THE INVISIBLE INFRASTRUCTURE with Tom Polen, Chairman and CEO, Becton Dickinson

Uh, I don't know how much of this you've caught today, but we're having a good time.

Sure. Again, thanks for having me and obviously very pleased to support who's watching. I love seeing the logo behind everyone's head from the green room. So, if you're not familiar with BD, I would consider and I think most hospital CEOs would consider us the most consequential medical technology company in America. And the reason for that is nine out of 10 people going into a hospital will be touched by our products. So, think about a syringe. 70% of all healthcare requires something as basic as a syringe to be delivered. 90% of all syringes in America, we make them in Nebraska. We make them in Connecticut. 70% of all IV catheters, which are pretty much in every patient's arm to deliver the therapies that we've been talking about, we make in Salt Lake City, Utah. We also make advanced things like the robotics that are running Amazon's retail sites that are shipping drugs to your home. We make those implantable stents, grafts, AI devices that are monitoring patients. So, we're about 20 billion in revenue. We make 35 billion devices a year at 27 manufacturing plants across America. We have other plants outside of the US, but again our scale is unmatched. 190 countries around the world, 35 billion devices, we touch every human on the planet roughly five times a year.

It's a very exciting time both in the company that helps us drive efficiencies and productivity. Two-thirds of our associates are in our manufacturing plants. So, we use it there. We use it in our R&D processes, but when it comes to patient care, we really see it having breakthrough transformation on both the cost and the quality. A few ways that we're using AI, we use AI as an example. We talked about and the congressman just spoke about the pharmacy. So, in the future, and I was on the board of Walgreens before we took it private. In fairness, over time, I would imagine 10 years from now, not many people here will be going into your retail pharmacy to pick up your prescription. If you're going to be on statins or GLP-1s for the rest of your life, those should just be delivered to your house. And those will be robots using AI as well that'll be checking every pill to make sure it's the exact number of pills, no medication errors. Stats are I think 4% of prescriptions at a retail pharmacy have errors because you don't count pills perfectly and put them in amber vials. We do that with 100% accuracy. That's AI doing that. In more advanced ways, we use AI in the ICU. As an example today, monitoring technologies that are looking at people's blood pressure not like you would use with a blood pressure cuff, but we look at it pulse by pulse of your heart every single beat and how your blood pressure is changing using advanced technologies. It's hemodynamic monitoring. We now have AI applications that are approved by the FDA that will say your blood pressure is about to drop 15 minutes from now. So before the patient alarms go off and harm's happening to the patient, we're predicting therapy. And now we have technologies that are working, putting AI in our pumps that will auto adjust the infusion to the patient so that side effect never happens and the nurse never even needs to run in and try to prevent it. But that'll be autonomous systems augmenting patient care. Because today, the way that things work is a doctor will say, 'Take this medication every four hours in the hospital.' And then your body gets out of line, alarms go off on the sensors on you, and then they try to get you back in line. In the meanwhile, bad things are happening to your body. Your blood pressure is not meant to swing, for example. It hurts organs, it hurts your brain, it hurts a lot of things. And what should really happen is someone say not take this drug every so often. Keep this patient's vitals in this range. Keep their blood pressure 120 over 80. And AI and the technologies, the devices will be continually adapting and keeping the patients perfectly. That's not that far away. I mean, those are things in our innovation pipeline that we have submission dates to FDA in our plan. So, it's really revolutionizing care and how it's delivered.

It's a good question. I do think generally, if I look at associates at BD, we have 800 nurses that work at BD. We have hundreds of pharmacists. We have hundreds and hundreds of doctors. They just focus on the patient. It's why they're in our industry. We have a saying in BD, we're very blessed to be able to fulfill our life's work through our work life. And I think generally that's a concept across healthcare where they just focus on more patient impact rather than pause and brag about it. It's just not in the industry's genetics. It's probably something we should do.

That's fascinating.

Sure.

For sure. So for example, we invented, every single one of you have definitely had our devices inside of you. If you've ever had your blood drawn, 90% of all blood in America is drawn with our needles that go in your body. And the whole concept of the little tubes that evacuate, we invented that concept.

We're proud of it. But that will all change in the future. We're now working on technology that you'll draw your blood by yourself at your house. And so that will shift. You won't have to go into a lab and have someone stick something in your vein. 10 years from now, you'll be drawing blood by yourself at your house and just call in and someone...

I think healthcare change is slow. Technology is becoming available in the nearer term, but it's very rare to see healthcare shift. There's big infrastructure. Even things as simple as the infrastructure of all the lines that fit certain size tubes has to get changed out to actually do things at scale. Big infrastructures have been built, but that's all coming. We have in the hospitals the infusion platforms that put big guardrails and safety around complex infusions. We have technologies that are bringing that into the home. We have wearables that are in our pipeline. We have technologies that we invented, PureWick for example, is one of our products for urinary incontinence in hospitals. That's our fastest growing segment, helping treat urinary incontinence in the home. And now we have mobile versions that people will be able to walk around the streets of DC and manage that condition. So we're investing very heavily. There are three areas that we invest about a billion dollars a year. The biggest number one is smart connected care, the use of AI, robotics, informatics to transform the cost and quality of care which we've talked about. The second one is enabling care to shift to new care settings including specifically the home. And the third one is we invest heavily in technologies that improve outcomes for patients with chronic disease. Devices like you see drugs now, devices are changing the outcomes for patients.

So I grew up on the Eastern Shore of Maryland, just outside of Eastern Maryland. Very close to where you are.

Well, I'll have you over for a crabfest.

I get the crabs off my dock.

I got so excited about talking about crabs. What was the question?

And this is where AI is going to come in. The reality is each of us today have in our pockets with OpenAI basically some of the smartest specialists in the world. It's amazing. If you have a rash on your skin, you take a picture of it and then you go to the doctor afterwards, it gives you pretty much the exact same feedback. It's unbelievable what it has. Those humanoids I talked about, of course they'll be able to see you and they'll have the knowledge of pretty much all specialists simultaneously to give feedback on what they're looking at. That's coming. It's not a question of if. It's coming and it's not that far away. Companies like BD, again, we're very focused on that home health side, whether it's the robotics that we have that are enabling drugs to be delivered to people's homes or for them to pick up medications in rural communities in new ways, to those products that help them enable things like blood collection to be done at home in simpler ways so they don't need to leave their home or suffer less in the process of drawing blood, particularly for people with difficult venous access. Again, all these technologies are coming to help enable that. So, I'm extremely optimistic. And you mentioned something extremely important, moving care into the home. We talk about clinician burnout. There's a real issue of family burnout when it goes to the home as well. So, technology has to play a really important role to prevent that from happening.

Absolutely. There are technologies, I heard you talk about telemedicine just a bit ago. There's some amazing AI technologies that we partner with that are used in hospitals that are coming into the home now. They basically are cameras that are in a hospital room that could be in your room at home and they're watching the patient. I was just at Mayo in Jacksonville two weeks ago and fall risk is a real issue. They have AI cameras in the room that as soon as someone starts moving in certain ways, it calls and says, 'Please stop, do not move. We are sending in support.' And they've had zero falls since implementing that technology. Or it can watch how often the patient is moving and then give ulcer risk scores because they're not rotating properly. And please patient, please rotate. You haven't rotated enough. Please move to this side. And again, dramatically reduce ulcer rates. Nurses can pop up real time on the screen and engage with the patients when AI is flagging to a nurse. Hey, the patient's doing X or Y, big risk. Nurses actually, it's not well known, you're more likely to be assaulted as a nurse in a hospital than you are as a security guard in a jail. The reality is you've got people, whether it's a family member or someone in delirium. There are 7 million people that are in hospitals who face delirium. You're on narcotics. Your body's been traumatized in a hospital. Often people don't know what they're walking into in a room. These AI systems are now literally pinging nurses and giving alerts. They're watching and saying high delirium risk in this room. They're aware, maybe they get the right support other than just themselves being surprised when they walk in. So, it's amazing what's just at the early cusp of what's happening. It's at a one right now, and we're on a journey to a 10 plus. So, I get very excited and all of that can be moving into the home as well.

129.

From a wearable perspective, we have some that are more in the high acuity setting. We have some in areas like urology, managing urinary incontinence. I think the bigger thing is we partner with essentially every major pharma company in the world. So most biologic drugs are delivered in our devices, including GLP-1s. And as you think about whether it's the ease of use of auto injectors and self injectors, but many new biologics are coming out that may need 10, 15, 20 minute infusion times.

It's not on anything that's with pharma. It would be the pharma company's logo, not ours.

We consider those confidential, those agreements. So, we don't talk about specifics. But we're very much into those wearables for drug delivery. So, again, pharma companies develop the molecule. They look to us to develop the device that helps deliver it to the patient in the most effective way. We spend a lot of time understanding what's the dexterity of someone with arthritis putting on a wearable and how do we need to change the configuration of that device to make it practical and how's that different than someone with dementia who's trying to manage that and how do we design devices differently? We go and we live and spend time. Our scientists and R&D teams are spending time in the patients' homes with them, dozens of them, understanding that, building it into our wearables and our devices. You can't do it any other way.

Probably not.

I won't be there, unfortunately. I have to head back.

Our other team will be there.

Very good. Thank you. Very nice to meet you. Thanks very much for hosting us.