Full transcript: Dimitar Tonev on London Real
0:26 Brian Rose: Good afternoon and welcome to London Real. My name is Brian Rose. With me, as usual, is Mr. Nick Gabriel. And joining us in studio today is our special guest, Dimitar Tonev, who is Well, we’ll go back to his title soon.
0:40 He’s either a disease area head of virology at Bristol Minor Squibb, or as you said earlier, a medical director of virology for the UK. Okay, medical director of virology for the UK. Wow, is all I have to say. I think, well, okay, you’re definitely a very unique guest. So we’re going to get to you soon.
0:59 Dimitar has just taken some alpha brain, but he is quick to note that it has not been proven in clinical trials. And so, we’ll have to get that done, right? Yes. When it closes tomorrow saying, I had the most amazing dream, we’ll pop it up on the show. That’s not good enough, right?
1:13 We actually need a clinical trial. Fair enough. But that’s, of course, AlphaBrain is provided by Onnit Labs, who are our partner in crime. And if you go to Onnit.com, that’s O-N-N-I-T for the people listening to us on iTunes. And type in London Real as a customer code, customer code, sorry, customer code.
1:30 You can get AlphaBrain 10% off, also Shroom Tech Sport. I’ve been taking it now for two days before my workouts with the Cordyceps mushrooms. I like it, I still wanna keep trying it. And also the Shrimp Tech Immune, just to help your immune system out. So check all those products out.
1:45 Nick has just taken all of them just now. So we’re just gonna have to keep an eye on him.
1:50 Nick Gabriel: Yeah, it’s a little low sample rate clinical trial, right?
1:53 Brian Rose: Yeah, it is a little sample rate. We actually had a couple conversations off camera that I wish we had taped with Dimitar so far.
2:00 Brian Rose: But I guess I’m gonna leave it over to you, Nick, to introduce our guest.
2:04 Nick Gabriel: Yeah, Dimitar, first of all, I’m happy to meet you. I don’t think we’ve ever had someone with such a high academic qualification in here, right? I think so, yeah. Yeah, that’s pretty good.
2:13 We had an economist, but you know. Oh, of course, yeah. This is different. Yeah, this is, I mean, your field of expertise, I know next to nothing about, but it does interest me. Could you tell us, I guess one of the things you find interesting about working in virology?
2:30 Dimitar Tonev: Yeah, you know, I’ve just been to a lecture yesterday in Royal Free Hospital when the guy, really a great guy that was responsible for this lecture, mentioned that most of the students during the first years of their training will develop some kind of affection for virology and viruses in general, purely because they’re very, very interesting and the, you know, background science is amazing. And second, unfortunately, they’re still responsible for loads of deaths worldwide. So it’s a kind of a natural challenge to try to avoid this deadly, to try to combat and, you know, to win against this deadly enemy.
3:11 And of course you’ve seen movies like Contagion recently where all these guys are working in a space shuttle costumes, which is really amazing. So probably during the initial years of training, we believe wrongly that virology means this type of amazing work, saving lives and risking your own. It’s not that sexy at the end of the day, but it’s still amazing science and it’s still very, very important from social perspective.
3:38 Nick Gabriel: So it’s almost, so virology is almost catchy like a virus.
3:42 Dimitar Tonev: Yeah, in a sense.
3:43 Nick Gabriel: Did you see Contagion? Man, I tried to watch it and it got to the scene where they were sawing up in the Gwyneth Paltrow’s head and I was just like, don’t really feel like watching this. Man, I’m a bit squeamish. Okay.
3:56 Brian Rose: It’s an interesting movie because it was a lot like a movie called Babble that came out about three years ago where you’ve got, the characters don’t really interact with each other in the movie. It’s kind of like you’ve got these semi-isolated things happening and there’s not a natural plot arc that you’re used to in movies. That’s Steven Soddenberg. I mean, he’s a genius and also crazy, but… Did you ever watch Traffic?
4:16 I did, yeah. I mean, he had his time on that, but did you… You watched it, yes? Has everyone in your field seen it?
4:24 Dimitar Tonev: Yeah, and we found it to be very realistic in terms of what might have been the normal reaction of institutions like the ones they’ve mentioned or countries in terms of the United States if the threat is really that serious.
4:38 We’ve been close to this if you remember the general kind of chaotic behavior during the initial phases of swine flu.
4:46 Brian Rose: The H1?
4:47 Dimitar Tonev: Yeah, so we were really lucky that the virus was not dead. This was dangerous in general in Hong Kong.
4:53 Brian Rose: They did some Quarantines and some Cullings didn’t they?
4:57 Dimitar Tonev: Yeah, actually it started in Mexico So the first affected country was United States specifically, California And of course the United States CDS identified the virus first But it’s it’s just the worst of the many pandemics and the least deadly one you probably remember the previous SARS drama that started in Hong Kong but end up being quite a big threat for a Canadian healthcare system and many others. Because it went from Hong Kong straight to Canada first.
5:29 Brian Rose: Okay, that was what, 2008 or 6?
5:31 Dimitar Tonev: No, it was probably around 10 years ago and then there were some cases of bird flu which is really more or less the kind of a background scare behind contagion because it was related to birds and the movie as well. So it’s always, this threat will be always around us, unfortunately.
5:50 Brian Rose: I always hear people making reference to the flu epidemic of like 1911 or 1918 or 1917 in the United States that killed millions or worldwide. Is that something you guys always look to as a base to make a comparison?
6:04 Dimitar Tonev: It is, yeah, it is amazing story, you know, in the history of medicine, probably we’ve never faced anything that big and that dangerous that killed in excess of 50 million guys. 50. 50 and based on some estimations probably even a hundred it’s difficult to understand because most of the victims are soldiers So during the first world war it came in three different waves And it’s almost impossible to identify how many of these guys were killed by the virus How many are killed by the other related to the very essence of war other health conditions?
6:38 So it’s difficult to really understand, but it’s an amazing piece of science I don’t know, it’s a little known fact, but there are really impressive physicians here in this country. And I would like to name one of these guys, Professor John Oxford, that went all the way up to Alaska to dig the remains of a couple of miners that died during the great Spanish flu pandemic in order to identify the virus based on this very few pieces of flesh remaining on this corpse in a permafrost.
7:13 Brian Rose: Is that dangerous at all?
7:15 Dimitar Tonev: Probably this is not something that put their wife in danger, but it did something amazing for the sake of science. And it’s a really interesting story. But it’s probably not our main topic.
7:26 Brian Rose: It’s interesting, though. How did that pandemic, it’s called a pandemic.
7:30 How did that die out? Did it kill itself out?
7:34 Dimitar Tonev: In general, the viruses are very quickly changeable in terms of their own kind of ability to kill humans. So most of the pandemics are coming in a couple of different waves, year after year. And the virus comes in a relatively changed genotype and phenotype.
7:57 And luckily for us, meanwhile, we are better and better prepared. And the virus is less and less, ideally, of course, able to kill us. But in general, it’s a natural process of kind of dying out. And it mutates into something else with the time. Yeah.
8:16 It’s in general, it’s the ability of the virus to really cause harm. It’s based on a couple of factors, specifically speaking about pandemic influenza, which is acute viral disease. Most of the other topics that we’ll be covering are chronic viral diseases. This one is acute viral disease. So it’s all about the specific type of the virus and whether humankind in general have met this virus previously, therefore being able to respond with the production of antibodies to neutralize this danger.
8:51 That’s an acute. So the worst virus would be a relatively new virus that we’ve never met before, therefore we are not prepared. Second would be not only unique in terms of genetic material, but would be really viable to delete fast and travel across quite successfully, which means stable outside of the host body, regardless of whether we are speaking here about humans or other hosts like birds or rodents or whatever. So if it’s new, if it’s dangerous, and if it’s able to survive outside of the host, therefore able to travel distances, it’s really…
9:33 Brian Rose: So those three characteristics will define something as an acute, as opposed to chronic?
9:39 Dimitar Tonev: Acute threat to humankind. And no, no, the difference between acute and chronic infection is actually based on the duration of this infection. Let’s say for something which is quite fashionable these days, like hepatitis C, if the body was not able to kind of overcome the infection in six months, the victory over infection most of the time means the creation of antibodies against the specific viral antigens. So if the body was not able to overcome this in six months, the infection is officially chronic one.
10:16 Brian Rose: Oh, I see.
10:17 Dimitar Tonev: It could go on for other 20, 30 years, gradually developing some kind of specific, let’s say complications which would be based on the organ localisation of the virus.
10:27 Brian Rose: Does that mean that if it takes a long time to actually kill someone does it also mean that that person can now spread it on to other people because they’re not dying quickly and is it more dangerous sometimes?
10:40 Dimitar Tonev: Unfortunately yeah, if you have this viral replicating in your body most of the time you are able to transmit this virus to others via different routes based on the typical characteristics of this virus. Exactly the same applies for acute viral infection unfortunately because you remember quite well the recommendations that were coming from the government and health protection agency during the beginning of swine flu pandemic like to increase the social, to decrease the social contacts. They would be really tempted most of the time to call schools because this was proven effective in previous pandemics. So less contact between humans kind of decreasing, at least theoretically, the likelihood of this virus to spread.
11:24 Nick Gabriel: So I have a question for you, Demetral, do you think the reason we haven’t seen something on the same scale as something like the bubonic plague is because of the fact that we have these far more complex and effective national health organizations and global health organizations? Do you think that that’s the only thing that’s prevented this from happening up since they used to take place like hundreds of years ago?
11:57 Dimitar Tonev: To a large extent, yeah. The guys in this organization like WHO or CCDS are doing a huge amount of work, not only to kind of quickly identify the virus in circulation, or to prepare us in terms of eventually submitting the identified by them viral characteristic to the manufacturers of vaccines.
12:20 But they’re actually trying effectively to predict what kind of virus we will be eventually facing in the next full season. That’s something which they’re doing on a regular basis. The likelihood of them being exact is very high. But it’s, of course, not always there.
12:37 Nick Gabriel: So I have another question.
12:39 Let’s say in the history of our species, Let’s say science had never come to the forefront or science didn’t exist and we had no pathology or immunology. How do you say that? Immunology? Immunology. Yeah, or virology or no medicine.
12:55 Do you think our species would have made it this far or do you think we would have become extinct due to some kind of epidemic or pathogen or something like that?
13:05 Dimitar Tonev: You mean without the proper healthcare?
13:08 Nick Gabriel: Let’s say healthcare did not exist. Scientific method even. Yeah.
13:12 Nick Gabriel: Like of cavemen or if we had never progressed beyond the Tonev Age, do you think ultimately we would still have gotten here and our immune systems would have done the job and produced antibodies that were required to keep replicating? Or do you think the species would have just been wiped out totally by some sort of…
13:35 Dimitar Tonev: It’s really difficult to predict what could have been, but on a couple of occasions in history that almost entire nations were killed by something which is not that dangerous in terms of pathogen and we’ve never actually proven that there are some suspicions that let’s say Inca’s empire was largely killed by disease which Spanish conquistadors kind of intentionally transferred to South America.
14:04 Nick Gabriel: Generally accepted these days?
14:06 Dimitar Tonev: I think so but I’ve never seen a real good proof like the ones Jon Oxford brought from Alaska many years ago,
14:12 Brian Rose: okay, I mean the whole if you’ve ever read guns germs and steel, have you read that book? No, I give Nick a copy but he lost it I think and but um, he talks about how um His question was how come the Spanish landed on the Inca’s doorstep and killed them Why didn’t the Inca’s land on the Spain’s doorstep and kill all of them and his argument goes that all the technology started in Mesopotamia and then people got to the division of labor and then once you have a division of labor you can get specialists and then You can have you know a guy that specializes in making guns or making a horseback ride You know with that kind of thing also he said the cohabitation with the animals allowed allowed to the mutation of a lot of viruses and Just by having sheep and all these domesticated animals They brought all of these viruses that they built up an immune system to and then when they went over to South America Yeah.
15:03 These people had never dealt with these strains and never lived with these animals and couldn’t deal with these diseases and that’s his theory. That’s an interesting theory. What do you think about that?
15:16 Dimitar Tonev: It’s interesting. It’s difficult really to predict whether it’s civilization, the natural development of civilization and in a certain extent will by all means be related to development of some kind of healthcare and we hear rumors and some of us are let’s say even believers that the the healthcare in Egyptian empire, at least for a dominant casta, was really very good.
15:39 And they were performing eye surgery. Yeah, the same goes for, let’s say, for Arabian famous physicians like Adi Sena, which actually are considered as the creators of modern medicine. So there are types of civilizations that were related to really well-established medical care. I’m not so sure about Incas, but given that we are still scared by their calendar, supposedly they have had some kind of successes in medicine as well. But that’s being said, they were definitely not prepared for this type of, most probably viral disease or kind of bacterial disease that came with Conquistador, like kind of obligatory pathogens, meaning they obviously lived in conquistador bodies, unable to kill them because they have had developed some kind of immune response against them through the years.
16:36 But unprepared local population, indigenous population, was really not prepared at all.
16:41 Brian Rose: I mean, if you were an Inca population and these guys showed up and everyone started dying around you, I mean, not from, you know, sword wounds, but just from the presence of them. And you you didn’t understand disease, how much of a mind fuck would that be? These guys show up and you die. I mean, seriously, if someone just showed up and said, hey, how are you Nick?
17:00 And then tomorrow you die because he touched you. I mean, they would be a God or a devil or.
17:06 Dimitar Tonev: Probably not that quickly.
17:08 Brian Rose: Yeah, but.
17:09 Dimitar Tonev: It’s still weeks.
17:10 Nick Gabriel: You know, when I speak or interact with someone like this or when I think about healthcare and virology virology and all these kind of things, what becomes clearest to me is how fragile we are, and just to make it to like, what, I’m 32, you’re 40, and how old are you Demeter? 44. Okay, just to make it to these ages, like, with all these things that can go wrong, it’s just, you have to be grateful, man, it’s amazing. Yeah. I mean, like, average lifespan being increased over the last 50 years or 100 years, I mean, I guess that has a lot to do with what you do, right, or what your company does.
17:50 Dimitar Tonev: In general, no, I can’t really take this credit, but in general, yes, the development of healthcare and development of science is really the most important factor. At the same time, worlds of other developments related to civilization in general, like, you know, better food in a certain extent, better, you know, kind of facilities and conditions for elderly people and so on and so on. It’s really a multi-factorial complex reason.
18:20 Brian Rose: There was recently something that was announced in the papers and I wanted to get your thoughts on it.
18:27 I don’t know enough about it but apparently in the laboratory that they had created like an airborne virus that was extremely dangerous and I wish I had more details about it and they’ve actually just suspended work on it for 60 days which is something they haven’t done before but they created some type of highly contagious airborne virus that could transmit between humans, something maybe along the lines of the movie. And then there was a big outcry as saying that there’s no way you can keep that in a lab, that there’s a very likelihood it will get out of that lab, and if it does, we’ll have a major problem on our hands. Is that something that, how should that be dealt with, in your opinion?
19:08 Dimitar Tonev: There are, I don’t know about this virus specifically, And of course, there are thousands of deadly viruses which are investigated actively. And of course, whichever is the institution is keeping them under really solid control. There are lots of procedure and different layers of security and safety, which applies to real dangerous viruses. But in general, it’s always a possibility. We believe that with the end of the Cold War, there is no substantial investments nowadays in development of bacteriological kind of weaponry.
19:47 But when that take a significant investment,
19:49 Brian Rose: I know we were talking about Tim Ferriss, author of the Four Hour World Week and the Four Hour Body, and he’s got a lot of chums that he has in Silicon Valley. Some of them are in pharmaceutical companies, and he mentioned on a podcast that one of the guys said, give me a few billion dollars and 40. Two weeks, he said. Two weeks and 40 of my guys and I will create a virus that can wipe out the planet. You think he’s being a bit cavalier?
20:12 Dimitar Tonev: It’s probably an over-optimistic view, and hopefully this will never happen. But with the proper funding, of course, lots of things could be created or further developed. And actually, there is no need for the humankind to do this, because viruses are doing this themselves. Once again, referring to this famous movie from last year. You could see this.
20:36 Brian Rose: I mean, millions and millions of people were dying, right? I mean, like 50, 100 million, it was just like 20% of the American population was dead. People were fighting over the vaccine. You know, it was assigned by the day of your birth. So it’s like, okay, if you’re born April 2nd, you have to wait until then to get it.
20:51 I mean, it was really, I mean, we are gonna see something like that in the next 40 years or in our lifetime, or will we?
20:59 Dimitar Tonev: It’s hopefully won’t be that bad and hopefully will be better prepared. But in terms of, let’s say, what have happened in this country a couple of years ago, it was always a kind of a well-established strategy for the British government, how to react in these kind of situations. And because they knew for sure that they will need at least six months, and six months it’s probably very optimistic to develop a vaccine since the first identification of the virus, they logically wanted to create some kind antiviral pool, pool of antiviral medicine that could actually delay the transmission of this virus in the population or kind of keep patients or others under relatively protected umbrella during this period of time they need to prepare the vaccine. The question is that all of the antivirals are created and driven by a specific genetic determinants of the virus. So if the virus is slightly changed or mutated virus, this virus might not be really influenced by this antivirus. We were lucky during the last pandemic that the available, let’s say, stockpiles of antivirals were effective against the virus. They were. For the last pandemic, yeah. And hopefully this will be always the case, but definitely in terms of influences specifically, there is a need, I guess, for more research and more antivirals because we have only two to
22:31 Preparations available two only two yeah as in two like two different two different molecules there are all new reminidase inhibitors so we need something more those two are generalized for viral for for for for full specifically flu we’re coming back to flu is that the most dangerous and the most likely the most likely to cause probably this type of dramas like the once described in contagion.
22:57 Brian Rose: What’s your, I’m always curious, like when you see a movie like that, you got like the WHO, which is a organization, and then you’ve got a pharmaceutical company like you, which are a for-profit corporation. I mean, they can’t call you up and say, start producing this, you know, this retroviral, whatever it is, this medicine.
23:18 Or can they? Or can they?
23:20 Nick Gabriel: Yeah, what is your relationship with them? I mean-
23:23 Dimitar Tonev: That’s a good question. It was always a very well-established relationship.
23:27 I’m currently not working in this environment, but in general, I’ve already mentioned that WHO is identifying well in advance the circulating types of flu virus for the next flu season, so they will do this during this north hemisphere summer, in order for the population to be prepared for the, let’s say, autumn normal peaks in flu activity. So this kind of cooperation between vaccine producers and world health organizations of any type, It’s well established and it’s working really well. It’s a kind of a normal seasonal virus, which we’ll know we will be facing.
24:05 This virus could cause some damage indefinitely. Unfortunately, it will kill elderly people or people with other chronic diseases. The pandemic types of virus are slightly different, but in general, the cooperation exists and will be equally effective and very much important in terms of potential damage of this type of pandemic viruses?
24:28 Brian Rose: I always find it really fascinating how science has just changed the game completely when it comes to natural selection.
24:36 And it’s just completely rewritten the rules. A lot of us probably wouldn’t be here if we hadn’t received some vaccination when we were a kid. How many times have we been really sick and had to go to the doctor and been prescribed something that’s probably ultimately saved our lives. Right, even antibiotics. Exactly.
24:56 Nick Gabriel: Something simple like that. Yeah, that’s kind of hard to fathom. So your work is mostly with hepatitis B and C, or what are your big challenges, or what are the things that interest you most right now?
25:10 Dimitar Tonev: Yeah, currently, my company is, I guess we should mention that I’m working for BMS. And regardless of this, of course, all the opinions expressed here, I might also not necessarily BMS.
25:22 Brian Rose: Can you tell us about BMS?
25:24 Dimitar Tonev: BMS is a well-known and substantial player against viral disease. It’s, let’s say, one of the classical, well-established American pharmaceutical companies. Since for Bristol Miles Squibb, OK. Yeah, preparing medication and developing new products in HIV, hepatitis C, and hepatitis B.
25:45 So that’s the three types of viruses related to a substantial chronic viral disease with the kind of very, very substantial health care outcomes.
25:55 Brian Rose: Do those diseases have the most market share? I mean, do those affect the most people in the worst ways?
26:03 Dimitar Tonev: Yeah, just a couple of probably figures in order to understand the magnitude of the problem. The world population that lives with hepatitis B virus is around 300 million.
26:15 Same figure for hepatitis C is around, all these figures are approximate, of course, are 170 millions and we believe that around 35 millions live with HIV.
26:28 Nick Gabriel: You know what I find fascinating is how malaria is such a huge killer and we never hear anything about it. Apparently, this is something I saw on the tube, a child dies every 45 seconds from malaria and malaria has been around for a long time.
26:49 Dimitar Tonev: It’s awful. It’s really the statistics are kind of really impressive in a negative way.
26:57 And sometimes something really simple like MosquitoNet could save lives, actually millions of lives in Sub-Saharan Africa. Same applies to HIV virus, which is still killing something like 2.5 million people per year. And most of these deaths, avoidable deaths, are in Sub-Saharan Africa.
27:17 Nick Gabriel: Is it avoidable because of medication or because of preventative behavior?
27:22 Dimitar Tonev: Yeah, because in both cases this is a reasonable way to prevent this and medication is available definitely nowadays HIV is a chronic disease.
27:32 Nobody should really die from HIV if diagnosed and treatment is started.
27:37 Brian Rose: This is mainly in South Africa, right? And Botswana and Sub-Saharan Africa is where the biggest problem is, right?
27:46 Dimitar Tonev: Most of countries from this area, South Africa actually did major improvements. They were famous historically many, many years ago with a movement called HIV Denialism, when some kind of prominent political figures were mentioning and actually defending the understanding that the virus is not causing the illness or deaths.
28:10 Brian Rose: You’re from South Africa. Can you shed any perspective on that? Because I know the head minister said, take a shower or something, or eat vegetables.
28:18 Nick Gabriel: This guy, he’s the, Jacob Zuma, who’s the current president of the country, I’m ashamed to say. It’s my understanding, and I don’t really follow South African politics much anymore, but it’s my understanding that he slept with some woman, there was some HIV scare or something, and he just said, no, it’s fine because I took a shower afterwards.
28:38 And that kind of like revealed his complete lack of understanding. And then the health minister said something like eat more vegetables. And then recently he’s gone in and actually taken an HIV test, so I think he’s actually gone to 180 another. They’re starting to recognize it.
28:53 Dimitar Tonev: What we are describing now was really 10 years ago, and it was really not something to be specifically proud of, but now I guess they’re moving forward.
29:01 They have full established health care system. They’re providing HIV medications to the vast majority of the population. So South Africa is probably the best example how things could change quite quickly.
29:14 Brian Rose: Have you been to a place like that where like a third world country and have you worked like on the ground, if you know what I mean? Because I can imagine that your, what you do is quite, I don’t want to say sanitized but you’re sitting in a lab in a first world country with all the resources at your fingertips.
29:34 I’d like to know your findings. Have you ever been to a place like that?
29:39 Dimitar Tonev: No, personally, no. I have a colleague. We were working with a guy that was previously responsible for establishing, let’s say, of the HIV health care system in Barbados.
29:52 And he knows what’s about a great deal about West Africa and what’s the situation in these countries. Another physician that I’m working with from Royal Free is actually working very, very closely with Ugandian professionals, healthcare professionals. So that’s my sources of information and the situation is getting better, but it’s not that good anyway. I remember, let’s say, the first years of HIV treatment in Eastern Europe, type of countries which I’m really well familiar with.
30:24 Brian Rose: You’re from Bulgaria. Yeah, specifically. I’d like to ask you more about that in a minute, but please continue.
30:31 Dimitar Tonev: And I could only share some experiences from these type of countries, which are fortunately not with that impressive prevalence and incidence of HIV, but on the other hand, definitely initially, the healthcare system didn’t respond in the best possible way.
30:47 Brian Rose: Why is that?
30:48 Dimitar Tonev: As I say, they were considered intravenous drug users or a homosexual population.
30:53 Brian Rose: Do you think that was just a kind of an ignorance or a shunning?
30:57 Dimitar Tonev: And without being officially mentioned, of course, for a very understandable reason, there were some attempts to criminalize intravenous drug use and therefore to restrict funding for, let’s say, reimbursement of medications, which were readily available for HIV.
31:14 Brian Rose: And that alone, that financial commitment can kill people, right?
31:18 Dimitar Tonev: Yeah. But we’re definitely Russian coming from typical, let’s say, pharmaco-effectiveness perspective let’s say what’s cheaper not what’s better but what’s cheaper and for a number of years you probably remember the example of Ukraine when before the changes all these countries were officially with a very small minority of positive HIV positive patients okay and after the changes let’s say in Ukraine this is probably the most impressive example figures exploded because there There was no iron curtain, there was no government control, and loads of real facts became available to the public and scientific communities. Fascinating.
32:02 Nick Gabriel: That’s how it’s so cultural. Just something like that, whether it’s in Africa or in Eastern Europe. Maybe like changing up the topic just a little bit, what do you think, you’re obviously very intelligent individual, I’d like to know, what would you be doing if you weren’t a virologist?
32:20 Dimitar Tonev: No, I definitely came from a non-medical background. My father was a professor of history.
32:25 My mother was dealing with reliability and generally electronical kind of devices. So none of my parents was really a medic. So I’ve always considered this type of development to be something of major interest. If it was not virology, it might have been probably gastroenterology, I did some kind of research earlier in gastroenterology and it’s still very much important. In general, let’s say viral disease like hepatitis is very much related to gastroenterology and hepatology specifically because bigger damage will be to your liver and actually what will kill most of the patients if they are not treated successfully will be a liver failure.
33:14 Nick Gabriel: Is this for hepatitis B and C?
33:15 Brian Rose: Speaking about hepatitis B and C. Can you talk about the difference between those two and how dangerous they are and the transmittability? I mean, I just always hear hepatitis C is serious, but I don’t know the difference. I don’t even know much about them.
33:27 Dimitar Tonev: Me neither. It’s really a different type of viruses and, you know, it’s a well-established fact that hepatitis B virus is much more clever and kind of difficult to combat and really causing probably more problems in the long run. It was never a virus of specific importance for UK, traditionally. The overall kind of prevalence is 0.3%. There are no that good or very credible official data, because the last health protection agency’s report is from 2013.
34:06 While preparing for this conversation, I’ve tried to find some more recent data. There is no any.
34:14 Brian Rose: When you said it’s a much cleverer virus, I found that was interesting. Is that just with regard to its mutatability?
34:24 Dimitar Tonev: They all mutate very, very frequently, and they are all able to produce billions and zillions of copies per day, so they all transmit very successfully and mutate very quickly.
34:38 The bigger problem with types of viruses like hepatitis B, they’re DNA viruses, so they’re incorporated with the human genome. To the attachment itself to the helix. And they’re creating something deadly and very clever called CCC DNA or covalently binded circular DNA, which unfortunately so far we were not able to kind of attack with our existing products.
35:03 Brian Rose: So does this mean that the virus is actually hiding within your DNA and using your DNA to replicate itself?
35:10 Dimitar Tonev: Exactly. They’re always using our DNA to replicate their own.
35:14 Brian Rose: That boggles my mind.
35:15 Dimitar Tonev: That’s why they’re very clever.
35:17 Brian Rose: That’s for hepatitis B, C and HIV?
35:19 Dimitar Tonev: It applies to all of them. They’re using, they’re hijacking our own genetic materials to replicate their own, which means they’re kind of stealing all the machinery available in the cells, in our cells, to replicate. But for hepatitis B virus, and to our extent for HIV virus, that’s the reason so far we can’t cure this disease. We could suppress the viral replication very successfully.
35:44 Brian Rose: But then it suppresses everything else as well?
35:47 Dimitar Tonev: Yeah. Suppress the viral replication to an imaginable small amount of less than 10 copies per meal, which is very, very small. But if we stop the medication, the virus will replicate again and will spread again across the body. So that’s only applicable to hepatitis B and HIV. Okay. Hepatitis C virus, being RNA virus, is slightly different, does not incorporate in the human genome.
36:16 Brian Rose: It’s in the ribosomes, right?
36:18 Dimitar Tonev: And we could really cure this virus very successfully.
36:22 Brian Rose: You can cure this one successfully?
36:25 Dimitar Tonev: We can cure it completely, yeah.
36:27 Brian Rose: And just as a perspective, B and C left untreated will kill a human in a similar way with level failure quickly?
36:35 Dimitar Tonev: Sometimes yeah after after a disease progression of something like 20 years it’s of course very much individual based on your gender, the age of initial infection, your immune response initially and many other factors which are related to your liver health like your diet whether you’re obese or not because this will be related to a processes in your liver like stereotosis in kind of accumulation of fat in your liver. So there are many different factors that are important for this chronic viral disease progression, but in general after 20 years you could expect some kind of a really deadly consequences like say roses, further down end-stage leaner liver disease and then unfortunately if you don’t have the ability to or available liver, liver, liver, liver transplantation services available, you will die.
37:32 That’s left untreated. If left untreated.
37:35 Brian Rose: OK. And sexual transmission is the number one way of getting all three of those?
37:42 Dimitar Tonev: Sexual transmission is, let’s say, very important and probably still leading for hepatitis B and for, let’s say, HIV specifically in, let’s say, something like 50% of the patient.
37:56 Hepatitis C, it’s definitely transferred better in terms of blood products or intravenous drug use. It differs between viruses and between countries, but I think nowadays the leading population for in terms of new patients for HIV in the UK is the homosexual men or MSMs, like we name them. So they are something like, for the last year, 2010, 3,000 new patients were identified in the UK. Perhaps out of sea. Which is for HIV.
38:33 Brian Rose: For HIV, okay.
38:34 Dimitar Tonev: Which is the highest ever figure in history.
38:37 Brian Rose: Really. You know what I find quite interesting, one is, so these viruses, you know, They’re just organisms on a different scale to us, right? The same way we’re on a different scale to like an elephant or a whale, right?
38:51 Just because, and they’re trying to survive, replicate and propagate on the planet the same way we are. And so we’re kind of in this competition with them.
39:01 Nick Gabriel: He said there, he said hepatitis B was craftier. Is that what you said?
39:05 Dimitar Tonev: It’s definitely a difficult enemy to provide.
39:08 I mean, this might sound like a stupid question, But how sentient do you think these viruses actually are? I mean, what do they respond to? Is it just light or temperature? Or how do they, I mean, when you guys actually look at the virus under the microscope, can you elicit some sort of response from that little organism? Or what is it, does this question make sense?
39:29 Dimitar Tonev: It’s likely, it probably needs some kind of qualification. You’re referring to their kind of ability to think, think, to be intelligent, or?
39:39 Nick Gabriel: Yeah, because you used the word intelligent. You said hepatitis B was more intelligent. So I’m asking.
39:47 I mean, I’m not expecting anyone to be able to have a conversation with it. But it’s like, does it respond to any stimuli, or is it just simply this thing just replicates? Or does this make sense?
39:59 Dimitar Tonev: In theory, we can’t speak about, of course, my expression was something like a joke. But we can’t speak about something quite intelligence.
40:08 But they are very well suited to the environment and they across all those years or centuries, they’ve developed in a logical for them direction to be more prepared to spread effectively, more prepared to be resistant to antivirus or other negative factors and in general to survive. What it’s probably not that clever, The virus in general should theoretically coming from human perspective, should be able to avoid killing the host because when the host is dead, the virus will die as well. But that’s of course not something that they will be doing intentionally, unfortunately for us. They won’t be doing so.
40:57 Dimitar Tonev: Yeah, in this respect, from viral perspective, the best virus should be able to spread and replicate without killing or without damaging substantially. Because it’s in its interest to do that. Kind of living in a normal and based on a mutual respect relationship, but that’s of course just a joke.
41:17 Brian Rose: I’m reminded of, as a scientist, you probably said that there’s absolutely no validity to this and I’m not making a judgement either way, but I remember watching an interview with a homosexual gentleman, this took place in the 90s, if I’m not mistaken, I watched this interview with him.
41:36 And he had been living with the virus for 20 or 30 years or something, no, my figures must be wrong. But he’d been living with it for a long time and he hadn’t started to display any of the symptoms of full-blown HIV. And he said what he did is he made an agreement with the virus. He said like, look, you need me and I need you. And I don’t know if he’s still alive today or not, but I find that interesting.
42:00 Dimitar Tonev: It’s probably bullshit. Probably just a great psychological way of dealing with his identity. It’s probably from a population of relatively well-described slow progressors. Unfortunately, this is a minority of HIV patients, I mean, it’s less than 5%, where the disease progression is really, really very slow, even to an extent that probably some of these These patients will probably die from some other reasons and will never reach this kind of treatment initiations kind of triggering values in relation to their CD4 counts and the viral loads.
42:42 Because being a chronic viral disease, nowadays, scientific community is recommending a specific points when the disease progression is considered important enough to initiate treatment. So not each and every newly diagnosed HIV patient will start treatment tomorrow. They won’t. They won’t necessarily. And for this population that we’ve just described, this probably will even never happen, or will happen very late.
43:08 Brian Rose: If you had to give one piece of advice for people listening as far as trying to prevent the transfer of all three of those HIV, hepatitis B and C, what would you say to people?
43:20 Dimitar Tonev: In general, I know that this type of advice is coming from a health care professional or don’t have a huge chance to be, you know, how to say, followed immediately because the typical advice of, let’s say, safe sex, it was obviously out there for a number of years, but it’s still definitely not followed and still sexual transmission of, let’s say, HIV is the leading one and so on. But in general, safe sex is extremely important for those three completely different viruses.
43:54 Another thing that is very much important, it’s still, let’s say, something like half of the British population with hepatitis C is from the intravenous, is well identified as being intravenous drug users.
44:07 Brian Rose: Okay. So clean needles is what you want. Without judging anybody’s behavior, clean needles, extremely important.
44:14 Dimitar Tonev: And there are services available across this country at least, and these services are providing clean needles.
44:21 Dimitar Tonev: And actually, all the other things you need to inject in a relatively safe way, I’m not referring to the harm of the narcotics itself. It will be always there, but at least in terms of spreading viruses, every effort has been done not to encourage this.
44:38 Brian Rose: You know what they do in this country? There’s one of the things I really admire about the British social system is how well developed it is. You can walk into pretty much any pharmacy and you can ask them for something called the Blue Pack.
44:54 Blue Pack is a package of clean needles, alcohol swabs, a little plastic box that you can dispose of your needle in, so you pop your needle in and then you can’t take it back out so you can throw it away safely. And I know this because I’ve got this friend who’s a bodybuilder and like one time I was walking with him, he’s like, oh, I just need to get a blue pack. Right. And I was like, what do you mean? He’s like, come with me.
45:19 We went into this pharmacy and he said, I need a blue pack. And the woman looked at him, you know, and she looked, I think she looked at him funny because most of the people who walk in there are probably junkies, you know, who like all that. And this guy like only eats organic beef and he’s got like a 3% body fat, like specimen of health, you know, but still they gave, they gave it to him for free. For free. Yeah, for free.
45:39 Brian Rose: And that’s amazing. This is a very cool country to live in. That is a good way to prevent.
45:44 Dimitar Tonev: It’s definitely. But there are some weaknesses at the same time.
45:48 Dimitar Tonev: And while it’s my personal opinion, I guess, I believe that HIV services are really well developed and are providing excellent care, which is probably leading the world, it’s not exactly the same for the care available for hepatitis C and hepatitis B. It’s very much we are wagging behind compared to other European countries in terms of number of diagnosed on a basis of the suspected number of infected and at the same time on a basis of number of patients on treatment compared to the whole number of diagnosed. So we are definitely, there is a huge room for improvement and this is something that it’s, we believe in the focus of the current government and definitely in the focus of existing scientific associations like BVHG and Basel here in this country.
46:36 Nick Gabriel: Tim, I want to ask you a question. What is your favorite thing about London? What do you miss most about Bulgaria?
46:44 Dimitar Tonev: It’s an interesting question.
46:46 Nick Gabriel: How long have you been here?
46:48 Dimitar Tonev: I’ve been here for the last seven years and more or less enjoyed every minute. Definitely not homesick. I’m missing my friends and my family mostly. I would appreciate if of course possible to see mountains from my window. But it’s highly unlikely. From anywhere really. Highly unlikely that this type of development will happen in a foreseeable future. So that’s the only thing probably that I’m missing. Of course, there is no need to mention the weather. It’s not ideal. It’s not ideal.
47:20 Brian Rose: But today is a lovely day. We’ve had a good year of weather, funny enough. It’s been pretty dry and pretty sunny. And no snow so far, But yeah.
47:30 Dimitar Tonev: One of my mates is joking about Kyoto Protocol, if you remember one of the first big meetings about climate change. So he’s telling me always, I don’t know what exactly they’ve decided, but I get it right this time, because we’ve never seen so much snow in the UK, and we’ve never seen so much sunshine during the summer, so climate is definitely changing. It is changing. Well, it’s definitely warming. I don’t know.
47:55 Brian Rose: There’s supposedly growing wine now in southern UK, which could never happen 30 years And Bulgaria just missing friends, that’s all.
48:05 Dimitar Tonev: Yeah, of course it would be probably an overestimation if I said there is nothing that I’m missing from typical Bulgarian things like, you know, food, music, and if you want slightly different understanding about the seriousness of life, it’s one of this typical Mediterranean type of countries which are traditionally associated with more or less laid-back culture. Nothing is that much of importance. Everything could happen tomorrow. Do you know this famous joke about one of the greatest ever Bulgarian football players called Stoichkov? You probably remember this chap. He was playing probably until 10 years ago. So his greatest moments were with Barcelona in Spain. He was a part of the previous great Barcelona team probably 10 years ago.
49:01 In this joke he is chatting to his mate from Brazil called Romario and they were explaining some specific perceptions for let’s say Spanish and Bulgarians. Romario is asking Stojkov what What exactly tomorrow means in Bulgarian, the actual expression is asega, but of course I don’t expect you to speak Bulgarian. Probably actually you could to a certain extent. And he said asega, which means something will happen tomorrow. It’s exactly the same like Spanish manana, but without this sense of urgency.
49:41 So this probably puts things in the prospectus.
49:43 Brian Rose: Interesting. perspective, before you got here, we were talking about Americans and the work ethic, because BMS is traditionally an American company, even though it is a global company, and we were talking about the quote-unquote American work ethic, and I told him that the first two-week vacation I ever took was after I got to the UK after two years. Before that, in America, you would never take a two-week vacation, because it’s almost a sign of weakness, or you said earlier, it’s a sign that maybe something’s drastically wrong with you, if you do that. And even if you are away, you’re expected to be on your Blackberry and all that stuff.
50:17 Nick Gabriel: It’s worse than Japan even. What do you think about that? But then the studies show that they’re not any more productive. They’re just working harder. Not smarter.
50:27 Do you agree with that?
50:29 Dimitar Tonev: Yeah, coming from, once again, this typical medical perspective for evidence-based data, I would like to see some kind of reasonable comparison, let’s say, between comparable Japanese, American and European population, given their absolutely different culture and different to a degree work ethic. I would argue that the GDP is, or per capita GDP is, that metric that… To radically, yeah, but it’s a kind of a very composite end point with what’s a father’s factors being involved in calculating GDP.
51:05 Brian Rose: I thought I read something about productivity, as in what a worker can accomplish in an hour. And apparently, even with France, with the 35-hour work week, those hours were more productive than the Americans. Because they were saying, OK, they’ve had their vacation. They’re relaxed. They’re putting in those seven hours a day.
51:20 The Americans responding to a BlackBerry at 2 in the morning doesn’t make it more productive. But my buddy of mine’s an investment banker in New York. And we went to a B-Thon vacation. And he was on his goddamn BlackBerry most of the time. And I was like, dude, I was like, first of all, you’re not president, so I don’t even mean around you.
51:35 And he said, dude, my clients expect a response within two hours. He’s like, I’m their investment banker. They want to buy and sell companies, and this is the way I have to do it. This is my job, and that’s end of discussion. And I understand it.
51:50 Nick Gabriel: I wouldn’t want to, I don’t think I could do that. Yeah, not me.
51:54 Dimitar Tonev: It’s a little bit of a simplistic view, but let’s say in the disease area We were describing previously chronic hepatitis HIV. Most of the new products, let’s say in the last 10 years, came from either American and European pharmaceutical companies, so very little development coming from Japan, which we’ve always considered to be a very technically developed country, well-prepared for almost everything.
52:22 And that’s being said, it’s not because their healthcare system is not good. It’s not that their patients are not equally well treated, but just looking into creativity part of the equation, it seems that, at least in this disease area, once again, I don’t know about cardiovascular neuroscience or other types of really important diseases, environmental diseases, I’m not aware of any meaningful development being driven by Japanese pharma companies.
52:50 Brian Rose: And so are you, in a roundabout way, making the point that that might be due to a lack of creativity on their part, or?
52:58 Dimitar Tonev: I don’t know. Really don’t know. Might be because this is not considered to be of major importers for them in terms of business drivers. Might be because they don’t consider this specific problem to be of major importers for Japanese population. Or probably because their tremendous work addicts and discipline is kind of going ahead or against the creativity.
53:22 But this is of course largely unknown so this is pure speculation
53:27 Brian Rose: interesting you know we only have a few minutes with left guys I just wanted to ask if if there’s one thing you want to accomplish in the next say 10 years at your job or assuming you’re doing this what it what would what would it be you know even if it’s slightly unrealistic what would you like to see
53:49 Dimitar Tonev: yeah you know you know Brian probably that a very close to my heart family member is is now devoted to life coaching and career coaching and even without her influence, I was previously involved in a couple of coaching events organized by my company and they are always asking for your life statement, your purpose in life. And how about these things being kind of difficult to establish. Mine was that I would like to help this company and the scientific community in general to move from HIV, where we are currently able to offer really great medical care, to transfer the same amount of success in a specific BMS, of course, settings, to hepatitis C, which is a gradually evolving, very, very interesting disease area with more than 30 compounds now in development in phase two and phase three.
54:46 So that’s really my personal target. I would like to be a witness of a new down of hepatitis C care, when we will be able to cure, compare it to 50% today, probably 80% and 90% of the patients in the next five years.
55:00 Nick Gabriel: Is it a PR campaign to a certain extent? I mean, everyone knows about HIV and AIDS and it’s the new disease, well, not new, but I mean, is it a PR to a certain extent? I mean, hepatitis C, I wouldn’t say many people know about.
55:15 Dimitar Tonev: Not really, because I’ve mentioned already the global figures, and let’s say in the UK we have something like 90,000 patients with HIV, the same time we have an excess of 200,000 patients with hep C. So it’s not new, it’s not that it was not known, but let’s say the public noise and the attention of society was very much in favor of HIV so far. Now this is changing gradually with other chronic viral diseases being considered of importance and for the very right reasons, figures speak for themselves.
55:51 Brian Rose: Wow. And you want to ask before we sign off?
55:54 Nick Gabriel: No, I mean.
55:55 Brian Rose: You want to take a nap after all that knowledge?
55:58 Nick Gabriel: Take a nap, I just want to process it all.
56:01 Nick Gabriel: I would love to come and spend a day at work with you and just see what your day of the routine is. I mean, maybe I am asking actually.
56:10 Dimitar Tonev: Yeah, it’s probably not that sexy, like we mentioned before, because definitely no space kind of environment or lab work. I’m not necessarily a scientist, I’m working in general in medical affairs, which is a kind of a mixture of clinical research, specific support for marketing, and definitely related to all sorts of other things like compliance, drug safety, and so on.
56:36 So it’s a kind of a composite science, which is here in the UK, a special, a separated specialty called pharmaceutical medicine. But definitely guys in labs are in close contact with us and we are driving this forward together.
56:50 Brian Rose: Wow, it’s really a pleasure having you on. Thank you for coming on.
56:54 Dimitar Tonev: Thank you very much guys.
56:56 Brian Rose: I think it was very specific, but I think a lot of our viewers will be blown away by this because it’s really interesting stuff. So thank you much and what a journey it is. Thanks everybody. We’ll see you guys next week.
