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Fractals Paul Martinetti 

  

[Colin Miller] 

Hello, I'm Colin Miller, CEO at the Bracken Group, and this is Fractals: Life Science Conversations. Bracken is the professional services firm for life sciences and digital health organizations. Our intelligence ecosystem fulfils consulting, regulatory, marketing and analytics needs with an integrated and strategic approach. 

 

Today, we'll be discussing transformative advancements across digital software and hardware programming, dermatological research, clinical practice and professional development. Really quite a wide range of life science niches to be sure, which is why I'm absolutely delighted to be joined by my colleague, Dr. Paul Martinetti, who's a senior partner at the Bracken Group. Paul's analytical and innovative achievements include the creation and development of projects such as the development and widespread adoption of an online photo-based acne severity consensus tool, revolutionizing treatment efficacy assessments across the industry. 

 

A clinical study t-shirt for assessing acne on the chest, shoulders and back, resulting in the approval of a groundbreaking treatment. Paul is adept at complex problem solving. He holds multiple patents and publications for his clinical work in dermatology and cancer research. 

 

He is proficient in multiple coding languages and of course, as we've already said, a senior partner here at Bracken. Welcome to Fractals, Paul, and thank you for joining me today. 

 

[Paul Martinetti] 

Thank you for having me, Colin. It's an honor to contribute to this program and I always enjoy our conversations, so looking forward to this one. 

 

[Colin Miller] 

Absolutely. Well, thank you, Paul. And likewise, as we've already discussed, your career has had some truly innovative aspects to it. 

 

You've been at the forefront in many different areas, including clinical practice and research, business and leadership development, programming and comprehensive analytics frameworks. With a holistic experience in mind, what does an integrated approach mean to you? 

 

[Paul Martinetti] 

Well, so to me, integrated is collaborative. So it's about us, not just me. It's taking our roles and our efforts out of their silos and working together to solve a problem, which means that it's also about defining the problem, welcoming all of the details and challenges and not just the parts that we already know how to address or that we're comfortable with. 

 

It's exposing assumptions and possibly getting out of our comfort zone to the point almost of admitting that we don't know exactly what the best move is to do next. And I really prefer this as a consultant. I prefer this from my clients because, you know, with a problem completely exposed, we might think to invite somebody from our group who we weren't previously thinking about and then end up working together to find the best way to solve it. 

 

So with that full range of skills and experience, to me, that's what integrated means. 

 

[Colin Miller] 

That makes a lot of sense and can bring in a team to basically accomplish the problem solved together. Does certainly speak to that integration. And can you give a case example, either in dermatology or sexual dysfunction or one of the areas that you've been involved with? 

 

[Paul Martinetti] 

Sure. So the development of the Acne tool was basically driven by I was experimenting with some photo technology, and this is quite some time ago, and had the opportunity to show this to our dermatology client. And so they were in a position, they're doing dermatology research and they're trying to get all the investigators on the same page. 

 

What do we mean by moderate acne? What do we mean by almost clear? The industry was using live models. 

 

So we would get the whole gang together at a hotel on a Saturday morning. Someone would be responsible for recruiting local models. And we'd sit them on bar stools and shine bright lights in their faces and basically look at their skin together and try to get in some kind of an agreement. 

 

It's very challenging to do that. Patients don't like to sit still. The thing that we're trying to agree on, which is the severity of their acne, is actually changing during the course of the consensus. 

 

Because the more you poke at it and the more you shine bright lights on it, lesions just get redder and redder. What we were able to do was exactly that. It's a snapshot in time of this person, you know, and there's their cheek and we can use that to discuss, you know, what does this represent? 

 

And so there was a bit of going back and forth with the experts, trying to explain to them what we have and what we can do. And then also learning from them, listening and trying to understand what it is that they want to communicate. And so we basically worked together as sort of like this little dance of my explaining a little bit to them and them explaining a little bit to me. 

 

And that's sort of how we how we arrived at the development of this tool. And then we honed it together over many years. And it became one of the favorites in the industry because, like I say, the patients hold still and they're comfortable in the photo. 

 

And the experts can really talk in detail about their work. And they love being able to do that. 

 

[Colin Miller] 

Fascinating. Is it still out there? 

 

[Paul Martinetti] 

Yes, we're still using it. 

 

[Colin Miller] 

Yeah. 

 

[Paul Martinetti] 

And we ended up working across the industry. What happened was that the experts realized the advantages to the tool and we continued to develop it together and make it more and more powerful. And then I had the really great position of being able to work across the industry. 

 

So I wasn't, wasn't linked or anchored to any one particular company, be it sponsor or CRO. And so the benefit there was that bit by bit, study by study, we could get the whole community basically in sync with what we mean by the details of their work. And as that patient gets better, you know, what does that look like? 

 

How do we describe it? Why is it getting better? And we documented all of this by capturing their input. 

 

So, yeah, we're still we're still doing it to this day. 

 

[Colin Miller] 

Fantastic. And I presume from what you said, you're not having to bring live subjects into anymore. It's all being done digitally or are you still doing it all digital? 

 

Really? Yeah. So you managed to get that crossover, which had to take some pressure off you. 

 

[Paul Martinetti] 

Right. And, you know, back to the original. And this this was integrated. 

 

We had skills from across the board. We had, you know, obviously we had dermatology experts who didn't know a lot about technology. Then we had me who didn't know at the time that much about dermatology. 

 

And over the years, we basically grew together. 

 

[Colin Miller] 

Wow. That is, is quite something. And not only did you help develop it, but it's still the de facto standard in the industry. 

 

From my perspective, that was really kind of an unusual, almost unique aspect of your career and working with multiple clients. Really fascinating. Are there other unexpected or interesting parts of working on a client project that you can talk about without breaching confidentiality? 

 

[Paul Martinetti] 

So the technology adoption is always a fascinating thing to see something right from the beginning. One of the things that was so memorable was a particular investigator meeting. We were in this really nice touring destination. 

 

And here we were Saturday morning on a beautiful day. And everyone's gathered around the computer instead of being outside. And they were having this discussion that one of the early tools that I had made was a lesion counting tool. 

 

And so you could picture a computer screen with a person's face on it. Let's say that the right cheek is exposed to the audience. And so here you have people whose, whose work they've dedicated their life to, to acne research. 

 

And what the tool allowed them to do was to take the mouse and to click on a pimple. And if they clicked on a pimple, it would label it with a black circle, which would designate that pimple as non-inflammatory. And then if they clicked on it again, it would, it would turn red, which would say that they wanted to label that inflammatory. 

 

And so here, all of a sudden, right before me was that they were having an absolute kick out of this thing. And they were sitting there. They would sit for half an hour, 45 minutes together, literally talking about each of the lesions in detail. 

 

And this was something that they really just clearly had never done before. So, well, when you see that, what do you get? And then there will be two pimples really close together. 

 

We call that one or two. What do you do when you get that? You know, and there was all this really great collaboration about the work, because, as I said earlier, the patient's just sitting still. 

 

The patient's comfortable in this case. And so they really took advantage of that for the first time to be able to take all this time to talk about something and not have to worry about the discomfort of the patient they were talking about. So that was really interesting to be able to contribute that, to be there for that and to provide that tool for them, for their profession. 

 

[Colin Miller] 

Absolutely fascinating, and the parallels that go into that and the atlases that have been created in medical imaging are very, very similar. I was involved with creating an anti-nerve growth factor atlas from radiographs and MRI scans and almost exactly that concept of, well, is that excretion an osteophyte or, you know, is it a small, medium and large? A very, very similar process, but in a totally different part of the anatomy and different imaging approach. 

 

[Paul Martinetti] 

It's great to see the technology bring the passion out in the people who work. I really love that part. 

 

[Colin Miller] 

Isn't it? It really is fascinating. I think that's one of the great opportunities we have as consultants to help further advance the medicine for clients, but also bring our academic colleagues, if you will, the physicians that are really seeing the patients, to have the opportunity to have those discussions. 

 

And the opportunity to really think through how they would characterize and score, if you will, particular aspects of the disease that we're looking at. 

 

[Paul Martinetti] 

Right, and then those exercises lead to consensus, and then when we have consensus over what we're looking at, it ultimately leads us to the best treatment for everyone. So, I mean, that's really our goal here. So it's really good work. 

 

[Colin Miller] 

I couldn't agree more. Nicely said. I also know that you do work and utilize AI, either ChatGPT, Copilot or one of the other programs out there. 

 

How have you used that? And can you perhaps give a few examples of how you're using it and how you're ensuring it's best appropriately used in your work? 

 

[Paul Martinetti] 

I'd love to talk about that. So, yeah, I use AI every day. You know, I have ChatGPT and for various functions. 

 

Where it's been most fun is in coding. So I still like to make small business apps. So coding in JavaScript, GoogleScript, Python. 

 

And so, you know, whereas before we used to have to go out on the web sometime and look for maybe the best practice or to get a little piece of programming done, what I'll do is just pose the question, I'll prompt ChatGPT and I'll see what it gives back. And what's fascinating is just in the same way that we talk about its imperfections, if you will, in conversation, it's also imperfect when it comes to coding. So a lot of times I'll get code back that either doesn't work or it gets me closer. 

 

And so the way I'm really using it is as a copilot or as an assistant, if you will. And then sometimes I'll do a little coding and then actually paste the code back into ChatGPT and say, well, so this isn't doing exactly what I want. This is what I want. 

 

And then it will tell me, oh, all you need is for just to add this one line and it'll do that. And so it becomes more of a collaboration, if you will. It's as if I'm working with somebody. 

 

And so it's been really it's been really fun for that. In my other work, in my content work, it's been really fun just to ask it for questions, ask you questions, and then I go out and validate the answers. So before I put any of the content, if you will, into production, I still consider myself, if you will, I am accountable. 

 

I'm responsible for this content. So if I ask ChatGPT for a list of things and I decide to use some of those things, I'm going to then go out and look for really valid sources to make sure that those things are real. So I'm not going to use it as a guidance. 

 

Then I'll put together my content, if you will, and then I'll feed it back into the system and say, what am I missing? So this is what I've got so far. What do you think would add to this or that? 

 

And so those are really the two key ways I've been using it as more of an assistant or a checker or what have I forgotten or what can I do better? That's how I've been using AI thus far. 

 

[Colin Miller] 

Wow, impressive. And the fact that you're using it daily and on multiple different approaches, quite fascinating. So how to lean into the new technology rapidly and use it to what is best for. 

 

[Paul Martinetti] 

Right, exactly. Using it safely. And I'm paying attention to the news and folks who have leaned on it a little too heavily and suffered by its imperfections. 

 

I mean, they're being quite honest with us here about its limitations, but there's still obviously a lot of power and it's getting better and better. 

 

[Colin Miller] 

It truly is. But kudos. Impressive the way you're pulling those pieces together and taking what's at hand and changing paradigms, but still keeping focused, as you said, on the business and what it is you're trying to accomplish. 

 

Right. 

 

[Paul Martinetti] 

We are still the experts. I mean, these technologies are very, very smart, but we still need to drive, today anyway, we still need to drive these tools. 

 

[Colin Miller] 

Yeah. 

 

[Paul Martinetti] 

Rather than being driven by them. 

 

[Colin Miller] 

Of course. That's which has, I think, created a lot of fear out there. Really going back to one of the other comments and themes here. 

 

You know, life sciences is such a collaborative industry and your own career showcases a really vast overlap in multiple fields. And with that in mind and knowing professional development is one of your key interests. How do you approach collaboration and team leadership for interdisciplinary projects, such as those involving both technology and healthcare professionals? 

 

[Paul Martinetti] 

So as a leader of a project, which is, of course, one of my favorite roles, I try to open myself up, lead by example, if you will, to listen and to learn a little bit from everyone. So I never feel like I'm the guy that knows everything. I like to ask questions and I like to listen to the responses. 

 

And, you know, we were taught this in medical school that 95% of the diagnosis is actually in the history. So you sit down with a patient you've met for the first time, just listen. Listen carefully and closely. 

 

And people, the more open you are, the more receptive you are to what they have to say, the more likely the answer will come out at some point. And I can give another example for early on. We had, you know, you can picture a group of us sitting in a room with a picture projected of a person with acne. 

 

And at one point, one of the experts said, you know, we've been arguing about this. Is it a mild? Is it a moderate? 

 

You know, if those two pimples weren't on the forehead, I would say this is a solid mild. And so we took the pause and I said, well, let me go see if I could do something about that. And so I took the photo over to one of my colleagues, who's just an outstanding Photoshop person. 

 

And she was able to remove the two pimples from that photo. And so we actually applied that across the board to a whole bunch of photos where there was really weak consensus. And we sent them back to the team. 

 

And then basically we asked them, what do you think? Does this look like the patient had two pimples removed? Or does it look like they just don't have the two pimples? 

 

And they said, well, wow, that looks really great. Actually, look, this is what we were talking about. And so now from that point onward, the experts actually knew that they could ask for certain pimples to be removed or to add it. 

 

And but before that, they didn't even know that they could ask for that. And I didn't know that that's what they wanted. And so, you know, this is how this is basically how we do it. 

 

This is the development. So both of us are learning, you know, from our two different directions. And it was really fun to be able to do that. 

 

And literally over the years, I mean, we were adding, it just got more and more detailed what we could add. We would add other factors, you know, post inflammatory hyperpigmentation scars and other things that come with acne to really to really do this right. 

 

[Colin Miller] 

Amazing. Thank you. I appreciate the insight. 

 

Jumping again in another part of your background, and I just wonder how you got into it from dermatology to sexual dysfunction and related infertility. How did that start? And what was the research that you were involved with that? 

 

[Paul Martinetti] 

It was serendipitous. I was working in a young startup in health care, health communications. And one of my colleagues attended a patient advocacy conference. 

 

And at that conference was a specialist in cancer survivorship, Dr. Leslie Shover. And she was looking for a multimedia partner with some understanding in health care. This was at the late 1990s, early 2000s. 

 

And what was really happening then, because I think everybody can kind of understand this. We had reached a point where if you had cancer, it was no longer a death situation. You were very likely at that point to survive it. 

 

And that was almost across the cancer industry. And so what was happening was there were a lot of people basically going back into normal life or trying to, and their body parts just didn't work. They had all kinds of deficiencies. 

 

They were, in a lot of cases, they were broke because treatment's expensive. So a lot of setbacks. And yet life, they were young, and they had survived, and they wanted to continue. 

 

So how do they do that? And so one of the things they would, of course, have to do is go talk to the doctor about what's not working right. And the doctors turned out they were sort of woefully unprepared to have these conversations. 

 

They at first didn't really know why. And then it was just an uncomfortable conversation to have. And then the same thing from the patient side. 

 

It's like, well, I have this problem. It's very embarrassing. How and when do I get it out? 

 

And what's the best way to tackle this? I have to fix it. It affects me every day. 

 

And so we met, and I was really in the heart of my technology passion at the time. It was a really exciting time in that companies were starting to move onto the web. And so what I was charged with there, so Leslie and I applied for, we were actually the first group to apply for a fast track, all three phases to submit the e-application, if you will, to the National Cancer Institute. 

 

And we won it. We were the only ones who won it. And we won all three phases. 

 

And what we started to create was a program called Banking on Fatherhood After Cancer. And the idea was to focus on men and to encourage them to understand and to sperm bank before starting chemotherapy so that when they survive, they could become fathers. And so we developed this program. 

 

And my charge was to be able to see this in the beginning, of course, from its academic parts, the research part of it and the impact that we were going to have and try to predict the future. What is it that we're developing? How is that going to evolve with technology? 

 

So in the late 1990s, we were still delivering rich media, if you will, on CDs. But I knew that if we had video images and text and sound, that those bytes were going to last. It seemed to me even at that time that a JPEG is going to be a JPEG even 20 years from now. 

 

I was fairly convinced of that because it was so portable. And so what I did was we wrapped the first version of the program, if you will, onto a DVD and CD-ROMs. And as the relationship with Leslie evolved, we applied for a grant to do the same thing for women. And then we applied for another grant to take the men's program to another level. 

 

And so over the 15-year period, we basically ended up in a situation where we had HD video online. And so my role all that time was to make sure that basically her messaging and her reach was seamless so we could reach the doctors, we could reach the patients. And with the media that we were creating, those investments would last for the program. 

 

So it was a super exciting time for me to evolve with her and to play all the different roles. I was coding in all these different languages and all the way up through doing the bookkeeping and running the whole project as a consultant for the SBIR and Grants.gov and all that fun stuff. So it was a really fantastic product. 

 

And in the end, we helped a lot of patients and a lot of doctors. 

 

[Colin Miller] 

Wow. Thank you for that story. One I'd never fully heard. 

 

I'd heard parts of it and really impressive. Thank you. Just going back into the life sciences for a moment. 

 

You know, the life sciences is always evolving. And at the moment, it's evolving pretty rapidly. So how do you envisage the future of digital health technologies impacting the life sciences, particularly in terms of patient care and research advancements? 

 

[Paul Martinetti] 

It's funny. So when we think technology and patient care, the first thing that pops into my head is first, do no harm. This was the oath that I had to take in medical school. 

 

And now that I see all of these technologies that are flooding their way in, I think that the technology people will need to also take this oath. They're giving us the evidence upon which we're making our decisions. And so if that's the foundation of what I'm doing in the clinical environment, that's what I'm giving to my patients. 

 

They should also be thinking, first, do no harm. And so I think it's a very interesting time. We have, as everybody knows, we have been recording content. 

 

We have so much content. And I'm not sure even if we thought about why we were doing all this recording of content, but we now have these machines in the form of AI, if you will, machine learning. We have these machines that are actually now capable of watching all of this content, because we are not. 

 

It takes too long for us to digest and absorb this. But these machines, as we're all seeing, we have this machine that can absorb all this video content faster than we ever could. And then it can actually give back to us, as I described earlier, as an assistant or as a co-pilot. 

 

And so I think that the future of patient care is going to be more and more of these implementations whereby the patient, think of bottlenecks, right? Think of something like, for example, autism spectrum disorder, a huge need to get that recognized in younger people. There's a huge opportunity here to basically set up technology to support us and help those patients get help faster by basically having these machines learn and having them assist the health professionals and then have those recordings then used for the benefit of others. 

 

[Colin Miller] 

Fascinating insights and seeing it at the cutting edge. So appreciate that. Well, with everything that you know and the way life is going, if you were suddenly given $100 million to invest in industry or society, where would you invest it and why? 

 

[Paul Martinetti] 

Well, society, I would invest it in neighborhoods. I think it's important to remember, especially those of us who are working our lives in healthcare, the invention of the sewer system was probably has saved more lives than all of the modern medical and surgical technologies combined. And so I think to have the greatest impact on improving health for society, we need sound homes, we need clean water, we need safe neighborhoods, and we need easy access to affordable and healthy foods. 

 

And so I think today with the advent of the social determinants of health and real world data, we're only going to see this fact sort of documented more and more. I think so many of our failures in medicine, those of us who've, again, dedicated our lives to try and help people by working in the pharmaceutical company, it's not always our fault that things failed. We realize that there are other factors. 

 

I think that right now, this increased awareness of those elements, we're finally getting a little bit of momentum there. And so I would take that money and I would invest it in neighborhoods. And I think that we will see success across the board increase. 

 

[Colin Miller] 

Thank you. Interesting insights. Appreciate the thought concept behind the invention of the sewer. 

 

And yeah, I can only imagine what it must have been like in the Middle Ages, the open sewers on the medieval roads in the big towns and cities. 

 

[Paul Martinetti] 

Yeah, we wouldn't be here, probably. Taking care of that, the plague would have wiped us out. 

 

[Colin Miller] 

Yeah, well, that's the problem that happened in the UK, certainly, and medieval Europe. So really, my final question, if you could speak to yourself at age 25 or thereabouts, what advice would you offer? 

 

[Paul Martinetti] 

I only recently learned that milk was giving me all kinds of allergy problems. And so I think I would tell myself to stop consuming dairy products. Ever since I have, I've been off every medication and no more exercise asthma and no more allergies. 

 

So that's sort of, I guess, a funny thought that I would have been nice to have had a few decades of less suffering. Otherwise, I think today, one of the things I value the most in my personal routine is my yoga and my meditation practice. And I only really started that recently, specifically meditating on acceptance. 

 

I think now in particular, we're living in a tumultuous time, and I'm sure all of the times are tumultuous, but we're not able to control what other people think, what they say and what they do. I think the real solution to our problems is to accept them. And then we only get one turn. 

 

And so when I accept, I find a place of calm there. And with a calm, clear mind, I find that I'm very open to the real world problems. And I feel like I'm really at my best place to lead by example, to lead some progress, to make the world a better place. 

 

And so I think I would tell myself at 25 to start practicing the yoga and the meditation then. 

 

[Colin Miller] 

I can appreciate that. Wow. Paul, it has been a fascinating journey to talk with you today. 

 

To hear, no, it really has. And even down to your personal experiences, you know, and thank you for opening up on health and mental changes as well in meditation practice, and the effect that that has. So again, it's been such a pleasure to have you on Fractals. 

 

Thank you so much for your time today. And look forward to further collaboration and working with you. 

 

[Paul Martinetti] 

Thank you, Colin. Likewise. This was really fun. 

 

[Colin Miller] 

Thank you. Thank you. Fractals is brought to you by Bracken, the professional services firm for life science and digital health organizations. 

 

Subscribe to Fractals via your preferred podcast platform. Visit us at thebrackengroup.com or reach out directly on LinkedIn. We'll be delighted to speak with you. 

 

I'm Colin Miller, wishing you sound business and good health. Thanks for listening.