Peter Attia MD346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine
EVERY SPOKEN WORD
130 min read · 26,182 words- 0:00 – 1:37
Intro
- PAPeter Attia
What I really enjoy about this type of discussion though, Sue, is one, it's the story of your career, but it's also the story of oncology. You are just a remarkable inspiration, period, as a physician, as a, as a business leader. I have been a fan of yours for-
- SDSusan Desmond-Hellmann
Thank you
- PAPeter Attia
... so long.
- SDSusan Desmond-Hellmann
People felt like you just needed to hit the cancer hard. You just needed to hit the cancer smart. [laughs] Hard wasn't the point.
- PAPeter Attia
A lot of people might not realize you're on the board of OpenAI, and you're the only person in medicine on that board.
- SDSusan Desmond-Hellmann
I think using AI more and more on pieces of the clinical trials process, so that if something takes time, it's because it's benefiting a human. The other thing is, you and I both know if you have five hundred patients in a trial and you look at safety, that's so limited.
- PAPeter Attia
Yep.
- SDSusan Desmond-Hellmann
Why don't we follow safety in every patient on the drug?
- PAPeter Attia
Exactly. Ongoing.
- SDSusan Desmond-Hellmann
Ongoing. So I think the opportunities in clinical trials are massive.
- PAPeter Attia
Do you think this is the most important thing that from a promise perspective, that AI has, has brought to medicine since-
- SDSusan Desmond-Hellmann
So far.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
Okay.
- SDSusan Desmond-Hellmann
I do. So far. Yeah.
- PAPeter Attia
And, and so what do you think would be the next mega unlock?
- SDSusan Desmond-Hellmann
I define culture in a really specific way, um, that when you come to work, y- you feel like the atmosphere, the, the surround sound brings out the best in you.
- PAPeter Attia
Mm.
- SDSusan Desmond-Hellmann
And that you have some ownership of tweaking it if it doesn't.
- PAPeter Attia
[upbeat music] Hey everyone, welcome to "The Drive" podcast. I'm your host, Peter Attia.
- 1:37 – 12:56
Susan’s medical training, the start of the AIDS epidemic, and the transformative experiences that shaped her career
- PAPeter Attia
Sue, thank you so much for making the trip, um, out to Austin. Um, really, really was excited to meet you last year. Um, and, uh, you know, just an, just an honor to spend part of a day with you and then realize that I could somehow twist your arm into coming on the podcast.
- SDSusan Desmond-Hellmann
I'm happy to be here. I look forward to it.
- PAPeter Attia
You've had just an unbelievable career. You are an absolute giant in, in many ways, but I, I love to always kind of give people a sense of how someone got to where they got. So if I recall, you grew up in Reno, is that right?
- SDSusan Desmond-Hellmann
I did. Yes.
- PAPeter Attia
And you went to high school and college and even medical school-
- SDSusan Desmond-Hellmann
I went to-
- PAPeter Attia
all the way through, right?
- SDSusan Desmond-Hellmann
... to, uh, um, I went to Catholic school for twelve years in Reno. That's, uh, I, I explain that when people wonder if I was at a casino for my childhood. [laughs]
- PAPeter Attia
[laughs]
- SDSusan Desmond-Hellmann
And then I went to University of Nevada, uh, both to undergrad and to medical school.
- PAPeter Attia
And then, uh, was it then that you ended up at UCSF for your residency?
- SDSusan Desmond-Hellmann
My dream, uh, you know this, with residencies, my dream residency was internal medicine at UCSF, uh, my first pick, and I got my first pick and went to UCSF as an internal medicine resident.
- PAPeter Attia
And that would've been what year that you landed there?
- SDSusan Desmond-Hellmann
Nineteen eighty-two.
- PAPeter Attia
Okay. So remind me where we were in the AIDS epidemic in San Francisco in '82. What was known?
- SDSusan Desmond-Hellmann
If you read MMWR, uh, that's 1981-
- PAPeter Attia
Mm-hmm
- SDSusan Desmond-Hellmann
... was the first, uh, um, indication. In 1982, we knew, um, uh, that there was, uh, something happening, especially to gay men, um, but there was a sense it was homosexuals, hemophiliacs, and Haitians. Remember that?
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
The, uh, three H's. And, um, it was, there was so much mystery still involved that, um, uh, I was and my colleagues were in a study to look at drawing our blood to see if we had been infected as a result of treating patients.
- PAPeter Attia
And what were they presenting with at the time? Because again, this is, it's hard for anyone of even my generation.
- SDSusan Desmond-Hellmann
Mm-hmm.
- PAPeter Attia
You've never seen a drug naive patient, right? So you don't under- like all of my experience with HIV, which was a lot in j-
- SDSusan Desmond-Hellmann
Right
- PAPeter Attia
... in Baltimore many years later, but, but everyone was on something. So, so how would these men present to you as a, as a medicine resident?
- SDSusan Desmond-Hellmann
Pneumocystis. Pneumocystis carinii pneumonia was the number one diagnosis, so that's what you saw in the hospital-
- PAPeter Attia
Mm-hmm
- SDSusan Desmond-Hellmann
... that, um, brought patients to attention. But it, it became increasingly clear-
- PAPeter Attia
And tell, tell folks why that's so unusual.
- SDSusan Desmond-Hellmann
Oh, it, it was a, a disease that immunosuppressed patients could get very rarely.
- 12:56 – 29:54
Susan’s experience working on the frontlines of the HIV/AIDS crisis in Uganda
- PAPeter Attia
me about how you wound up in Uganda.
- SDSusan Desmond-Hellmann
After I got my, uh, master's in, in, uh, public health, I became the oncologist at, at, uh, UCSF in the university hospital, um, for the AIDS clinic. So all the patients-
- PAPeter Attia
This is Moffitt?
- SDSusan Desmond-Hellmann
This is Moffitt.
- PAPeter Attia
Yep.
- SDSusan Desmond-Hellmann
So the, San Francisco General had a very well-known program run by oncologists for AIDS patients who were in the safety net hospital. Um, but in the university hospital, if you were very sick and you had Kaposi sarcoma, you saw me.
- PAPeter Attia
Mm-hmm.
- SDSusan Desmond-Hellmann
Um, and my husband, 'cause we had just gotten married, um, who was an e- we were interns together, he was in the lab in ID doing, uh, immunology work.
- PAPeter Attia
Mm.
- SDSusan Desmond-Hellmann
So, um, the, uh, two of the chiefs of medicine at UCSF were approached by the Rockefeller Foundation, who had started to become worried about heterosexual transmission of HIV. Remember I talked about the Haitians and the, the hemophiliacs and homosexuals? One H wasn't heterosexual, and so there was a lot of disbelief about African HIV, and in fact, some people thought it must be, um, uh, gay sex, but people are too embarrassed to admit it.
- PAPeter Attia
Mm-hmm.
- SDSusan Desmond-Hellmann
Um, there were other theories, but, um, people just did not understand what was going on in Africa, and so the Rockefellers said, "We'll give you a grant at UCSF. We'll, uh, grant you money to study heterosexual transmission of HIV."
- PAPeter Attia
And this was through an epidemiologic contact tracing lens, not necessarily going into the lab and trying to figure this out.
- SDSusan Desmond-Hellmann
Not going to the lab, but really looking at epi and, and particularly there was a hypothesis that if it was heterosexually transmitted, there was something to do with sexually transmitted diseases.
- PAPeter Attia
Mm-hmm.
- SDSusan Desmond-Hellmann
Um, and that there was something about increasing your risk if you had untreated STDs-
- PAPeter Attia
Yeah
- SDSusan Desmond-Hellmann
... sexually transmitted diseases. So, um, uh, the w- we were asked to go. Um, UCSF had no global health, um, [laughs] just to, to put this into context. Um, we had a, a flat and two Honda Civics. I still remember this, that, uh, we gave my dad power of attorney, we sublet our flat, and we sold our Hondas [laughs] and, and moved to Uganda, which I'm, I'm laughing in part because I had never been east of Chicago.
- PAPeter Attia
[laughs]
- SDSusan Desmond-Hellmann
I mean, [laughs] this was, this was a, uh, pretty dramatic thing to do, and it was only-
- PAPeter Attia
And I'm sorry, you, your husband, and who else? That's it.
- SDSusan Desmond-Hellmann
The two of us.
- PAPeter Attia
That's the team.
- SDSusan Desmond-Hellmann
That's the team.
- PAPeter Attia
That's the, that's the dream team. [laughs]
- SDSusan Desmond-Hellmann
That's the team. That's the team. And, and Uganda was a place where on the positive side of things, the NCI had set up a collaboration with Uganda Cancer Institute-
- PAPeter Attia
Mm-hmm
- SDSusan Desmond-Hellmann
... uh, where they did some really great things in lymphoma and, um, Burkitt's lymphoma, if you remember-
- PAPeter Attia
Yep
- SDSusan Desmond-Hellmann
... those stories, and, um, a- and one of the physicians at UCSF had been associated with that, um, John Ziegler. So there was a connection to the Uganda Cancer Institute.
- 29:54 – 41:21
Susan’s time working in general oncology and her transition to biotech where she helped develop taxol—a top-selling cancer drug
- PAPeter Attia
And so you came back to the US after about three years.
- SDSusan Desmond-Hellmann
Uh-huh.
- PAPeter Attia
And did you go back to UCSF?
- SDSusan Desmond-Hellmann
Well, we wanted to go back to UCSF, but we had not, um, uh, uh, kept our academic careers going as much as we should have. Um, we didn't publish enough, and they didn't have a global health program or money for us.
- PAPeter Attia
Taking care of a million people with HIV wasn't, wasn't enough to justify coming back to [laughs] UCSF.
- SDSusan Desmond-Hellmann
It, it actually wasn't.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
Uh, so we said, well, gee, you know, w-when the chief of medicine outlined for us the plan for us to stay, a large part of it was taking care of patients to pay our way.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
So we said, boy, taking care of patients, we know what that looks like, so we went into private practice.
- PAPeter Attia
In San Francisco?
- SDSusan Desmond-Hellmann
No, we moved back to Kentucky, where Nick is from.
- PAPeter Attia
Okay.
- SDSusan Desmond-Hellmann
So we moved back to Kentucky, and, um, I was, uh, in a two-person oncology practice with a former classmate of Nick's, uh, in Lexington.
- PAPeter Attia
You were doing, at this point, oncology unrelated to... Not necessarily focusing on HIV and AIDS-related cancer, breast cancer.
- SDSusan Desmond-Hellmann
I, I was doing good old-fashioned American oncology.
- PAPeter Attia
Okay.
- SDSusan Desmond-Hellmann
Yeah, and I hadn't, um, I didn't take my oncology boards when we went to Uganda because I was in Uganda. So, um, I still sort of laugh about taking the, uh, DeVita [laughs] oncology book with a yellow Sharpie. [laughs] And I reread, uh, the big oncology book twice.
- PAPeter Attia
Is this the DeVita, Hellman, Rosenberg book?
- SDSusan Desmond-Hellmann
Yes, yes.
- PAPeter Attia
Yeah, yeah, yeah, of course.
- SDSusan Desmond-Hellmann
Yeah, yeah. It's brown these days, I think. It's, uh... And I reread it twice and t- took my boards and, and did fine. So I was ready. [laughs]
- PAPeter Attia
This is unbelievable. So you're sitting in l- in Kentucky practicing garden variety oncology.
- SDSusan Desmond-Hellmann
Mm-hmm.
- PAPeter Attia
And w- and then you... So, so talk to me about what that's like 'cause that, that just must seem... I mean, that's completely orthogonal to what you've been doing for the past couple of years.
- SDSusan Desmond-Hellmann
It was so, so, so, so different. And, um, I think the good news was that, um... And, and Nick was in a practice where he was more like a hospitalist. You know, they, somebody'd get a fever in the ICU, and they'd call that ID group.
- PAPeter Attia
Mm-hmm.
- SDSusan Desmond-Hellmann
Um, and, uh, a- and my practice was a two-person practice. It was very classy. I saw a lot of lung cancer. It was Kentucky, you know, so there's a lot of smoking, a lot of people from Appalachian. Um, uh, the... I actually like taking care of patients, so that part I liked, but I really missed the kind of intellectual research, um, collegial stuff, uh, that I was used to at UCSF 'cause we had been there nine years by that time, you know, because we were still UCSF faculty when we were in Uganda. Um, so it, it, Nick was called about, um, Bristol Myers Squibb search for an expert on HIV because they were trying to follow AZT with, uh, the next antiretroviral. I think it was DDI and D4T were both in development then. And so they recruited Nick to come and work at Bristol Myers Squibb out of private practice. And Nick said, um, "I won't come unless you have a job for my wife." And they said, "No, we have a nepotism clause. We, we don't allow couples to work at Bristol Myers Squibb." So he said, "Fine, I won't come." He's a good husband. [laughs]
- PAPeter Attia
[laughs]
- SDSusan Desmond-Hellmann
This is, this is one of our favorite stories 'cause it's a true story. [laughs] So, so they called him back, and they said, "We really, really, uh, want you to come 'cause w- we want this program to do well, and, um, could your wife be a consultant? Will she, would she agree to be a consultant and not a full-time employee?" And he said, "Yeah, that'll work." So we moved to Connecticut, and, um, he had a, a, a job, and I was the trailing spouse. And I can just see what this looked like. I'm making this up now. [laughs]
- 41:21 – 51:03
Genentech’s origins, and its groundbreaking use of recombinant DNA to develop biologic drugs
- PAPeter Attia
So you left Bristol Myers Squibb in '95?
- SDSusan Desmond-Hellmann
'95, yeah.
- PAPeter Attia
And you went to Genentech.
- SDSusan Desmond-Hellmann
Mm-hmm.
- PAPeter Attia
Tell me where Genentech was in its life cycle then. So Genentech had been around for a while, but I mean, when did Genentech get founded, in the sev- mid-'70s, late?-
- SDSusan Desmond-Hellmann
1976.
- PAPeter Attia
Okay. Give, give folks a little bit of a history of Genentech. Genentech's a, a storied company-
- SDSusan Desmond-Hellmann
Yep
- PAPeter Attia
... but also a different company in that it was founded on a new technology.
- SDSusan Desmond-Hellmann
Yeah, Genentech's a really interesting, um, company 'cause it, it, it claims to be the first biotech company. There's some cetus, uh, back and f- uh, and forth about that, but it was based on genetic technology. That's where the Genentech name came from, and what Herb and Bob, the co-founders of Genentech, wanted to do is kind of do a proof of concept, um, uh, that you could use genetic technology and make medicines, make big medicines, proteins, antibodies, medicines that would almost certainly have to be injected rather than swallowed 'cause they're large, um, and they're, uh, protein, so you break them down if you swallow them. But their initial goals were focused on insulin, which they out-licensed to Lilly and Pfizer, um, and growth hormone, human growth hormone. So before Genentech, uh, when you were a parent and your child was short, you needed to give that child, um, growth hormone that came from cadavers, and that had a risk of, uh, this slow virus disease, and that was the, um, uh, not a good trade-off for, for parents. So the concept of having recombinant, of having human-like growth hormone was a really wonderful thing. So Genentech's first drug was human growth hormone, and the, um, it was a tour de force. It was really amazing that, um, uh, in the late '70s, they were able to, to do this fermentation and purification because they had to prove to FDA it was pure human growth hormone with no contaminants. Um, and it became famous for that, and, and people were excited and thought this was cool.
- PAPeter Attia
Tell people kind of briefly how this worked. What was recombinant DNA technology? How, what were they putting the gene into? How did they get the gene to make-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... the protein? Like, it's such a, we take this all for granted today 'cause we have-
- SDSusan Desmond-Hellmann
It's tricky, yeah. [laughs]
- PAPeter Attia
Yeah, but, but it's, it's so incredible.
- SDSusan Desmond-Hellmann
So what you, w- w- what you see if you go to Genentech or a company like Genentech is you see these tanks, and the tanks are like a cell ICU, you know, like an ICU for a cell. So the, the cell is the, y- y- what you're doing is you're teaching the cell to make at very high amounts growth hormone, way higher than your cells or my cells would. Very high. And then you're teaching the cell through this genetic engineering to secrete it into a medium, into this soup that is really a lot of growth hormone, and then you're taking away the cells after they secrete it. You're purifying that growth hormone, and you put it in little vials, and that's the process of biotechnology. And you can trick a cell into making almost anything you want, not completely, but almost anything you want, and make it very much like human, which is neat. So you don't have to go to a human to donate you growth hor- hormone 'cause it would be too small.
- PAPeter Attia
Or in the case of insulin, I mean, they were using insulin from pigs and other-
- SDSusan Desmond-Hellmann
Porcine insulin that made allergies.
- PAPeter Attia
Yep.
- SDSusan Desmond-Hellmann
And expensive.
- PAPeter Attia
Yep.
- SDSusan Desmond-Hellmann
So human insulin really changed how you thought about treating, uh, people who have, um, uh, diabetes. So Genentech made growth hormone, and, and Genentech sold growth hormone and set up something I actually think is a really neat thing that Genentech, uh, did, which people said, "How do you know that by giving, uh, kids extra growth hormone it won't cause leukemia or, you know, a fourth arm to sprout out or so," you know, weird things to happen.
- PAPeter Attia
Hmm.
- SDSusan Desmond-Hellmann
And Genentech said, "Well, we'll follow every child." So they set up a patient registry, one of the first patient registries ever, and followed every child until they reached their final adult height. And the physicians and their staff entered this into a computer. And so this is an amazing amount of information. So if the FDA ever asked us, "You know, do you have this with growth hormone? Did you have that with growth hormone?" We had not an example, not like you s- you wouldn't even do statistics on it. It's every child ever treated with Genentech's growth hormone.
- PAPeter Attia
Do you have a sense of how many kids that was over the-
- SDSusan Desmond-Hellmann
Oh, hundreds of kids, thousands of kids by now.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
Yeah, yeah. And, um, so Genentech got really good at that. And in fact, when I went to Genentech in 1995, the chief medical officer at Genentech was a pediatric endocrinologist, an expert on short stature and, and growth hormone, but it's a pretty small market. This is-
- PAPeter Attia
Yeah
- SDSusan Desmond-Hellmann
... you know, uncommon. So Genentech decided that they, uh, um, they would get good-
- 51:03 – 1:00:57
Susan’s move to Genentech, and her pivotal role in the development and success of Herceptin as a groundbreaking therapy in targeted oncology
- PAPeter Attia
it.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
You finally earned the respect you deserve. You've got this struggling company, Genentech. Was it the opportunity?
- SDSusan Desmond-Hellmann
Oh, yeah.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
Yeah, for, for sure it was the opportunity. I will tell you, if you were me in 1995 sitting down with Art Levinson, and he was the head of research then.
- PAPeter Attia
Yep.
- SDSusan Desmond-Hellmann
And he was talking about the future in oncology and what the plans were, you'd have gone, too. [laughs]
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
You'd have gone, too. It, it, for sure it was the opportunity. Um, we were doing well. I, I, I will say that, um, further down on the list of pros and cons was, uh, West Coast is home. I mean, Connecticut was kind of snowy and cold. [laughs]
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
I didn't come over on the Mayflower, turns out. [laughs] But I mean, I loved people at Bristol Myers Squibb. I loved the job. Um, uh, and I loved being-
- PAPeter Attia
But heading back to San Francisco was-
- SDSusan Desmond-Hellmann
In San Francisco.
- PAPeter Attia
Yep.
- SDSusan Desmond-Hellmann
Yeah, yeah. So that, that was a big deal. But I believed Art when he said we're gonna be a cancer company.
- PAPeter Attia
So what was the first thing you worked on?
- SDSusan Desmond-Hellmann
Uh, [laughs] thrombopoietin. I, they hired me to work on thrombopoietin.
- PAPeter Attia
Interesting.
- SDSusan Desmond-Hellmann
It was going to be the third leg of the stool. Uh, EPO, so for, make your red cells go up, uh, Neupogen for your white cells, and, uh, TPO for your platelets. And it was a big race. Amgen was in the race.
- PAPeter Attia
Who developed EPO?
- SDSusan Desmond-Hellmann
EPO's, uh, Amgen.
- PAPeter Attia
Amgen, okay.
- SDSusan Desmond-Hellmann
Yeah, EPO and Neupogen.
- PAPeter Attia
Got it, okay.
- SDSusan Desmond-Hellmann
Yeah, so they were the... And you know, Amgen and Genentech had always been kind of-
- PAPeter Attia
Yep
- SDSusan Desmond-Hellmann
... uh, rivals. And, uh, when, when they cloned, um, thrombopoietin at Genentech, like everybody know... You know, I read the paper, and then they called me, did I wanna come work on it? It was that kind of thing.
- PAPeter Attia
Yep. And when you clone it, does that, if you publish it, that doesn't give you the right to... I mean, it's a race for everybody.
- SDSusan Desmond-Hellmann
It's a race.
- 1:00:57 – 1:12:12
The rise of antibody-based cancer therapies: the development of Rituxan and Avastin
- PAPeter Attia
where does... I mean, we've gotta be getting close to Avastin now too, right?
- SDSusan Desmond-Hellmann
Yeah, so we, um, but, but don't forget Rituxan [laughs] 'cause that's-
- PAPeter Attia
Oh, yes, yes.
- SDSusan Desmond-Hellmann
So when I said people didn't believe in, in you could, you could treat a solid tumor, they thought you could treat lymphoma because we did. So antibodies were so, um, Disliked. People did not believe in antibodies, that in '95, '96, IDEC was gonna run out of money. So IDEC had made an antibody to CD20, a very important marker on, on all, uh, lymphomas. And they were gonna run out of money, so some of our business development folks talked to them about, uh, Genentech doing a deal with them on Rituxan. And that, it, it, you know, I think f- uh, it, it is impossible to overstate how important Rituxan is in lymphoma. You, I often think when I'm in product development of patients I've cared for, I had this great 83-year-old pharmacist who wa- when I was in practice, and he had, uh, a lymphoma that was low grade. It wasn't really... You know, he was a little tired. He was fine. And so we did watch and wait, my not favorite [laughs]
- PAPeter Attia
[laughs]
- SDSusan Desmond-Hellmann
... strategy of oncology. Let's watch and wait as you dwindle. He'd be a perfect candidate for Rituxan, just, like, perfect. Four doses, you can repeat it. It's, it, and it just... In fact, it works so well. H- here's when I changed my mind on antibodies. Somebody runs in my office and said, "Oh, we have a case of tumor lysis syndrome." So tumor lysis syndrome being somebody got Rituxan, they had a lot of lymphoma, and the cells are breaking down so fast their kidneys can't keep up, and they have to be dialyzed.
- PAPeter Attia
[laughs]
- SDSusan Desmond-Hellmann
Oh, that's only an antibody. No chemo, no, no payload, nothing. That's when you know you've got, uh, a good drug.
- PAPeter Attia
And how many cells in the body, how many types of cells in the body express CD20?
- SDSusan Desmond-Hellmann
Um, it's mainly a B cell, uh, um-
- PAPeter Attia
But it's not as specific as CD19, is it?
- SDSusan Desmond-Hellmann
I think 19 and 20 are CD, both, uh, B cells.
- PAPeter Attia
They're both.
- SDSusan Desmond-Hellmann
I'd have to look at it to see.
- PAPeter Attia
Yeah, I, I know that CD19-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... is on the B cell, but I don't, I didn't know the, uh, okay.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
And, um, and this is, we were talking about this earlier. This is chimeric.
- SDSusan Desmond-Hellmann
It's chimeric, yeah.
- PAPeter Attia
Yeah, so tell folks what that-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... implies 'cause that's another wrinkle in the story.
- SDSusan Desmond-Hellmann
Well, that's the other thing that I think is y- you know, there's so many dogmas of, that we believe until data proves us, uh, otherwise. So one of the warts of, of Rituxan was thought that it was a chimera, that we would-
- PAPeter Attia
[laughs]
- SDSusan Desmond-Hellmann
... uh, it, it had too many mouse parts to human parts and that we would cause, um, [lips smack] uh, human anti-chimeric antibody, HACA. Um, and FDA was very concerned about this, so we measured and measured and measured. And it, it, uh, turned out probably because the patients had lymphoma that they didn't get HACA. They, uh, very tiny numbers, and they, not clinically-
- PAPeter Attia
Mm
- SDSusan Desmond-Hellmann
... relevant. And you can treat them a lot. Yeah, I mean, you can treat patients over and over again. Herceptin's 93% human, so not a chimera, but not fully humanized. Um, and none of the patients treated with antibodies that I've seen, uh, not with Genentech or IDEC antibodies, have really had problems. They've had other problems based on target-related problems, not based on the antibody.
- PAPeter Attia
And the CD20 antibody was just also a straight naked antibody?
- SDSusan Desmond-Hellmann
Straight naked antibody.
- 1:12:12 – 1:24:40
The step-by-step drug development process and the scientific and strategic challenges involved
- PAPeter Attia
hit, hit pause. I wanted to do this later, but this, I think this is the right drug to go through two things. One, even though I've done this probably half a dozen times on the podcast, you should never assume somebody remembers it. I want people to understand what the difference is between a Phase I, a Phase II, a Phase III study.
- SDSusan Desmond-Hellmann
Mm-hmm.
- PAPeter Attia
Also understand what's pre-clinical. Um, it's not intuitive to people why-
- SDSusan Desmond-Hellmann
Mm
- PAPeter Attia
... it costs a billion dollars to get a drug to market and why it can take a decade. Um, and then se- within that, if you could just embed enough of the details about decisions that you can make that will make or break you, right?
- SDSusan Desmond-Hellmann
Yeah, yep.
- PAPeter Attia
You, how many times has a drug failed because the experimental design, the wrong patient selection-
- SDSusan Desmond-Hellmann
Mm-hmm, mm-hmm
- PAPeter Attia
... the wrong disease selection?
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
You, it is, you have got to line up four pieces of Swiss cheese just right to get the pen through to hit it. So let's-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... sorry to interrupt, but let's go back to-
- SDSusan Desmond-Hellmann
No, no, no, that's good
- PAPeter Attia
... you got Judah Folkman talking about VEGF, VEGF, VEGF.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
That then turns into, well, if we made an antibody to VEGF, okay, so there's your idea. Now-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... start the clock and start the dollars.
- SDSusan Desmond-Hellmann
Yeah, so if you, um, if you start with a target-
- PAPeter Attia
Hmm
- SDSusan Desmond-Hellmann
... often in oncology today, we'll start with a target. Th- there's two things you have to s- to start with. One is what's the best way to turn down or turn off that target? Is it a small molecule? Is it an antibody? Um
- PAPeter Attia
Tell folks the difference. How do you think of small molecule versus antibody? Where do we draw the line?
- SDSusan Desmond-Hellmann
So here's a really simple way I think of that helps me. Small molecule is chemistry. Small molecule is, it can be, not always, a pill. Uh, um, a small molecule, you're, you're impacting on often pathways or enzymes or things that happen in the cell. Um, a large molecule, whether it's a protein or especially an antibody, an antibody's biology. An antibody, you're trying to do something that may be immune in nature, or you use the antibody as a delivery device. You're getting something to the cell. Um, it's a, a company like Genentech, um, and many modern companies really like antibodies. I like antibodies because when something happens, it's on target. It, it doesn't tend to be off target. Small molecules, that chemistry tends to have surprises in negative ways off target, like liver toxicity-
- PAPeter Attia
Yeah, so this is-
- SDSusan Desmond-Hellmann
... or kidney toxicity.
- PAPeter Attia
This is the way I, I do this through cardiovascular medicine-
- SDSusan Desmond-Hellmann
Uh-huh
- PAPeter Attia
... to explain to people the difference between a statin and a PCSK9 inhibitor. You have these two very common drugs that are used to lower cholesterol.
- SDSusan Desmond-Hellmann
Yeah.
- 1:24:40 – 1:27:22
The ethical and economic controversy surrounding Avastin’s high cost and limited survival benefit
- SDSusan Desmond-Hellmann
excited.
- PAPeter Attia
Yeah. Now, at this point, I'm in medical school-
- SDSusan Desmond-Hellmann
[laughs]
- PAPeter Attia
... just down the street. I'm at Stanford, and I remember we had a d- big discussion about this. I'm in my first year of medical school, and the discussion we had in class was, I think at the time Avastin was $100,000 for the treatment. Extends median survival by whatever, but I think it was eight months.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
The UK said no. The NHS said-
- SDSusan Desmond-Hellmann
Right
- PAPeter Attia
... "We are not paying for this"-
- SDSusan Desmond-Hellmann
Yep
- PAPeter Attia
... because at the time, the NIH, uh, pardon me, the NHS had this $100,000 quality adjusted life year hurdle.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
So they were, which is understandable, right? That's-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... how do you throttle supply side economics. They said, "Look, we can't pay for a drug, we can't pay more than $100,000 for an incremental year of quality adjusted life year. This is only giving you eight months." That's why I know it was less than 12, and so the NHS flatly said, "We're not paying for this."
- SDSusan Desmond-Hellmann
Yep.
- PAPeter Attia
And I do believe people in the UK could pay out of pocket for it.
- SDSusan Desmond-Hellmann
You can get it out of pocket, but not through the National Health Service.
- PAPeter Attia
That's right.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
People in Canada could not, because you couldn't have private insurance in Canada, though you could come to the US for treatment. And so of course, this just became a great topic of discussion for-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... med school-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... you know, freshmen. Um, what was your thought at the time of, you know-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... have we moved the needle enough? How do we think about the economics of this?
- SDSusan Desmond-Hellmann
Had a, a lot of different reactions. First of all, with Avastin, it was the first time I remember reading, and I think it was one of those curtain raiser, um, things in The Wall Street Journal for the breast cancer study. It, and the, the title of it, the headline was, um, "Avastin might help breast cancer patients, but can they afford to take it?" And it, I was shocked that it was the first time I had read, in as long as I had been at Genentech, um, that somebody couldn't afford one of our drugs. Like, that, that instead of saying, "Oh, isn't that cool? Rituxan, Herceptin, Avastin," it was too much money, and that felt really important to me and really, uh, um, not good. Uh, we had as a company a philosophy that no patient should go without any of our drugs because of an inability to pay. So we had a bunch of patient, um, uh, what do you call those? Patient support programs, whatever.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
Um, so we had a bunch of different things in place. So I knew we had those programs, but that doesn't help the patients in the UK, and it doesn't help the overall cost 'cause we're actually supplementing, but the cost is still really high. And we started to have a lot more discussion at the executive committee about the price and how we would think about it and how we would price the drugs, um, because that was, like I say, that was not, um, uh, not good.
- 1:27:22 – 1:41:14
Susan’s tenure as chancellor at UCSF: leading during a financially strained period, and her strategic approach to fundraising and institutional development
- PAPeter Attia
How, uh, did you go straight from Genentech to being the chancellor at UCSF? Well, th- I, just because I wanna stay with the story, I wanna continue the arc of your career.
- SDSusan Desmond-Hellmann
[laughs]
- PAPeter Attia
'Cause we haven't even, we're at the halfway point, right?
- SDSusan Desmond-Hellmann
[laughs]
- PAPeter Attia
We're like the, we're one third of the way into-
- SDSusan Desmond-Hellmann
Early days.
- PAPeter Attia
Yeah, yeah, yeah, yeah, yeah.
- SDSusan Desmond-Hellmann
We're in the '90s.
- PAPeter Attia
So what, how did you, given the incr- like, you are truly on the cusp of what is happening in oncology and biotechnology.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
And now the same institution that said you can't come back here to have a clinical appointment-
- SDSusan Desmond-Hellmann
[laughs]
- PAPeter Attia
... after saving the people of Uganda is now offering you the highest post essentially outside of a provost-
- SDSusan Desmond-Hellmann
Mm-hmm
- PAPeter Attia
... I'm guessing, right? Or I, I don't even know what a chan-
- SDSusan Desmond-Hellmann
It is the highest post.
- PAPeter Attia
It is the highest post. Okay, so, so that's-
- SDSusan Desmond-Hellmann
[laughs]
- PAPeter Attia
... that's kind of remarkable. And, and does that just speak to the, what, what they saw as the vision of that institution, which was, you know, few people have learned what Sue has learned in the last 10 years, and we want that type of leadership here?
- SDSusan Desmond-Hellmann
So first of all, on the Genentech side of things, Roche bought us.
- PAPeter Attia
That's right.
- SDSusan Desmond-Hellmann
So they had a-
- PAPeter Attia
That was '99? What year was it?
- SDSusan Desmond-Hellmann
That was 2009.
- PAPeter Attia
Oh, 2009. Oh my God. Okay, I'm off by a whole decade. I thought that was sooner.
- SDSusan Desmond-Hellmann
2009, so the, um, which was not what we wanted. We, like, it was a f-
- PAPeter Attia
It's a hostile takeover.
- SDSusan Desmond-Hellmann
A hostile takeover.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
Yeah. They, they call it in the business world a squeeze out.
- 1:41:14 – 1:53:18
What Susan learned as CEO of the Bill and Melinda Gates Foundation: strategic processes and decision-making frameworks
- PAPeter Attia
So then let's get to the next chapter. What, what all of a sudden, um, in 2013, 2014, leads to the next transition to being the CEO of the Bill & Melinda Gates Foundation?
- SDSusan Desmond-Hellmann
Well, uh, to my surprise, um, I, uh, I think I got an email or a, I think it was an email from Melinda, um, did I have time to talk. Um, and, uh, UCSF throws a big event every year that's kind of friend making, fundraising, everything, and we give out, um, awards, you know, recognition to people whose, um, uh, whose work we respect a lot. So I had invited Melinda the year before and thought, "She'll never come." [laughs] You know, you invite people, like a, the throwaway invite.
- PAPeter Attia
Hmm.
- SDSusan Desmond-Hellmann
And she accepted and came. Actually came with her mom and dad, even better. And I thought that was nice. Uh, so she sent me an email, uh, and she said that she and Bill, um, wanted me to look at being the next CEO of the Gates Foundation. And I was surprised. I had not, you know, expected that. And, um, so I started having discussions with them. It was actually funny because I, uh, I went up to Seattle, and they were having all this hush-hush. You know, this was very, uh, cloak and dagger. So I went to their house, um, to, uh, 'cause I had had a meeting with Melinda, and I needed to meet with Bill, and it was Halloween. [laughs] The kids are coming and going, and it was kinda crazy. Um, and so I had talked to him, and, and I talked to my husband. You know, my husband worked at the Gates Foundation. He led the HIV and TB programs about five years before. And-
- PAPeter Attia
Was he still there?
- SDSusan Desmond-Hellmann
No, no.
- PAPeter Attia
Oh.
- SDSusan Desmond-Hellmann
He had gone.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
He was commuting to Seattle, which was dreadful.
- PAPeter Attia
Oh.
- SDSusan Desmond-Hellmann
Um, and, uh, uh, so he, but he knew the Gates Foundation, so he and I were talking about this, and I was like, "Oh, God, you know, I'm only been at UCSF five years. It's not, I f- I've just found where the bathrooms are," you know, that kind of thing. Um, and it was going well. I was happy with that. Um, so they got on, they asked for a teleconference, and they got on the phone, and especially Bill made this big pitch that only, that, that a lot of people could do the UCSF job, with all due respect, [laughs] as Bill would put it, but I was the only person who they both wanted and who could do this job. I was perfect for the job, and it's really important for the world, and I needed to do it. [laughs] It was-
- PAPeter Attia
I assume that the rationale for that was their, ob- obviously their focus is, um, on he-
- SDSusan Desmond-Hellmann
Glo- global health
- PAPeter Attia
... global health.
- SDSusan Desmond-Hellmann
Global health, yeah.
- PAPeter Attia
And you have the background in the clinical side, the research side, the epidemiologic side, the management side.
- SDSusan Desmond-Hellmann
Right.
- PAPeter Attia
So there's kind of, those are four legs of a chair. Were there other things that I'm missing that they felt were kind of essential pillars?
- SDSusan Desmond-Hellmann
I think now, I, I think it was less obvious then, but I think now they had started to kind of have disparate views of how the foundation should operate. Melinda's been really all over women's issues, you know, all over. And Bill Would do, you know, another run at polio. [laughs] You know, it's like they, they, they... Their passions. They-- The, the goal broadly that all lives have equal value, which by the way, I think is a, a wonderful thing, um, they share, but they come at it from different ways. And so I think that the, the thing that resonated for me is that I could see both those points of view.
- PAPeter Attia
But those points of view don't strike me as mutually exclusive for an organization with enormous resources, right?
- SDSusan Desmond-Hellmann
Yes and no. Um, I think, uh, it, it's one thing to have enormous resources. It's another to know where one of the most important, um, assets they have is the time and energy of Bill and Melinda.
- PAPeter Attia
Hmm.
- SDSusan Desmond-Hellmann
You know, they actually show up-
- PAPeter Attia
Yeah
- SDSusan Desmond-Hellmann
... things happen.
- PAPeter Attia
So how did you weigh this decision?
- SDSusan Desmond-Hellmann
I thought that I could add value. I thought I would learn a lot. Um, and I did think that, that UCSF would be fine without me. I felt like we were back on our feet financially. I thought that Sam Hawgood, who was the dean of the School of Medicine, I had a ton of respect for him and thought he was the obvious person to take my place, um, and that it would be okay.
- PAPeter Attia
Were they surprised? Were they-- Did they try to talk you out of this?
- SDSusan Desmond-Hellmann
I don't think they did. I actually think they had a lot of respect for the Gates Foundation and thought, "Oh, well, that's a cool job."
- 1:53:18 – 1:58:15
Susan’s philosophy of leadership and how she sought to build an empowering, values-driven culture at the Gates Foundation
- PAPeter Attia
And are you basically only able to affect that through your interaction with your direct reports and just hope that that's the infusion of culture that then trickles down? Because y- it's hard to go two levels below your management, and yet the people who probably need this compassion the most are people you're not even going to meet.
- SDSusan Desmond-Hellmann
Yes and no. Um, one thing about traveling a lot or having, you know, you have big events or things like that is, is you meet people on trips.
- PAPeter Attia
Mm-hmm.
- SDSusan Desmond-Hellmann
And that's different people-
- PAPeter Attia
Yeah
- SDSusan Desmond-Hellmann
... throughout the organization. So I think there are opportunities. I also set up meetings, like when people would have a, a grant that needed to be signed, the pr- business process was it would show up on my computer. So I changed the business process, so I got the group that, that, uh, could fit around the table in my office, and we would talk about the grant. So I could interact with more people that weren't my reports-
- PAPeter Attia
Hmm
- SDSusan Desmond-Hellmann
... which I really liked. Um, so I do think it is mostly through your reports, but I think there are ways that, um, a, at a senior level you can interact with people culture-wise.
- PAPeter Attia
Yeah. Uh, the word culture is, is, is something that, that I think i- it's very misunderstood, right? When, when you think about the culture that you wanted to bring to the Gates Foundation, I'd like to understand what that was and how successful you, you think you were able to, to, to be. Uh, and I say that because-
- SDSusan Desmond-Hellmann
Mm-hmm
- PAPeter Attia
... you were in an organization where you also had very powerful other present people-
- SDSusan Desmond-Hellmann
Yeah
- PAPeter Attia
... whose culture was also a part of the organization.
- SDSusan Desmond-Hellmann
S- so for me, um, I define culture in a really specific way, um, that when you come to work, y- you feel like the atmosphere, the, the surround sound brings out the best in you.
- PAPeter Attia
Hmm.
- SDSusan Desmond-Hellmann
Um, and that you have some ownership of tweaking it if it doesn't. So that, that's something that you feel like you can control, 'cause if you're the, in, uh, thousands of, of people or hundreds, thousands, tens of thousands of people, y- and you're the CEO, you're not gonna do that. But that you set up that culture. O- o- one of the, my favorite, um, stories from Genentech was being at a product development meeting that, um, my, uh, successor as medical officer, Hal Baron, was running. And Art and I both attended just 'cause we loved it and we wanted to be there, but we weren't decision-makers. We were just attendees.
- PAPeter Attia
Which is kind of odd, right? The person who's the decision-maker is sitting in the presence of the two most senior people in the company.
- SDSusan Desmond-Hellmann
Mm-hmm. Mm-hmm. Just-
- PAPeter Attia
But you're leaving it to him to make the decision.
- SDSusan Desmond-Hellmann
We're leaving it to him.
- PAPeter Attia
Yep.
- SDSusan Desmond-Hellmann
Yeah. But in this case, there was someone who, um, the discussion was about Herceptin and h- h- how, how well the test to find who was HER2 positive performed, and if you got more patients, you would get more commercial, right? But you would have patients who wouldn't benefit. And someone who I won't name said, "You know, but if we have a, a test that does like this, we can get more money." And as if in unison, Art and I both rose up from our chairs and said, "We never do that. We don't do that here." Done. Like, everyone kind of sat down and... [laughs] We weren't the decision-makers. But see, that's culture.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
That's like, you know, y- if you wondered, it's right where the decisions are being made and everything else. That, that for me is, is culture.
- PAPeter Attia
Hmm.
- SDSusan Desmond-Hellmann
Um, um, the other one that, because I'm in so many meetings and was in so many meetings at Gates Foundation I had a practice that it, I would sit, Bill would be there, or Melinda would be there, but often Bill and me there, and you're presenting. And Bill's peppering you with questions, some of them very tough, um, in a very tough way. I would look at you. "You got this." I would just-- I, I can't tell you how many people-- I actually didn't even know I did it, that I would nod-
- PAPeter Attia
You were the coach
- SDSusan Desmond-Hellmann
... smile, coach. I would also stall. I'd s- "Hey, hold on a minute, Bill. I think he's, he's just getting ready to answer that question. You're talking over him right now." You know, just a nice way, not confrontational. That for me is culture.
- PAPeter Attia
Hmm.
- SDSusan Desmond-Hellmann
I want you to succeed. I want you to know I want you to succeed, you know, and I want, if somebody's, you know, it's, it's the guy who runs the foundation. It's the two people who are the chairs, and so it's gonna be scary. Um, so if there are-- That's why I think that bringing out the best in people and giving people agency to do that on their own means that if somebody sees Art Levinson say, "That's not the way we do it here," they'll go down the hall in a different meeting and say, "You know, I heard Art say..." I think that's really powerful.
- 1:58:15 – 2:14:30
The erosion of public trust in science during COVID, the communication failures around controversial treatments like ivermectin, and the need for better public health engagement and transparency
- PAPeter Attia
So this brings us up to kind of 2020, and was, w-were you at the, uh, the foundation when COVID hit?
- SDSusan Desmond-Hellmann
I had announced that I was leaving and w-- you know, literally packing the house as COVID hit. A-actually a few miles from us, the first case in Washington State.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
Nursing home.
- PAPeter Attia
Yeah, yeah. Interesting. Um, l-let's talk a little bit about COVID, right? So, um, I've talked before about this idea of the difference between science and advocacy, and I still haven't really wrapped my mind fully around it other than kind of a sense of lost opportunity with COVID. Um, uh, w-what are your-- And what do I mean by that? Well, on the, on the one level, there was so many pretty incredible things that happened with respect to the speed with which a vaccine could be developed that really made a difference-
- SDSusan Desmond-Hellmann
Mm-hmm
- PAPeter Attia
... in terms of mortality for a subset of the population. Um, but a lot of that's overshadowed today by the lingering doubts, the lingering suspicions, um, the mistakes that were frankly made. And my fear is I'm not convinced we're better off today in terms of preparedness for a pandemic than we were in twenty nineteen, which seems like an unimaginable statement given what we've been through.
- SDSusan Desmond-Hellmann
Mm-hmm.
- PAPeter Attia
So do you think I'm too pessimistic, or w-how do you feel?
- SDSusan Desmond-Hellmann
I do not think you're too pessimistic. I am absolutely horrified. Horrified. Uh, uh, it, it is... It's shocking to me that the, the narrative has, is in the place it is today. Um, and the-- And I'm honestly still processing how we got here from there because it's, um, it is a really bad place, and I think you're right. I think if it happened again today, it would be the way it was with worst of COVID, but even worse because trust and, um, a-and also the, the, um, the need to have sides and winning and losing. I mean, I'm, I don't remember, um, health and medicine being winning and losing and sides, um, as I've been in this business for forty years. It's just weird. I don't get it.
- PAPeter Attia
Yep. I, I, I concur with all of that. Um, and I do wonder what it will take to restore confidence. I, I, I-- You know, look, we could sit here and talk about mistakes. It might be that the medical community and the scientific community need to be more vocal about acknowledging mistakes, and I do think an enormous mistake, though it's understandable to me why it happened because so much was happening so fast, but I believe deep down it was an enormous mistake to be the head of science, to be the head of advocacy. I think having, having Dr. Fauci as being both of those hats was a cataclysmic error. No-- And it's not about him.
- SDSusan Desmond-Hellmann
Mm-hmm.
- PAPeter Attia
No human can do that. A scientist has to be an impartial-
- SDSusan Desmond-Hellmann
Yep
- PAPeter Attia
... observer of fact who is happy to change his or her mind-
- SDSusan Desmond-Hellmann
Mm-hmm
- PAPeter Attia
... in the presence of new information with no attachment to what has been said in the past.
- SDSusan Desmond-Hellmann
Yep.
- PAPeter Attia
An advocate has to be driving policy and action, and sometimes they have to settle for the best you can do.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
Any port in a storm.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
When you put those two hats on the same people, I worry that you lose all trust. And I, I do wish the medical community could have an open and honest discussion about that. And, and I would, I would say that not if, but when-
- SDSusan Desmond-Hellmann
Mm-hmm
- PAPeter Attia
... we will have another pandemic.
- SDSusan Desmond-Hellmann
Mm-hmm, mm-hmm.
- PAPeter Attia
There's zero doubt in my mind.
- SDSusan Desmond-Hellmann
Bird, bird flu's working hard on it right now.
- PAPeter Attia
Yeah, we will absolutely have another pandemic. I hope it is decades from now, but we will. I hope somebody will remember that lesson and say, "We want our chief communicator of the s- of the state of the science-"
- SDSusan Desmond-Hellmann
Yep
- 2:14:30 – 2:28:17
The role of AI in transforming medicine: from drug development to cancer detection and beyond
- PAPeter Attia
I wanna talk a little bit about AI. A lot of people might not realize you're on the board of OpenAI. Um, and you're the only person in, in, in medicine on that board. [lips smack] So talk to me a little bit about how that came about, um, and I, and I wanna obviously talk about the implications of that, what you're excited about and what you're afraid of.
- SDSusan Desmond-Hellmann
So I joined, um, the OpenAI board almost a year ago now, um, when they had, um, had had in November of, uh, 2023 what they call the blip-
- PAPeter Attia
Mm-hmm
- SDSusan Desmond-Hellmann
... which is, uh, CEO fired-
- PAPeter Attia
Yep
- SDSusan Desmond-Hellmann
... board changed, uh, over. Um, and I have been, um, so impressed by the intellect, the commitment, the sense of responsibility of folks at OpenAI. Um, I hope this is, um, this is maybe a, a little crazy, but here's what I hope. Uh, if, if I had a top two things for AI, one is in some of the things we've been talking about in product development. I mean, I love product development. I think it is the best job on Earth.
- PAPeter Attia
Mm.
- SDSusan Desmond-Hellmann
You get to make new medicines for people who are sick. Who wouldn't w- you know, you go home and tell your mom and dad that, they're happy.
- PAPeter Attia
Yeah.
- SDSusan Desmond-Hellmann
So, so what if we could take the tool of AI and make easy the things we can make easy? So you don't use AI to change a clinical trial. I still wanna know, does your tumor shrink? Do you feel better? Do you have side effects? But there's a lot of study reports, there's toxicology reports, there are a lot of things that are labor, uh, and paperwork that are actually very important to establishing the safety, uh, especially, but also the efficacy of a drug. I think using AI more and more on pieces of the clinical trials process so that if something takes time, it's because it's benefiting a human, not because we just couldn't do it fast enough. So the clinical trials, I think, still has some, uh, opportunities for that.
- PAPeter Attia
Well, tell, give me a time and money sense in terms of savings.
- SDSusan Desmond-Hellmann
Yeah.
- PAPeter Attia
'Cause I, uh, this is a very important question. How many... Yeah.
- SDSusan Desmond-Hellmann
If you said that there's, the cl- the entire clinical trials program for a drug is six years, let's just make that up, six, seven years.
- PAPeter Attia
IND to approval.
- SDSusan Desmond-Hellmann
IND to approval.
- PAPeter Attia
Okay.
- SDSusan Desmond-Hellmann
Um, I would wanna cut it down by two years. And-
- PAPeter Attia
You, and you believe AI can do that right now?
- SDSusan Desmond-Hellmann
I think-
- PAPeter Attia
I mean, or we're on the path to that?
- SDSusan Desmond-Hellmann
I think we could be on a path to that, yeah. Now, the, the challenge of it is gonna be, if you say, uh, this example I like to give 'cause it's, it makes sense for people. If I'm changing five-year survival, if this is sort of a mature-
- PAPeter Attia
Yes
- SDSusan Desmond-Hellmann
... established thing, I gotta wait five years.
- PAPeter Attia
Yep.
- SDSusan Desmond-Hellmann
I can estimate things, and I can work with FDA to make sure if people can benefit, we can look at that.
- PAPeter Attia
But, and you could argue with a regulatory change in the FDA, if we said greater emphasis on safety to approval-
- SDSusan Desmond-Hellmann
Right
- PAPeter Attia
... greater emphasis on post-market surveillance for efficacy, we shift this thing a little bit. Now you could say at three years we're trending, you get a provisional approvement, uh, uh, approval.
- SDSusan Desmond-Hellmann
Approval.
Episode duration: 2:28:17
Install uListen for AI-powered chat & search across the full episode — Get Full Transcript
Transcript of episode ib88qkNY3LQ
