By Gloria Onwneme, Medical Student, University of Nottingham, UK
Dr. Harris Eyre, MD, PhD, Fulbright Scholar (WG Walker) is a psychiatry trainee, and Chief Medical Officer and Co-Founder of CNSDose, a company which has developed and deployed a world-leading genetic test to aid the antidepressant selection process for primary care physicians, psychiatrists, and people with depression. He is also an executive-in-residence at the Texas Medical Center in Houston, the world’s largest medical complex.
Dr. Eyre obtained his Bachelor of Medicine and Surgery at James Cook University (2011), and went on to be awarded a PhD for his work on the pathophysiology of late-life depression at University of Adelaide (2016). Partway through his PhD, he was awarded the Fulbright Scholarship for being the top-ranked postgraduate scholar in Australia, and was a visiting graduate researcher at UCLA.
Dr. Eyre was the 2017 Early Career Outstanding Alumni Award for the College of Medicine and Dentistry at his alma mater, and is a 2018 Victorian State Finalist for the Young Australian of the Year Award.
Dr. Eyre has been published in World Psychiatry, American Journal of Psychiatry, Lancet Psychiatry, and Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, among others.
When did you first decide to become a doctor? Why?
I decided to go into medicine in my early teenage years. I initially wanted to go into sports medicine, because I played a range of different sports in school, and thought it would be cool to bring together my interests in performance psychology, sports, and bone and tissue injury. I was either going to do physiotherapy or sports medicine, and I was fortunate to do get into medical school.
How/why did you choose the medical school you attended?
I went to James Cook University because it was the closest one to my home town in Queensland in Northern Australia, and it was the only one I got into. It turns out that James Cook University was a fairly new medical school, and it was modeled off the Oxford Medical School style of small class sizes. It was set up by actually by a former Oxford professor, and it turns out that those small class sizes were really fantastic. I got very personalized tuition from professors and learned the importance of mentorship from senior people.
What surprised you the most about your medical studies?
The first thing was this focus on socially progressive issues. I’d had a fairly sheltered upbringing, I would say, and the university was very socially progressive, and focused on healthcare for people in rural, remote indigenous and tropical settings. So I got hit by this very progressive approach to healthcare, and by the importance of equity of high quality healthcare delivery to people of all different backgrounds. That was a real awakening for me about the social determinants of health. Interacting with people in rather remote towns, and really learning to love all aspects of care delivery here, was amazing.
The second thing was that I realised that I could work part time when I was a med student and do research on the side. The first three years of med school weren’t very exciting. I wasn’t a very good student, and my heart was only half in it. Then I involved with a local professor of psychiatry in my third year. That’s when my perspective started to change and I really went from being a pass-credit student to a high-distinction student. I just got really inspired by this local professor who was doing all this interesting neuroscience and public health research. I was then able to add research to my med school portfolio.
That’s when I really shot off in this trajectory that I’m on now.
The final thing about med school was that the first three years were very non-clinical and very much book-driven, which didn’t really suit my mindset and learning style. But in the last half, it got very practical and very human-centric. I’m very much a social person and driven by social interactions and that’s also contributed to the increase in my grades and my interest.
What information/advice do you wish you had known when you were beginning your medical studies?
There’s not much that I wish I could have known at the start, except recognizing that if you are humble and motivated and compassionate, then senior people are very willing to mentor you and massively accelerate your career and give you great opportunities. So I’d advise students to focus on recognizing people’s willingness to mentor and support them and send them ahead by quantum leaps. It would have been helpful if I had known that a little earlier.
Why did you decide to specialize in psychiatry?
So I went into psychiatry because it started out as an interesting way to meld my interest with sports medicine with psychiatry. So the first research project I did with this local professor of psychiatry was to look at the effects of exercise on the treatment of depression.
Eventually, I just found out that psychiatry fitted me really nicely. I’m really interested in human behavior, fascinated by the brain, and fascinated by the science of the immune system in the brain, one of the things I was introduced to early on. I was interested in how that immune system influences the development of psychiatric disorders.
Has specializing in psychiatry met your expectations? Why?
Absolutely. Being a clinician in medicine is a pretty great thing to be, if you just consider the close-up that we get of human behaviour. You’re seeing patients from all walks of life, from different socioeconomic contexts, backgrounds, cultures, religions, ethnicities, age ranges. You’re also exposed to multidisciplinary teams.
I also became interested in the interface between the clinicians that work on the front line and the administrators that work on the back end and deal with quality improvement in finance and legal matters. Being in that rich environment and seeing that tapestry of how a health system fits together with patients was great for an observant person like myself.
What do you like most about being a psychiatry trainee? Explain.
The patients. I also think that teamwork is definitely one thing that I really enjoy. I’m a social person, so it was great to work in interesting and diverse teams of people. The other thing was the willingness of senior doctors to be good mentors. Some of these mentors helped me get my Fulbright Scholarship.
Once I had the recognition that diverse careers were possible, it was good to develop the skills which are honed through clinical work. As doctors, we’re very well trained, we’re analytical, we’ve got good communication skills and leadership skills, and so we actually thrive in clinical and nonclinical environments alike.
What do you like least about being a psychiatry trainee? Explain.
The lack of innovation in the health system was very frustrating. Knowing that things could be done in a better way, whether it came to diagnosis or treatment. Innovation seemed a long way away.
The inflexible training program was also one thing that I rubbed up against many times. It’s hard to take a year off to go over and do an internship with the World Bank, or an investment bank, or in a start-up company. It’s very challenging to take time off, and to have that bit more flexibility. There’s a lot of dogma within the upper echelons of Training Colleges that don’t allow for that and don’t see the value of it. People also don’t really see the value of it within the hospital management structures, and therefore don’t cater to it.
What’s your typical work week like?
As co-founder and chief medical officer of CNSDose, I’m involved in selling the technology to the US. I live in Houston, Texas, and work at the Innovation Institute of Texas Medical Center which is a megaplex of hospitals. It’s the biggest medical precinct in the world. Every day is different. I tend to work across time zones, so I don’t have a nine-to-five job. But I’m involved in business development: this involves selling the technology to clinics, large hospitals, or insurance companies. We will open in Australia shortly, and we’re exploring the Chinese market as well.
I can be involved in the medical input for marketing and sales strategy. I can be involved in understanding how we get through the FDA’s regulatory pathways, and the pathways that exist in other countries. Understanding our intellectual property strategy, to protect what we’re doing. I also look at product development: how can we make our products better, or more accurate; how do we run more trials to demonstrate the value?
A lot of the work is done over the phone, because we’ve got people all over the US and in Australia. It’s very exciting. I get to interact with totally different people, from doctors to business executives, bankers, philanthropists, IP people, biomedical engineers, and geneticists.
Tell me more about how you started CNSDose.
Initially, I did a lot of things in parallel. I tend to bucket my career phases in a couple of different categories. There’s the phase where I was purely a psychiatry trainee. Ultimately I knew there was more to helping the people with mental health conditions than seeing them one-on-one.
The next category for me was getting into research, where I did my PhD looking at the neuroscience of depression. I did half in Australia, and the other half at UCLA with my Fulbright Scholarship. I realized that I was interested in research because it really gets into the details of epidemiology and neuroscience. The downside is, though, that most work that we do is published in journals that pretty much no one reads, if you want to be really crude about it. So doing pure research wasn’t going to work for me either.
But when I was in California, I was cognizant that, in mental health, there was a need for new technologies to come in like computer engineering, big data analytics, and genomics. I had met a couple of people there who were on the leading edge of the transition into “digital psychiatry”, which is the convergence of neuroscience, engineering, and so on. It was fascinating, and brings together all of my different interests. So after that phase in California, I went back to Australia with a completed PhD. I did six months of health system management training, because I knew that the final piece I needed to understand was how technology is implemented in health systems, and how they’re implemented and paid for successfully. After all of that, I jumped into the CNSDose start-up.
To be honest with you, I initially worked on CNSDose as what you might call the “weekend warrior”, and in the nights, while in hospital management training. I then jumped in fully, once it was funded enough to pay me a decent wage. It’s kind of surreal, but I feel like I get paid to do what I love to do.
How is CNSDose set to change clinical practice?
I’ve personally put my training on hold because I’m taking a bet on this area of psychiatry: if you can develop a high quality technology and bring it to the clinical world, you can do more for society in that role through scaling these new technologies, than you could do seeing patients day in, day out. So what I do is bring my understanding and skill in clinical medicine, research and business, and bring stakeholders from each of worlds together to develop these new technologies that have decent evidence behind them.
Our technology has been run through two different clinical trials and is being used every day in the US. We’ve performed a couple of thousand tests; we’ve signed a big contract with a very large well-known health system in the US.
The problem that we see is that depression is very common. It’s very costly to people in society. Antidepressants are the mainstay of treatment for people with moderate to severe depression. The current standard of care in treatment is trial-and-error of antidepressant prescription. We currently have a certain algorithm we run through when prescribing antidepressants, but that only works half the time. With every medication that fails, a patient has less of a chance of being responsive to the next medication. So when you’re depressed, there’s this sort of hopelessness and helplessness that gets you as you try and fail each medication. So it’s a very dire problem at the moment. 100 million people – which is probably a conservative estimate – struggle with this.
So the CNSDose technology is used mainly by primary care doctors or GPs, who do most of the prescribing, but it’s also used by psychiatrists. Clinicians get the cheek swab from the patient, the doctor signs the request form, and sends it to the lab we’re affiliated with. At the lab, we look at patients’ liver genetics, and the genetics of the blood brain barrier, and then we can provide close guidance on the choice and dose of antidepressant. Results come back within five days: the results are in the form of a one-page report. We call it a decision support tool. Ultimately, the doctor and the patient need to make the decision, but we categorize the drugs into three categories, and this helps clinicians choose the drug and dose. The central category is average dose for these medications, which are preferred. Then there are the low-dose column and high-dose column, which have less preferred medicines. The clinical scenario determines how the report and the technology are used.
What do you like most about working in CNSDose?
Being able to have a good quality technology that’s innovative, and being able to scale that around the world. To know that you can spot the problems in the mental health system, develop something new and scale it to be used by patients and doctors and improve outcomes – that is the best thing about the work. To achieve that, I interact with all these different interesting people. It fires off all the different parts of my brain. I’ve got to review clinical trial data, to talk about the clinical scenarios, to pitch to investors, to think through how to problem-solve around IP or regulatory issues.
What do you like least about working in CNSDose?
I guess the one thing to be cognizant of is that the timelines for knowing that you’re helping people is much longer. In the clinical scenario, you can often help someone in half a minute, or five minutes, or an hour, and it’s very fulfilling to be able to do that and see, with immediacy, that what you’re doing actually benefits patients. In the world of innovation, that could take months or years. 18 months can go between initiating talks with a hospital system, then seeing them actually use the technology. You’ve just got to recalibrate your expectations of the time it takes to make a difference.
On average: How many hours a week do you work? How many weeks of vacation do you take?
On average, it’s probably 60-80 hours a week, but that goes in peaks and troughs. Also, because I really just love the job, the hours aren’t that bad. This is what I do for fun, anyway. The other point is that there are flexible roles when it comes to entrepreneurship and health care. You can do this part-time or full time.
My company is currently an early stage growth company, so it’s not really prudent to take five, six weeks off. I can’t be covered, because I’m one of the core people in the company. I tend to take long weekends here and there, and I have learned to switch off very quickly when I do have time off. I spread downtime across the year, but I maybe have three weeks off a year. It’s slightly more gruelling than the normal gig in healthcare.
How do you balance work and life outside of work?
I guess the first thing is you’ve really got to be super aware of your energy and exhaustion levels. Building a company like this is like running a marathon. You can’t just overwork yourself and burn out. You’ve got to be acutely aware of work-life balance. I make sure that I sleep eight hours a night. I make sure that I exercise during the week, that I eat healthy, hang out with friends a lot to take my mind off of work. Those are the ways that I personally like to ensure balance.
What types of outreach/volunteer work do you do, if any?
I like to talk to, and support, young people to get into the careers of their choosing, whether they’re medical students or science or business students, especially if they want to work in health innovation. I recognize that it’s really difficult to know how to move forward in the area. It’s not a clear pathway. You’ve got to think very carefully about how you’re going to begin your journey in this space, but anticipate the barriers and work up to it for a number of years. I want to support people in achieving their potential, and I know that the health system needs people that are doing this sort of innovative work.
From your perspective, what is the biggest problem in health care today?
Well, I’m obviously biased towards considering mental health issues. There’s probably five big problems. One is inadequate access, whether in rural or metropolitan settings. The second problem is that diagnosis is subjective. It’s based on discussions and interviews, which is obviously fraught with inaccuracies and variability between clinicians. The third problem is that treatment is often based on trial-and-error; it’s not precise. The fourth problem is that preventative approaches are very poorly developed. And the final issue is that there is this lack of innovation and developments to solve these issues. Those are where I’m trying to apply myself.
Where do you see medicine at large in five years?
To focus on the mental health sector: I would love to see much more widespread development and use of precision technology. I want to see more objective ways of diagnosing people with different biomarkers, more accurate ways of treating people, better prevention approaches. I would like to see those things hitting the clinic, or at least being run through high quality trials. A high-tech mental health sector would be great.
Where do you see pharmacogenetics in five years?
It would be great to see a number of randomized controlled trials being completed, which would lead to pharmacogenetic-based decision-making becoming standard of care across the world. Instead of trial-and-error for antidepressant selection, we’ll routinely do these genetic tests to guide that process.
What is your final piece of advice for students interested in pursuing a career like yours?
There are two important parts to the mindset you need to have. The first is humility: you’ve got to subordinate your ego yet and recognize that when you’re getting into these diverse areas, you’re not going to be an expert. You have to listen intently, and integrate the wisdom and new learnings from these new fields. There’s just so much to learn, whether it’s finance, regulatory affairs, product development, writing. You’ve just got to be humble and curious and eager. The second part is that you’ve got to work really hard. Expect to make some small sacrifices along the way, because it’s going to take a lot of effort to learn, and to establish yourself, and to gain experience.
Beyond the mindset work, you need to surround yourself with good mentors. You need to know that someone has probably done your dream job before, or a variation of it, and can help you to get to where you want to be. If you appeal to them and their expertise, they’re likely to want to help you out, particularly if you’re eager to learn and you’re hardworking.