Episode #145. Cancer Isn’t One Size Fits All, Why Treatment Shouldn’t Be Either, with Jim Foote, CEO and Co-Founder of First Ascent Biomedical

Summary

---

Risk Never Sleeps Podcast: Episode #145

Cancer Isn’t One Size Fits All: Why Treatment Shouldn’t Be Either
Guest: Jim Foote, CEO and Co-Founder, First Ascent Biomedical
Host: Ed Gaudet
Date: November 6, 2025

---

Episode Overview

This episode delves into the future of cancer care with Jim Foote, CEO and Co-Founder of First Ascent Biomedical. Jim discusses how his company is reinventing oncology by using functional precision medicine—developing personalized cancer treatments tailored to the unique biology of each patient. The conversation covers the inadequacies of current “standard of care” approaches, the role of AI in customizing therapies, Jim’s personal motivation following a family tragedy, and lessons learned from a career spanning technology, cybersecurity, and healthcare.

---

Key Discussion Points & Insights

1. What Is Functional Precision Medicine?

• Jim Foote explains First Ascent’s approach:
  “What it really means is designing a customized, personalized treatment program specific to you and the biology of your cancer—as individualized as your fingerprint.” (00:47)
• A move away from “one size fits all” in cancer care.
• The limitations of standard of care—based on population averages rather than individual specifics.

2. Partnerships & Platform Background

• First Ascent is negotiating partnerships with organizations like the Mayo Clinic, notably for leveraging large-scale data in AI-driven therapy customization. (01:20)
• The company has been validating its approach and technology for over a decade and officially launched in 2018. (01:28)

3. Integrating AI and Rich Biology Data

• First Ascent’s innovation came when they combined advanced biological data with their technological platform in 2018.
  “In 2018 is when we really brought the biology pieces and the technology pieces together to really help support patients better.” (02:01)
• Jim offers a unique analogy: treating cancer as an “electrical circuit” and targeting multiple points to switch off malignancy. (01:40)
• Their AI is focused not on large population datasets, but on creating a “truly n of one study” for each patient.
  “Our training set is all about you... when we analyze a patient they’re their own control.” (09:09)

4. The Human Cost and Personal Motivation

• Jim’s transition from a tech and cybersecurity career to cancer innovation was catalyzed by the loss of his teenage son to cancer:
  “My son was one of those one in three. He died from cancer at the age of 17.” (03:10)
• He was struck by the disparity between business technology and what was available to clinicians:
  “I had access to tools and technology at my fingertips to make trivial decisions in business that these professionals didn’t have to make great decisions about somebody’s care.” (03:31)
• “Cancer picked the fight with the wrong guys… It won that battle, but I’m going to win the war.” (03:59, 04:07)

5. Technology, Cybersecurity & Cancer: Unlikely Parallels

• Jim draws comparisons between cybercriminals and cancer:
  “They both want to evade detection. They both want to constantly mutate and morph so that you can’t find them. And they’ll take everything from you if you let them.” (04:58)
• Urgency in both cybersecurity and patient care—emphasizing the need for anticipation and proactive defense.

6. Rethinking the Standard of Care

• Critique of current protocols:
  “Standard of care is great, but it still results in one in three cancer patients dying. It is the number one killer of children by disease type. And the standard of care is built off averages over time.” (02:26)
• First Ascent enables a radical improvement:
  “When doctors use our platform to help guide treatment, patients benefit 83% of the time better than standard of care.” (09:43)
• Potential to impact the fate of hundreds of thousands:
  “618,000 Americans will die from cancer in 2025… to be able to have a potential impact on helping them have better outcomes by 83%. That’s why I’m so excited about what we did.” (09:59)

---

Memorable Quotes & Notable Moments

On Career Motivation and Mission

• ”Cancer picked the fight with the wrong guys… It won that battle, but I’m going to win the war.” – Jim Foote (04:07)
• ”I’ve never had more fun, worked harder and made less money in my entire career, so I must be doing something right.” – Jim Foote (07:08)

On Advice to His Younger Self

• “Don’t let anybody ever tell you there’s something you can’t do.” (08:09)
• “I always equate healthcare and specifically oncology like NASA… SpaceX comes along, do it faster, cheaper and safer, because they weren’t rocket scientists. And I think that’s where we are with healthcare today…” (08:27)

Leadership & Taking Risks

• Referencing bungee jumping in New Zealand as the “riskiest thing” ever done (10:33–12:19), a metaphor for calculated risk-taking in business and life.

On Failure and Pushing New Boundaries

• “Don’t be afraid to take risks. …If you’re not taking risks and failing, you’re not pushing the limits of technology and your own abilities. But you should only fail once, learn from it and improve.” (13:49)

---

Key Segment Timestamps

• 00:47 – What is functional precision medicine?
• 01:28–02:24 – Company history and the tech/biology fusion
• 03:10–03:52 – The personal loss that prompted the company’s founding
• 04:58 – Cancer and cybercrime parallels
• 07:08–07:58 – Career reflections and advice for younger self
• 09:09–09:59 – How First Ascent’s AI and approach differs from mainstream models, “n of one” medicine, and patient outcome improvement
• 10:33–12:19 – “Riskiest thing I’ve ever done”: Bungee jumping in New Zealand
• 13:49–14:38 – Advice to young people entering healthcare and cyber

---

Speaker Attribution & Tone

Jim Foote’s perspective is visionary, personal, and pragmatic, weaving stories of loss and hope, technical mastery, and a relentless quest to make patient care as individualized as possible. The conversation with Ed Gaudet is frank, fast-paced, and peppered with humor, pop culture references, and practical insights.

---

Additional Noteworthy Segments

• Personal Interests – Jim’s love for the outdoors (mountain biking, skiing, running) and music taste (Eagles, U2, Creed, Pink Floyd, “everything from Hannah Montana to Nickelback”). (07:30, 12:41)
• Bungee Jump Story – A vivid account reflecting Jim’s willingness to take risks, both personally and professionally. (10:33–12:19)
• Advice for New Professionals – Lean into your strengths, embrace failure as learning, and maintain authenticity and grace in a divided world. (13:49–15:02)

---

Final Takeaways

• Cancer treatment must become as individualized as patients themselves—“as unique as your fingerprint.”
• Dramatic improvements in outcomes are possible with a data-driven, AI-enabled, personalized approach.
• The urgency and mindset drawn from cybersecurity and technology fields can and should transform healthcare.
• Taking risks—personally and professionally—is essential to innovation and impact.

---

Notable Quote to Remember:

“Our training set is all about you… when we analyze a patient they’re their own control. It’s a truly n of one study.”
— Jim Foote (09:09)

---

Transcript

[A]

Foreign.

[B]

Welcome to Risk Never Sleeps, where we meet and get to know the people delivering patient care and protecting patient safety. I'm your host, Ed Gaudet. Welcome to the Risk Never Sleeps podcast in which you learn about the people that are on the front lines protecting patient safety and delivering patient care. I'm Ed Gaudet, the host of the program, and today I'm live at Health, and I'm with Jim Foote from First Ascent Biomedical, the CEO and founder and co founder and co founder and welcome, Jim.

[A]

Thank you. It's great to be on your show. Thanks.

[B]

So start off by sharing a little bit about your organization, your role, how long you've been around for the listeners.

[A]

Yeah. So First Ascent Biomedical focuses on functional precision medicine in oncology. A lot of people don't really realize what that means, but what it really means is designing a customized personalized treatment program specific to you and the biology of your cancer as individualized as your fingerprint.

[B]

Ah. So we were talking a little bit about that before the show and how the Mayo Clinic is building out that data set to enable that with the AI platform. The Mayo Clinic platform, which is pretty exciting. Do you partner with them today? We.

[A]

We aren't partnering with the Mayo Clinic yet, but we are in negotiations with them to partner with.

[B]

Oh, excellent. Okay, great. And how long has the company been around?

[A]

So we've been actually testing and validating our platform for over a decade. We officially launched in 2018.

[B]

Wow. Okay.

[A]

And, you know, have been accelerating the company ever since.

[B]

And AI from the beginning or.

[A]

Yeah, we've actually been validating and publishing our AI Before AI was AI. So again, for about a decade, we've had this hypothesis that if we look at a cancer like an electrical circuit, if we can find drugs that turn that circuit off in as many ways as possible, the cell ultimately dies and the patient survives.

[B]

Oh, brilliant.

[A]

What we were missing was a piece of biology that really threw off a really rich data set. When you combine it with DNA and rna, it ultimately gives you a much higher fidelity into cellular response and how it works. And so in 2018 is when we really brought the biology pieces and the technology pieces together to really help support patients better.

[B]

So we all are binary, then?

[A]

We are all binary. And that's the fundamental premise behind what we do. You know, if you look at the standard of care, standard of care is great, but it still results in one in three cancer patients dying. It is the number one killer of children by disease type. And the standard of care is built off of averages over time. It's enough people that look like you respond to treatment like you, but the reality is there's only one of you. And genetically, we're all different. And so that's where we take a different approach in that we say if we acknowledge biologically we're different, then why shouldn't our treatment be as unique as us? And that's what functional precision basically does.

[B]

And how did you come up with the idea?

[A]

Well, it's an interesting story. I spent my entire career in technology solving problems. My son was one of those. One in three. He died from cancer at the age of 17. Thank you. And it's one of those things where once you see what you've seen, you can unsee it. And what I saw was an amazing group of nurses and doctors and hospitals and insurance companies and pharmaceutical companies all coming together to try to save my son's life. But what I also saw is I had access to tools and technology at my fingertips to make trivial decisions in business that these professionals didn't have to make great decisions about somebody's care. And so that's really the genesis of why we started the company.

[B]

I always love to know and understand the origin story. Yours includes, obviously, the passing of your son, which is awful. I'm very sorry about that.

[A]

Well, I always say cancer picked the fight with the wrong guys. There you go. It won that battle.

[B]

It's cancer.

[A]

Yeah. But I'm going to win the war, so.

[B]

Excellent, excellent. So how did you get into tech?

[A]

Well, in the 1980s, you know, it seemed like the thing to do. And I always, kind of jokingly, I've never been one of those, you know, sitting behind the computer screen, programming as a little kid, all of those types of things. But in the early 80s or late 80s, everybody was going into technology. And I've always been a problem solver. And in those early days, there were lots of problems to solve. But when you look at the technology turn, it transforms every 18 months. And so it constantly fed that desire to solve problems.

[B]

Yeah.

[A]

And that led to a lifelong career with a adp. Big payroll company.

[B]

Yeah.

[A]

You know, the last decade, believe it or not, I spent as a chief security officer in cybersecurity. Yeah, all right, okay.

[B]

But.

[A]

But when you look at a cyber criminal and you look at cancer, they're actually the same thing, except one kills you. They both want to evade detection. They both want to constantly mutate and morph so that you can't find them. And they'll take everything from you if you let them.

[B]

Yeah.

[A]

And so you Know, it's kind of that mindset of the tenacity to again, you're up against an adversary every minute and there's a sense of urgency that you have to bring to everything that you do.

[B]

Yeah, it's a great point. And with ransomware, actually, the attackers now are killing patients.

[A]

Yeah, absolutely.

[B]

Patient care, disrupting ambulances. If the health system is down, the hospital is down. If you live in a rural community, you could be on another two hour drive.

[A]

Absolutely.

[B]

And by that time. Yeah, it's all bets are off.

[A]

Right.

[B]

Yeah. So it's terrible. And we have to solve both problems.

[A]

That's right.

[B]

F. Cyber.

[A]

Yeah.

[B]

Cybercriminals too. Right.

[A]

Amen to that.

[B]

Amen. Amen. Amen. So interesting. So you know what the word VAX and VMS means? The Digital Equipment Corp. Do you remember? Yeah, yeah, yeah.

[A]

Well, you know, again, when I started, funny story, when I was in school, they actually had me write a machine language program. Ones and zeros.

[B]

Yeah.

[A]

It took me a week to write. It took me a day to key it into the microprocessor. And then you hit compile and it printed my name out one time. And the professor's like, you win, you got it right. And I'm like, this is the craziest thing I've ever done in my life. I never want to be a programmer. So that's great. Now I'm helping people with cancer.

[B]

That's great. I built a first application was a video inventory management system.

[A]

Yeah. VMS system.

[B]

College. Yeah.

[A]

Now we're dating ourselves.

[B]

We're dating ourselves. So if you aren't doing this job, what would you be doing? What are you most passionate about?

[A]

It's a great question. I actually wanted to be retired by this point in my career.

[B]

Me too.

[A]

We're very similar and I really genuinely feel that it's. You know, throughout my entire career, I've always felt like my jobs picked me and I didn't pick them. I got to a point where I felt like this job picked me and if I didn't do it, I'd regret it the rest of my life.

[B]

Yeah, yeah.

[A]

And so, you know, I kind of always say I've never had more fun, worked harder and made less money in my entire career, so I must be doing something.

[B]

Amen to that. I think I'm in the same pace paper record as you are. Yeah, exactly. Because the hours, I think when I was in the military and I think we made like 37 cents an hour because you were always on, you know.

[A]

Yeah, exactly.

[B]

So Interesting. So any hobbies? Any interesting?

[A]

Yeah, you know, I'm an outdoorsman, I mountain bike, I ski, fish, I hunt, fly fish. I do a little bit. You know, you look at me, I'm 6 foot 5, 250 pounds. I actually run. Not fast, but I, you know, I tell people I eat and because I eat I got to run. So.

[B]

Yeah, I have the other problem. I'm 510 and probably 280, so I got to stop eating and.

[A]

But you know, what if you just run a little bit, just walk a little bit anyways.

[B]

Well, we've been walking this whole three days, right? I think we're clocking 12, 15,000 steps. It's been insane. You know, you go back in time and talk to your 20 year old self, what would you tell them?

[A]

I would tell myself, don't let anybody ever tell you there's something you can't do. I would say, you know, when you look at what we're doing, and I tell engineering students all the time, when you look at healthcare, I always equate healthcare and specifically oncology like NASA. NASA couldn't innovate because space travel is hard. It was expensive, very dangerous. We had to put life and safety above everything else. We know how that story ended. SpaceX comes along, do it faster, cheaper and safer. Why? Because they weren't rocket scientists. And I think that's where we are with healthcare today, specifically oncology is we need an infusion of technology, we need to do it safer, we need to do it faster and we need to do it cheaper. And I think that's where again, you infuse technologists into the healthcare system and we can transform it and we can do it safer and we can do it faster and we can do it.

[B]

Cheaper, especially with AI. I mean it makes everything now possible. The impossible that we all dreamed about.

[A]

Yeah, I mean the tricky thing about AI is again, how the standard of care is built is off of averages. Right. These large language models process a whole bunch of data that hopefully looks like you. And what we do a little bit differently with our AI is our training set is all about you. How do your cells respond to the drugs? What does your genomics look like? We analyze it with AI. So while these large language models start from the top and work their way down, they'll be able to make marginal improvements. We're actually starting from the bottom, working our way up. So when we analyze a patient, they're their own control. It's a truly n of one study and what we've been able to show and publish is that when doctors use our platform to help guide treatment, patients benefit 83% of the time better than Dr. Schweisser standard of care.

[B]

Wow.

[A]

And that's, you know, you start thinking about 618,000Americans will die from cancer in 2025 to be able to have a potential impact on helping them have better outcomes by 83%. That's why I'm so excited about what we did.

[B]

Yeah. No, it's certainly an exciting time in healthcare and every industry, really, that's embracing AI. It's a good time to be in technology for sure. This is the Risk Never Sleeps podcast. I've got to ask you this question. What's the riskiest thing you've ever done, Jim? And it can't be fly fishing.

[A]

No. You know, I do a lot of risky things. Just ask my wife.

[B]

Oh, this will be good.

[A]

We were in New Zealand and I bungee jumped off.

[B]

Oh, you did? Are you kidding me?

[A]

You did the bungee? So the funny, funny story. So we're on the bridge where bungee was invented in New Zealand, and I stepped to the edge and my kids are watching, and I take that leap. And soon as my feet left the platform, I thought, you know what? This is the dumbest thing I've ever done in my life.

[B]

How old were you when you did that?

[A]

This was a few years ago. Oh.

[B]

That might be the winner. The award for the riskiest. And folks, he is tall and big. Imagine jumping off a bridge with a rope tied to your ankle that a.

[A]

15 year old strapped onto you.

[B]

Yeah. From New Zealand. What?

[A]

What?

[B]

Nothing against New Zealanders. Amazing. Yeah. What do you remember about the experience? Did you snap back? Did you?

[A]

Oh, yeah, no, I actually. My hand touched the water and then it. It pulled me back.

[B]

I thought they had a weight. I always thought about doing it, but I. I thought I was too heavy to do it.

[A]

They do have a weight limit. I dieted before you did.

[B]

Okay, so I was cheated.

[A]

I was just barely under the weight limit.

[B]

You touched the water with your hand.

[A]

What is.

[B]

That is just crazy. I didn't think he went down that far.

[A]

Yeah, yeah, it did. It did.

[B]

Now, you must have snapped back quite a bit.

[A]

I did. I recalled. But, you know, thankfully that day, so my son also did it with me and my daughter, and he wanted to do this one. It was called the Nevis. So it was literally a gondola that was strung between two mountain tips. And I was like, I don't want to do that. I don't want to do that. But I can't say no. Fortunately, the winds were too high that day, and so we just did it. Off a bridge. Was his only.

[B]

It's just off a bridge, folks. Just over. We didn't do it. Of a. Spanning the gorge. Okay.

[A]

I shouldn't say all this, because now it's like, oh, and by the way, trust me to help you with cancer.

[B]

I actually. I would trust you. You'd be the guy I trust. You take risks. All right, so you're on a desert island. What five records? What five albums? What type of music do you like?

[A]

So it would definitely be probably the Eagles.

[B]

Okay. They're here, you know. No, at the Sphere.

[A]

Oh, yeah, yeah. And, you know, I listen to everything, but I like Eagles. I like you two.

[B]

Okay.

[A]

You know, I like trying to think of some of the other ones. You know, I like a little bit of everything. I mean, on my playlist, when I run, I've got everything from Hannah Montana, too. Headbanging stuff.

[B]

You're that guy.

[A]

I am that guy.

[B]

Headbanging stuff like White Snake or.

[A]

Yeah, yeah. Nice.

[B]

All right.

[A]

We were just talking about Floyd and not head banging, but, you know, I like Nirvana.

[B]

It is head banging in another way.

[A]

Being Floyd, you know, I like Creed. I like Nickelback.

[B]

Nice. Yeah.

[A]

Nickelback.

[B]

Yeah. Canadian band.

[A]

I think so.

[B]

Yeah. A lot of good bands came out. I'm not sure Nickelback would.

[A]

They're good, but.

[B]

But Neil Young came out of Canada and the band came out of Canada.

[A]

And even Neil Diamond.

[B]

Neil Diamond.

[A]

Neil Diamond.

[B]

Neil diamond, yeah. Yeah.

[A]

I loved.

[B]

What was it? Hot August Night. Hot August Night. Is that the name of the live album? I think. All right. What advice would you give to kids coming out of school that want to break into healthcare, cybersecurity, since you were a CISO at one point. Yeah.

[A]

You know what I would say? Find something that you're good at and lean into it. Don't be afraid to take risks. I think the scary thing about this generation is they're afraid to take risk because it's information overload. And then if they make a mistake, they feel like it's going to be published all over social media. The thing is, is if you're not taking risks and failing, you're not pushing the limits of technology and your own abilities. But you should only fail once, learn from it and improve. And I mean, again, I've built a career off of pushing the limits of everything I've ever touched. And so that would be the advice I would give them, is don't be Afraid of. I hate the word failure, but. A setback. Use it. Learn from it. Never repeat it again. And keep pushing forward.

[B]

Yeah. Don't take yourself too seriously. Be vulnerable.

[A]

Right.

[B]

Yeah. Put yourself out there. Be authentic. Everything they don't do.

[A]

Everything they don't do. Right.

[B]

Unless you're on TikTok.

[A]

Get off your phone, get off the TikTok. Keep talking to people. But, you know, and honestly, be genuine. Be sincere. Be gracious. Be filled with grace. It's so easy to create division. Even in cancer. It's. You know, everybody wants you to choose sides.

[B]

Yeah.

[A]

And, you know, I've got one enemy. Cancer.

[B]

Cancer.

[A]

And, you know, and I'm actually proud to say that we've received money from Governor DeSantis and his wife. We've actually received money from Governor Shapiro, so the state of Pennsylvania and state of Florida. Yeah.

[B]

Where do you live? Where's your office?

[A]

So our office is Miami. Okay, great.

[B]

And so you're on South Beach.

[A]

No, no, no. Unfortunately, we're in a little industrial park. We're getting a profile of Jim here.

[B]

Bungee jumper, late night, midnight.

[A]

I'm not the south beach guy.

[B]

No, no.

[A]

I'm the Hannah Montana guy.

[B]

Yeah, I know that. I know that about you now. And Pink Floyd, don't forget.

[A]

Oh, I love Pink Floyd. So. And Nirvana.

[B]

Oh, Nirvana.

[A]

Yeah.

[B]

Did you ever see any of those bands in concert?

[A]

No. No, I didn't. We just went to a Creed concert. Yeah.

[B]

How was that?

[A]

They are as absolutely as good in live as they are, you know, on any album or cd. Yeah.

[B]

That's great.

[A]

Fantastic.

[B]

Yeah. I like Train. You like Train?

[A]

I love Train.

[B]

I saw them in. They put on a really great show.

[A]

They always make me cry. You know, some of their songs. Oh, yeah.

[B]

Drops a Jupiter.

[A]

Oh, yeah. Yeah. It just tugs at my heart.

[B]

All right, this is Ed Gaudette from the Wrist Never Sleeps podcast. If you're on the front lines protecting patient safety and delivering patient care, remember to stay vigilant because risk never sleeps. Thanks for listening to Risk Never Sleeps. For the show notes, resources and more information and how to transform the protection of patient safety, Visit [e-mail] that's C E N S I N E T. I'm your host, Ed Gaudet. And until next time, stay vigilant because risk never sleeps.