of itself. 0:08:50.440 --> 0:08:52.960 Vertex has been working on that puzzle for decades. 0:08:53.920 --> 0:08:56.640 There are tens of millions of people in the US 0:08:56.760 --> 0:09:02.079 that get pain experiences every year, either acute or chronic pain. 0:09:02.600 --> 0:09:05.439 One thing that really interested me is why does it 0:09:05.559 --> 0:09:09.600 seem like some people are more sensitive to pain than others. 0:09:10.040 --> 0:09:14.800 It's a very subjective thing pain, and it's actually we 0:09:14.840 --> 0:09:19.280 don't understand what makes different people sensitive or not to pain. 0:09:20.120 --> 0:09:23.040 I would say though, that there are outliers. I mean, 0:09:23.080 --> 0:09:25.400 there are definitely some people that are way off the 0:09:25.520 --> 0:09:28.760 charts in terms of their ability to detect pain or not. 0:09:29.200 --> 0:09:31.800 Would you be able to break down for me a 0:09:31.800 --> 0:09:34.120 little bit further into what exactly is pain? 0:09:34.800 --> 0:09:39.040 It's a really good question. So pain is an unpleasant sensation. 0:09:39.640 --> 0:09:42.840 It's something that you experience, and so therefore it is 0:09:42.880 --> 0:09:46.960 something that has been processed by your brain and depending 0:09:47.000 --> 0:09:51.959 on your state of mind, literally that affects your ability 0:09:52.000 --> 0:09:56.720 to sense pain. So it's a complicated process by which 0:09:57.160 --> 0:10:01.160 we perceive pain. Now, now the way that we're trying 0:10:01.200 --> 0:10:03.280 to approach it, which is to kind of take it 0:10:03.440 --> 0:10:06.960 out of the brain part, because we know it starts 0:10:07.440 --> 0:10:10.040 in the periphery. In most cases, it's due to an 0:10:10.040 --> 0:10:14.600 injury or a surgery or damage to a nerve that's 0:10:14.679 --> 0:10:17.760 outside the brain, so that part of the body is 0:10:17.800 --> 0:10:21.640 sending signals to the brain. It hurts, it hurts, and 0:10:21.679 --> 0:10:24.600 then you're processing those signals, and depending on whether you're awake, 0:10:24.640 --> 0:10:28.760 a sleep distracted, you feel different levels of pain. Our 0:10:28.800 --> 0:10:30.560 goal is to try to cut it off so it 0:10:30.559 --> 0:10:34.360 never really gets to the brain. Opioids work at the 0:10:34.440 --> 0:10:38.280 level of the central nervous system. They actually suppress the 0:10:38.280 --> 0:10:40.959 inputs that are coming into the brain, and so we're 0:10:41.000 --> 0:10:43.960 trying to work from the outside of the brain to 0:10:44.120 --> 0:10:46.160 reduce the pain signals into it. 0:10:47.120 --> 0:10:51.199 That's the unique aspect of Vertex's approach to research, innovative 0:10:51.240 --> 0:10:54.640 approaches based on the underlying mechanism of the disease. 0:10:55.880 --> 0:10:59.960 The way we're approaching pain is by targeting these proteins 0:11:00.120 --> 0:11:02.880 that have been identified through human genetics as playing a 0:11:02.960 --> 0:11:07.280 key role in the transmission of pain signals in the 0:11:07.320 --> 0:11:11.120 pain sensing neurons. If you think about the pain sensing 0:11:11.160 --> 0:11:15.680 neuron as a wire, it's transmitting a signal that says 0:11:15.840 --> 0:11:18.160 I've got pain in one part of my body to 0:11:18.280 --> 0:11:21.280 the other part of your body, and for that signal 0:11:21.320 --> 0:11:25.400 to get transmitted, it has to be conducted along that wire. 0:11:25.800 --> 0:11:29.800 To conduct that electrical signal through that sensory nerve. It's 0:11:29.880 --> 0:11:32.800 kind of like a bucket brigade. One channel opens at 0:11:32.800 --> 0:11:35.080 one end and it passes the electrical signal to the 0:11:35.080 --> 0:11:38.760 next and that gets passed to the next one and 0:11:38.800 --> 0:11:41.400 so on, and that's how the signal gets propagated. And 0:11:41.480 --> 0:11:45.040 so you know, we're trying to interrupt that transmission. 0:11:45.480 --> 0:11:48.440 The work is focused on researching the mechanism of how 0:11:48.440 --> 0:11:51.080 a pain signal travels in the body, with the hope 0:11:51.160 --> 0:11:59.000 of making a difference for patients. It's been two years 0:11:59.040 --> 0:12:02.880 since Damien's acts, and other than walking with a slight limp, 0:12:03.280 --> 0:12:06.360 he's moved on with his life. He doesn't dwell on 0:12:06.400 --> 0:12:10.199 those pain filled months after his surgery. In fact, he 0:12:10.240 --> 0:12:12.480 says he really doesn't remember most of it. 0:12:13.760 --> 0:12:17.040 You tend to block out memories that you don't want, 0:12:17.679 --> 0:12:21.720 you really do. They're painful, So I think that's why 0:12:21.800 --> 0:12:24.319 I don't remember more about that time in the hospital. 0:12:24.840 --> 0:12:27.560 What he does remember is that when the pain was 0:12:27.679 --> 0:12:30.280 so bad it made it difficult to even stand up, 0:12:31.040 --> 0:12:32.400 he never lost his passion. 0:12:32.679 --> 0:12:34.280 I don't want to give up on music. I don't 0:12:34.280 --> 0:12:36.400 want to give up on my music. As long as 0:12:36.400 --> 0:12:39.080 I'm close to the music and keep playing music, I'm 0:12:39.160 --> 0:12:40.760 very happy. So that's what. 0:12:40.760 --> 0:12:41.240 I want to know. 0:12:41.240 --> 0:12:42.160 I want to be at peace. 0:12:49.480 --> 0:12:52.840 This is Targeting the Toughest diseases. A podcast from Bloomberg 0:12:52.880 --> 0:12:56.920 Media Studios and Vertex Pharmaceuticals. If you like what you hear, 0:12:57.320 --> 0:13:00.880 subscribe and leave us a review. I'm Jordan gos forre 0:13:01.480 --> 0:13:02.320 Thanks for listening.