Susan Desmond-Hellmann
Appearances
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
If you were in Uganda at the time, gosh, especially amongst males, but also males and females, it's so hard to give those numbers. But I would say about a third of patients who sought medical attention probably had KS, some KS.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Depend on the population you treated. It was double digits in the country as a whole. If you were 16 years old, if you were a 16-year-old girl and you went to the STD clinic, you had a 50% chance of being HIV positive. 16, and most of those girls, it was their first and only sexual partner. It was Russian roulette to have sex in Uganda then.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You got the bullet in one of the two chambers. Yeah, yeah. And the best business in town, Coffin Maker. We would go, we would drive back to where we stayed, and you would see, if you've ever been in an African village, like they'll prop up the coffins made of wood, and you just see them because that was so astounding.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The feeling of being scared and sad in San Francisco in 1982, multiply that by a thousand in 1989. It was... terrifying. If we hadn't gotten ARVs, this was killing people. But, you know, the same time, the first time we went back to San Francisco from Uganda was six months after we had left.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I went back to the Kaposi Sarcoma Clinic that I had led and said to the nurse, oh, yeah, ask about your patients. I had so many great guys who I cared for. All my patients were dead, all of them, six months. The sense of how bad HIV was before antiretrovirals, it's impossible to overstate it, just impossible. And when we were in Uganda,
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was really clear that you could see someone's immune status with a good physical exam if they had Kaposi's sarcoma. I wrote a paper that I think is a good paper if you do global health and you have limited resources. It was a paper that had one observation. If you had Kaposi's sarcoma on your soft palate, on the roof of your mouth, you had HIV. 100% predictive.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Kaposi sarcoma, there's a Mediterranean form and an African form. It happens on your skin. It can cause elephantiasis, but it doesn't go in. The mouth is just a surrogate for your GI tract. Doesn't happen unless you're immunosuppressed with HIV.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Many would die from pneumonia. There was severe cachexia, and then they were prone to pneumonia and other problems. But Kaposi's sarcoma in the lungs or the stomach can also cause bleeding, and you can die from that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We knew most of the clinical syndromes associated with HIV.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, Bob Gallo was one of the, Luke Monnier was, you know, they had a fight over who deserved the credit. But yeah, we knew about HIV then. And we knew the biology. And we knew as soon as we got to Uganda and examined patients that this was heterosexual transmission of HIV. And we knew that untreated STDs were a big reason. And that was a very important thing.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It wouldn't be that high, no. So one of the really important aspects of STDs is high frequency of herpes and chancroid, really open lesions that are very, very, if not treated.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
High viral load and transmissible. Yes, yes. So we knew all of that. Now, we also knew that some of these were treatable, that both medication, also Museveni, the still leader of Uganda, had this very funny campaign called Zero Grazing. So they raised a lot of cows, and this is very important in Uganda is having a herd of cows. It means you're an important man, you know.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Museveni always wears this hat like he's raising cows. So Zero Grazing, the farmers and many people knew what that meant. One wife, one partner, no grazing. And so there was a pretty good public campaign. We did a lot of condom distribution.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They were very on board. They also knew that this was going to be a geopolitical problem for them if people were dying in the prime of their lives at the rates they were. They got that. This was really clear to them.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
In East Africa, there was quite a bit. There was a lot of HIV in Kenya, and there were programs like the one that we had in Kenya, Tanzania. There were others where it was more unknown, I think not talked about. I mean, the program I know about... most today is the program my husband's been working with for 15 years, which is Elizabeth Glazer Pediatric AIDS Foundation.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They work now, I think, in 12 countries in sub-Saharan Africa, and many of the southernmost countries are heavily affected by HIV still.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, no, I can't estimate it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
If there's 16 million people, it wouldn't have surprised me if there were a million people who died. I mean, it's that kind of numbers. I'm probably exaggerating, but not by much. And I think the sense of feeling overwhelmed is just really important. What I realized I was doing, I don't know if you've interacted with people in the military much, but if they were on the battlefield, they triage.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I triaged. I triaged in San Francisco. If you didn't need chemotherapy, but you had Kaposi's sarcoma, I didn't see you.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The simple one was vincristine. Vincristine is actually reasonably good against KS. I used it in Uganda a lot. It does cause some neuropathy, but if you're careful about how much, and then bleomycin. Again, you have to be careful because of the pulmonary toxicity. Good old-fashioned vincristine and bleo, and then Texel. Texel was approved for Kaposi's sarcoma after I left Uganda.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It wasn't a drug before then. I would see the patient and I would literally ask them and their family, can you walk? If you can walk.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You're too healthy. We'll delay. There was triage because I only had on the shelf a certain amount of chemotherapy.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I have this philosophy, which I don't recommend it for others. It's just my philosophy. I love people. I love interacting with people. I love getting to know the patients who I care for. And it makes me happy to think I'm helping. Helping might be helping them get better. Helping might be helping with their pain or they can talk about dying with me because it doesn't make me scared.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So I get a lot of joy in trying to contribute, even if I feel overwhelmed and if I step back and think, how can we cope with this? My coping is... Is leaning in. Yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Well, first of all, my husband is more introverted and probably gets more sad, but we are also a good team because we are there for each other. And I think it's a special thing done in small amounts, not too much to be able to come home and say, boy, that was tough. Here's what I dealt with today, or I need to tell this story, or I want to talk about this.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The other thing we did, which is I think so important is I do drive a lot of joy in trying to help, but I'm not a martyr. I don't believe in it. Okay, you worked hard, I worked harder. You suffered, I suffered more. I hate that. So we went to Greece. We still laugh about going to Greece and eating our way through Greece for a week. When we were in Uganda, we had a couple of other good trips.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We went on a hilarious safari to a place that was Moya Lodge that had been closed to all tourists had just reopened. And it was so great. We saw hippos and elephants. And we realized we were the only what you call in Uganda, Amazungu, which is a white person there. So it was a grand adventure. So we had some grand adventures and played tennis, enjoyed friends.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We did as much to keep our spirits up as one can.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Well, we wanted to go back to UCSF, but we had not kept our academic careers going as much as we should have. We didn't publish enough and they didn't have a global health program or money for us.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It actually wasn't. So we said, well, gee, 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. So we said, boy, taking care of patients, we know what that looks like. So we went into private practice.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
No, we moved back to Kentucky where Nick is from.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So we moved back to Kentucky and I was in a two-person oncology practice with a former classmate of Nick's in Lexington.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I was doing good old fashioned American oncology. I didn't take my oncology boards when we went to Uganda because I was in Uganda. So I still sort of laugh about taking the DaVita oncology book with a yellow Sharpie. I reread the big oncology book twice.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, it's brown these days, I think. I reread it twice, took my boards and did fine. So I was ready.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was so, so, so, so different. And Nick was in a practice where he was more like a hospitalist. Somebody would get a fever in the ICU and they'd call that ID group. And my practice was a two-person practice. It was very classy. I saw a lot of lung cancer. It was Kentucky. So there's a lot of smoking, a lot of people from Appalachian. I actually like taking care of patients.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So that part I like, but I really missed intellectual research, collegial stuff that I was used to at UCSF because we had been there nine years by that time because we were still UCSF faculty when we were in Uganda. Nick was called about Bristol-Myers Squibb search for an expert on HIV because they were trying to follow AZT with the next antiretroviral.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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, I won't come unless you have a job for my wife. And they said, no, we have a nepotism clause. We don't allow couples to work at Bristol-Myers Squibb. So he said, fine, I won't come. He's a good husband.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
This is one of our favorite stories because it's a true story. So they called him back and they said, we really, really want you to come because we want this program to do well. And could your wife be a consultant? 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. He had a job and I was the trailing spouse.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And I can just see what this looked like. I'm making this up now. Yeah. Oh, God, we've got an LMD. You know what an LMD is. We got this lady from Lexington, Kentucky. She's in private practice, oncology, and we're stuck with her. Let's have her do drug safety on Taxol. We have this new drug and it's really busy. It looks like it might work. And so we'll put her on drug safety.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
She can't hurt anything doing that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I don't think that registered because there were so many people there who were very traditionally trained at NCI or at Yale or wherever they were. And they were traditionally trained in oncology. My experience in Kampala in Uganda didn't make an impact. But here's what was funny. Nick and I didn't have a statistician. As I told you, we just, the two of us went.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So we brought this little compact computer and all the SAS manuals. We didn't have a TV. We didn't have newspapers. We didn't have anything. So we taught ourselves how to do SAS programming. When I got to Bristol-Myers Squibb, one of the really interesting things about Taxol is it causes severe neutropenia, but it's short. It's like this short, severe neutropenia.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And so I wanted to study that because I thought it was really important in why people weren't really getting infections.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
When I talked before about how few new chemo drugs there were, Taxol was one of the first new chemotherapy drugs. So Taxol is a product of the yew tree and it's a microtubule poison. It is, if you think about it coming from the yew tree and you think about sap, think about trying to dissolve sap in water and give that to a patient. That's plenty hard. The dissolving fluid that's given with Taxol
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And we want to block that. So this was not just a good way to block cellular division, which is so important in cancer therapy. It's really important because it's very different than some of the old chemotherapy drugs. And if you're resistant to those old drugs, here you have a brand new mechanism of action. So that's a terrific thing. but it's not easy to dissolve it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So the dissolving agents are like soap. They dissolve the Taxol. And when the National Cancer Institute tried to use it, some patients got severe allergic reactions from that, and they got scared and put it on the shelf. So Bristol-Myers Squibb went to the National Cancer Institute and said, you know, that drug might really be active. We're willing to carefully go back in the clinic and test it
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
and give people agents to counterbalance the allergic reactions and see if we can get away with it. So they did that and they got an approval in ovarian cancer, a brand new agent. Now, Taxol was really exciting because first ovarian and then breast cancer were these indications where we had not had new drugs or really any drugs that were active in the case of ovarian for a long time.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And because I was a safety person, I was really trying to understand and put into context all these safety issues so it was possible to safely treat patients with these drugs.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It had been approved for ovarian cancer when I showed up.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We're doing post-marketing surveillance on ovarian and putting together a U.S. submission and a European submission for breast cancer. So I started talking to the statisticians there about how I wanted them to program to get the data we needed for the safety label. And I'll never forget... the guy looking at me and saying, do you know how to do this?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I'm happy to be here. I look forward to it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I said, well, I had to learn in Uganda because I didn't have somebody like you, you know. So it was sort of funny that I was very happy to prove myself. It didn't bug me. It made me more feisty. Like, I'll show you I'm not underdosed in the kinds of things you need to do in this place. And by the way, I loved every minute of being at Bristol-Myers Squibb. They were pros at cancer drug development.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They were pros at monitoring safety. And I thought it was so much fun because you got to make drugs.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You had Merck. You had Novartis. I think Novartis was a combo of a couple. It was smaller, much smaller. And cancer was Bristol-Mars Squibb. I mean, they had made cisplatinum, carboplatinum. They had a lot of those drugs. And people who had made those drugs were still there. And I was really happy to learn from them. I felt very lucky to get to be around these folks who knew about Taxol.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So we got Taxol approved in the U.S. and in Europe for breast cancer. It became Bristol-Myers Squibb's number one drug. I became the project team leader for Taxol.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Too long. He really enjoys that story because he, like all good family stories, it gets embellished over the years. And he tells this story like, you should actually want her. You don't know this, but he's a good husband.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That's right. That's right. I'd be better at tennis. Yeah. I had more free time. But yeah, no, I think that's the thing that I love to mentor. I think it's really underrated to listen to students and hear what's on their minds. And I remind students about the role of serendipity. And I think I'm a poster child for the role of serendipity.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
95.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Genentech's a really interesting company because it claims to be the first biotech company. There's some Cetus back 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 that you could use genetic technology and make medicines.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I went to Catholic school for 12 years in Reno. I explain that when people wonder if I was at a casino for my childhood. And then I went to University of Nevada, both to undergrad and to medical school.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
make big medicines, proteins, antibodies, medicines that would almost certainly have to be injected rather than swallowed because they're large and they're proteins, so you break them down if you swallow them. But their initial goals were focused on insulin, which they outlicensed to Lilly and Pfizer, and growth hormone, human growth hormone.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So before Genentech, when you were a parent and your child was short, you needed to give that child growth hormone that came from cadavers. And that had a risk of this slow virus disease, and that was not a good tradeoff 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.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And it was a tour de force. It was really amazing that in the late 70s, they were able to do this fermentation and purification because they had to prove to FDA it was pure human growth hormone with no contaminants. And it became famous for that. And people were excited and thought this was cool.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So 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, like an ICU for a cell. So the cell, 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. And then you're teaching the cell through this genetic engineering to secrete it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So you don't have to go to a human to donate you growth hormone because it would be too small. Or in the case of insulin, I mean, they were using insulin from pigs and... Porcine insulin that made allergies inexpensive. So human insulin really changed how you thought about treating people who have diabetes.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You know this with residencies. My dream residency was internal medicine at UCSF, my first pick. And I got my first pick and went to UCSF as an internal medicine resident.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So Genentech made growth hormone and Genentech sold growth hormone and set up something I actually think is a really neat thing that Genentech did, which people said, how do you know that by giving kids extra growth hormone, it won't cause leukemia or a fourth arm to sprout out or so, you know, weird things to happen. And Genentech said, well, we'll follow every child.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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, do you have this with growth hormone? Did you have that with growth hormone?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We had not an example, you wouldn't even do statistics on it. Every child ever treated with Genentech's growth hormone.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, hundreds of kids, thousands of kids by now. Yeah, yeah. So Genentech got really good at that. And in fact, when I went to Genentech in 1995, the chief medical officer of Genentech was a pediatric endocrinologist, an expert on short stature and growth hormone. But it's a pretty small market. This is uncommon.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, and the FDA was not happy about that and pushed really hard on Genentech to control that use.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
People were using it in HIV. They were using it in sports, anything where you wanted to have more muscle mass. That's exactly right. Genentech had done some studies to look at whether that was a good idea, and none of the studies came out successful.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
the benefits did not outweigh risks of having increased blood sugar and some other things that would happen. So one of the aspects of Genentech that happened in the early years before I was there is they learned how to make enzymes, same genetic technology, telling the cell, make these enzymes. And some of the enzymes actually got out-licensed
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
to make commercial enzymes like that you use when you wash clothes and things like that. So that wasn't core to Genentech. But they had an enzyme activase, a TPA, tissue plasminogen activator, that could break down blood clots.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
1982.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was intentional. They had a really great, there's a clinician researcher, Dave Stump, who is a clotting expert. He's he-monk on the heme side. He was there and really pushed them to do this. And the concept was that if you could break down the blood clot, you could cure the heart attack. you could save lives.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And the interesting thing, if you are interested in doing trials, is they started the concept of a large, simple trial. This was early on, and people in cardiovascular, Gene Brunwald and his followers had started these large, simple trials. So Genentech kind of bet the farm on this TPA. And the farm was that they could change the outcomes in 30 days.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
There'd be more people alive than dead if they were treated with Activase. And two of the people involved in the studies, you probably know their names, were Rob Califf and Eric Topol.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
If you read MMWR, that's 1981, was the first indication. In 1982, we knew that there was something happening, especially to gay men, but there was a sense it was homosexuals, hemophiliacs, and Haitians. Remember that?
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#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think he was at the Cleveland Clinic. And they ran a group called the Timmy Group and they did all these studies named Timmy. And so they did this big trial and it worked. If you treated with Activase, you could break down the blood clots. So Genentech started this franchise in cardiovascular and, again, did this really interesting patient registry to look at 30-day outcomes for post-marketing.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
But stints came along. And so the franchise of Genentech and people who were treated with TPA really went down. And the stroke indication was tricky.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And so the stroke indication on paper was really cool, but pragmatically was really tough for hospitals to execute. Genentech also made another enzyme-like molecule, DNase, pulmozyme, for cystic fibrosis. And that was approved very tiny. It decreases how thick your secretions are. But with Vertex's CF drugs, it's also been scooped. So when I came in 95, Genetic was really struggling.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They had those three drugs. They had growth hormone, TPA, and palmozyme.
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#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think they needed the money.
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#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I don't think they have the scope to even make it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, yeah. Yeah, 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, and he was talking about the future and oncology, what the plans were, you'd have gone too. Yeah. You got to. For sure, it was an opportunity. We were doing well.
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#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I will say that further down on the list of pros and cons was West Coast is home. I mean, Connecticut was snowy and cold. I didn't come over on the Mayflower, it turns out. I mean, I loved people at Bristol-Myers Squibb. I loved the job. And I loved being in San Francisco. Yeah, that was a big deal. But I believed Art when he said we're going to be a cancer company.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Ah, thrombopoietin. They hired me to work on thrombopoietin. It was going to be the third leg of the stool. EPO, so make your red cells go up, neupogen for your white cells, and TPO for your platelets. And it was a big race. Amgen was in the race.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, EPO and neupogen.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Amgen and Genentech had always been kind of rivals. And when they cloned thrombopoietin at Genentech, I read the paper and then they called me. Did I want to come work on it? It was that kind of thing.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It's a race.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So you patent it, then you publish, then you make the recombinant.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Three H's. There was so much mystery still involved that I was and my colleagues were in a study to look at drying our blood to see if we had been infected.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Mm-hmm. Genentech, one of their great assets started by Herb Boyer is they publish. They don't stop the scientists from publishing. They get the lawyers in there quick and they make sure that they protect the IP of the company, but they want people to publish. It's very academic.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So thrombopoietins, EPO and Neupogen are as if you design them to make recombinant forms and give them for cancer patients or other patients who need them. Thrombopoietin, not so much. To make it simple, if you said, okay, your platelets are going way down from your chemotherapy and I'm going to give you thrombopoietin to make them go up, they come back up really late and they go too high.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So I'm making you at risk for a blood clot by giving you a million platelets, but later than you need to and you're recovering on your own already.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Once we looked at how it worked in patients, we knew better than we had before. The kinetics of really recovering from not all chemotherapy, as you know, causes your platelets to go low.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Right, right. And this tricky thing about going too high, if you're wrong, it's a problem.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You could platelet-pherese them. I mean, there are remedies, but you don't want to do that. Anyway, so thrombopoietin proved to be very, very difficult drug. And I learned a lot about the cancer equivalent or the product development equivalent of tulip mania. Yeah. When everybody's so excited, you get excited too. And it's like, oh, I did learn a lot.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I've often reflected on what might happen that I'm not thinking about now. But what also happened is the labs at Genentech had been working on Herceptin, on Trastuzumab. For a while, Art became the CEO. Art Levinson became the CEO in 95. And he wanted to push on having trastuzumab, Herceptin, get into the clinic.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
trastuzumab, or I'll call it Herceptin because it's less of a mouthful, is a antibody. Like you and I have antibodies that fight disease in our bodies. And it's an antibody that targets this protein called HER2. And HER2 matters because about one in four women with breast cancer have too much of it. And when you have too much of it, if you've got too much HER2 from the time you're diagnosed,
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Your median average survival is three years. If you don't have too much of it, it's seven years. So you know what matters. So the concept with this antibody is turn that off. Whatever bad thing that drives it down to three years, turn that off and go back to seven years. Pretty simple concept.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The thesis was that it was telling the cell to grow. That it was giving a growth signal to the nucleus to say, grow more. And if you could shut that off, you'd grow less. Now, later, we armed Hercept and we put a payload on it. So then you could say, both change the grow more signal and you've got a little bomb on there.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So you'd get a twofer. In fact, another company has one, AstraZeneca, that's so powerful with a bystander effect, you don't even have to have overexpression. So that antibody, I'm talking about it now because anybody in breast cancer knows about her too.
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#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You see it on TV in direct-to-consumer ads.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It is, yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I mention that because it seems impossible. There was a lot of people at Genentech who were negative about Terceptin. Did not think we should invest. The dogma was that antibodies were all hype. They'd been overpromised as smart bombs, smart missiles, Time magazine, all of this, but that they had flopped.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I don't think the things had even been commercialized. I don't think they had gotten out of the clinic, that people just weren't seeing benefit. I have a very good friend who's an oncologist, and he said, you just can't treat a solid tumor, a solid tumor versus leukemia or lymphoma, with an antibody. You need something more powerful.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And remember what was happening at the same time is, if you want to talk about the history of oncology, The amazing thing is being at ASCO, the American Society of Clinical Oncology, and two different rooms. One room, we hear that Herceptin is going to change forever how we think about antibodies in breast cancer. Way better than we thought, improved survival.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The other room doing bone marrow transplant for breast cancer and having the South African group who published a paper saying it worked retract the paper and go through and talk about how much of it was fraudulent, fraud, fraud, fraud.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Pneumocystis. Pneumocystis cariniae pneumonia was the number one diagnosis. So that's what you saw in the hospital that brought patients to attention.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So at the same time, this nearly toxic, nearly lethal bone marrow transplant for breast cancer was debunked at the same time as we said what we call now a naked antibody. No payload, no chemo. You give Herceptin, you're going to help that patient with breast cancer. Just an antibody. Welcome to modern oncology. It could not have been more clear.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And it was a distraction because people felt like you just needed to hit the cancer hard. You just needed to hit the cancer smart. Hard wasn't the point.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yes. But don't forget Rituxan. Yes. So when I said people didn't believe in you could treat a solid tumor, they thought you could treat lymphoma because we did. Antibodies were so disliked. People did not believe in antibodies that in 95, 96 years, IDEC was going to run out of money.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So IDEC had made an antibody to CD20, a very important marker on all lymphomas, and they were going to run out of money. So some of our business development folks talked to them about Genentech doing a deal with them on rituxim. It is impossible to overstate how important rituxim is in lymphoma.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I often think when I'm in product development of patients I've cared for, I had this great 83-year-old pharmacist when I was in practice. And he had a lymphoma that was low grade, a little tired. He was fine. And so we did watch and wait, my not favorite strategy of oncology. Let's watch and wait as you dwindle. He'd be a perfect candidate for Rituxan. Four doses, you can repeat it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, it was a disease that immunosuppressed patients could get very rarely. Most clinicians had never seen it before. What was also clear is that there were many other infections that were not as obvious or life-threatening as pneumocystis was when we saw it right away. What was interesting from an outpatient perspective was capsic sarcoma.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
In fact, it works so well. 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. Oh, that's only an antibody. No chemo, no payload, nothing.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That's when you know you've got a good drug.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It's mainly a B cell.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think 19 and 20 are both B cells. I'd have to look at it to see.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It's chimeric, yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Well, that's the other thing that I think is, there's so many dogmas that we believe until data proves otherwise. So one of the warts of rituximab was thought that it was a chimera. It had too many mouse parts to human parts, and that we would cause human antichimeric antibody, HACA. And FDA was very concerned about this. So we measured and measured and measured.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And it turned out, probably because the patients had lymphoma, that they didn't get HACA. Very tiny numbers and they're not clinically relevant. And you can treat them a lot. You can treat patients over and over again. Herceptin is 93% human, so not a chimera, but not fully humanized.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And none of the patients treated with antibodies that I've seen, 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.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Straight naked antibody.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It's targeted to destroy the CD20 positive cells. But it turns out that if you have lymphoma, you've got a reserve in your marrow of other CD20 cells of more immature that grow up and replace. So it's not like you're really at a huge risk for untoward reactions from your CD20 antibody.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I can guess. I don't know if anyone's done a formal study. I do think at some point in oncology treatment, if you have a tiny amount of disease left, especially something like lymphoma, you may take care of it yourself.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And honestly, if it comes back, that's the other thing that I find really interesting about antibodies. The dogma with chemotherapy, if you are on Taxol and your tumor comes back, I wouldn't give you Taxol again. If you're on Herceptin or Rituxan and your tumor comes back, in a heartbeat, I'd give it to you again. Yeah, it's a very different thing than chemotherapy.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Probably they were. I think Taxol kind of went to that next level and then they went the further level compared to today's prices low. But Rituxan, I think more than Herceptin, because people started using it more, like you'd use four times or eight times and recurring, Rituxan sales went very high, very fast.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
At Boston Children's. Yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, you didn't meet him?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Kaposi's sarcoma is a really unusual purple-colored tumor, very visible externally. It caused nodules. In patients with HIV infection, it also caused internal organ involvement, and patients would cough up blood or they would vomit blood. But what was really sad and difficult is the combination of cachexia and Kaposi's sarcoma meant that everybody knew you had AIDS. He sort of wore it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah. I don't remember.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I'm smiling because I had a word for Judah Folkman talks, which I heard many of. He was a phenomenologist. Yeah. He would say, this patient had this, so it must mean that. He just connected dots all the time. I mean, some of it made no sense to me, but some of it was like, wow, I wish I thought of that. He was just a really fun person to listen to. I used to tell this story so many times.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
His thing was the cancer can't grow larger than a BB if it doesn't have new blood vessels. That was his thing. It stuck at a certain size. And so VEGF is the primary way, vascular endothelial growth factor, is the primary way that you grow new blood vessels if you're a tumor cell. People went crazy about this hypothesis.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was more than the TPO that I was describing because it was due to Folkman and he's very compelling and very charismatic. And just because the hypothesis really- It's logical. It's logical. It resonates. It sounds like a good thing.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Napo Ferrara, also a great character, Italian OBGYN who came to Genentech and worked in one of the labs, made an antibody, actually same backbone as Herceptin, to VEGF.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Mostly human. Again, I think about 93, 94% human. And so we decided we should go after an antibody for VEGF as our next big oncology program. I still remember, by the way, one of the things that Gwen Fyfe, who's a great clinical oncology trials expert, was in charge of the program. And Gwen and I talked the day before the first patient was going to get treated with anti-VEGF.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And Gwen said, my nightmare is that all the blood vessels fall apart. We've just put that into someone's body. And I said, well, you know, we did all the tox studies. We're like, I don't think it's going to be that bad, but we have no idea what, I mean, it just felt- And I'm sorry, this was before the first phase one patient? This was the first phase one patient.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
But the first human dosing of anti-VEGF, and we knew how important VEGF was. So we were scared.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They'd just gotten there.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, it was wild. It was wild.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So we're into the clinic and we make progress and it's really good news and lots of studies and we're ambitious. We want to do a lot of different, we wanted to do lung cancer and we ought to do breast cancer.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Herceptin and Rituxan were easy.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
There is one tumor where VEGF plays a seminal role, and that is renal cell carcinoma. And yet renal cells are really tough to study. It's just, it's not set up clinical trials wise.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It should be easier. It may be the sites and where the clinicians are who care for it. It may just be that pragmatic. We kept struggling to figure out how to do a good renal cell study. But we thought we could do a breast cancer study because we had a lot of networks of breast cancer patients and particularly patients who weren't eligible for Herceptin because many of them weren't.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So we wanted to do a late stage breast cancer study because if we could help these patients, we would find out right away.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Metastatic breast cancer who had already tried- Progressed through everything. Everything. So really tough high bar.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We wanted to have at least 50% shrinkage. We wanted to change time progression.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And what was interesting for me was that this old-fashioned Kaposi's sarcoma was fundamentally different than what we were seeing. We also saw non-Hodgkin's lymphoma in numbers much smaller than Kaposi's sarcoma. But Kaposi's sarcoma was a very big problem in San Francisco. It was very common in gay men, and it was common in the population we saw.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So if you start with a target, often in oncology today, we'll start with a target. There's two things you have 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?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So here's a really simple way I think of it helps me. Small molecule is chemistry. Small molecule, it can be, not always, a pill. A small molecule, you're impacting on often pathways or enzymes or things that happen in the cell. A large molecule, whether it's a protein or especially an antibody, an antibody's biology.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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. A company like Genentech and many modern companies really like antibodies. I like antibodies because when something happens, it's on target. It doesn't tend to be off target.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Small molecules, that chemistry tends to have surprises in negative ways off target, like liver toxicity or kidney toxicity.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That's really a good example. And the choice of molecule is driven by that. When I was first in product development, there was this thing of, oh, you need a pill, especially for chronic indications. You need a pill for compliance.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Look at obesity drugs. Turns out, A lot of people would take an injection if they want to. But once you have your selection, you need to make sure you can make it. And one of the critical things for a biotech company, if it's a protein or an antibody, is the small scale. production of it in small, they call it a mini firm.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The mini firm has to resemble what is actually going to be used because the next thing you start doing is a bunch of models. Judah Folkman giving a great talk doesn't mean you believe that blocking VEGF will help cancer. So we do models in mice. We may do larger animals. We do fewer animal models than we used to because they're really limited.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I would rather have a great target with good biology than an animal model, but it's still helpful. It's still helpful. And then the critical thing is the preclinical work that you do What FDA is going to want to ask you, and they should, this is not them being bad, this is them being good. They're going to want to ask you about toxicology. What's your safety plan?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Based on biology of VEGF, what are you most worried about? I'm most worried about bleeding. It's an antibody. I'm most worried about an allergy to the antibody. Did any of the tox studies show allergy to the antibody? What are you going to look for and how are you going to look? How often are you going to measure the patient?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So the preclinical safety plan is really important and based on what you find in toxicology. The other thing that's essential is, and especially modern oncology, if you have a targeted therapy, you must have a diagnostic. And that is wicked hard because you've got the therapeutic and the diagnostic at the same time.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Now, things like CD20, things like VEGF are very ubiquitous, so it's not really targeted in the sense of HER2, where we needed a diagnostic. But if you need to have that, we had what we called a clinical trials assay for Herceptin that wasn't to be marketed.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So we had an in-house clinical trials assay that we used all the way through phase three.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was fine. It was nothing wrong with it, except it wasn't approved. So not fine. So when we went to FDA, they said, we're not approving Hercept until you have an approved diagnostic.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So we went to DACO. We went to several diagnostic companies, and DACO said, we'll make you an immunohistochemistry test for HER2. And Hercept test is made by DACO. But we had to go back. and correlate that with the clinical trials to make sure that it was the same as the clinical trials assay.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
we were too inexperienced to realize we should have.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, for sure. It was a mistake.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, gosh, it could be years. It could be two, three years because you're doing animal models.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So the investigational new drug is asking the Food and Drug Administration permission to ship an unapproved drug across state lines. If you and I wanted to do something in Austin, we could actually do it, which is sort of weird when you think about it. But most people don't really want to do that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think it's probably a reflection of my own personality and my own wish to be a physician, that my memories of those days are much more about sadness, about my patients and about people my age dying or being pretty clear they were going to die.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You got to have the IND. So the investigational new drug is the request. And what happens is that you take all this information I've been talking about, that you know you have a molecule. You trust the way you're producing the molecule. You understand the biology enough. You have a safety plan and you have a phase one protocol. So phase one has one purpose. We're all greedy. I've been there.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It is only for safety. Phase one is, is it safe to give humans this molecule? Is it safe to give it once? Is it safe to give it multiple times?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It's absolutely true. And it's not uncommon. And you see people all the time backing up on the dose thinking, oh, that was more than we needed or more than we wanted. But phase one with a good preclinical package, a good IND, phase one should be uneventful. And because we are greedy in oncology, we always look to see if anybody responds just because that's what we do.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
But phase one often, to be fair, has some really tough patients who are trying something and have tried a lot of other things. So the patient population can be tough to find any efficacy in. So phase one, I always think of phase one as it might be a year that you're in phase one if you're doing a really good job.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, gosh. In the tens of millions?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, tens of millions. And then you get into the 20s and 30s and 40s of millions with the phase two, depending on how big your phase two is. And phase two, I think that's where people can use their intellect. I think in many ways, phase two, you start to look at what's the right dose and schedule. Very, very important to get the right dose and schedule.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Who do you want to treat? And really what phase two is supposed to do, with one exception, phase two is supposed to get you ready for phase three. You've got a dose, you've got a schedule, you've got a patient selection criteria, and you've got a hypothesis of where this is going to be a drug. The exception in oncology is sometimes you want to get an approval off phase two.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
When we tested anti-VEGF in breast cancer in phase two, we wanted to use that as an approvable study. Because we would go in and say, look, it can be a contingent approval, but these patients have nothing else to do. And so I think that can happen, especially targeted therapy, where you've got the perfect target and FDA's feeling good about it too. That can be a phase two study.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
But most of the time you're getting ready for phase three.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We did colon, but not the kind of study that I just mentioned for approval. We did a traditional phase two in colon. So what happened is the breast cancer study failed. And I was so disappointed. I was so hoping that that would work. I still remember that day. For me, it was like, oh, we need more better drugs for breast cancer.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I mean, a story that brings it to life is many patients started selling their life insurance because they were sure they wouldn't live long enough and they wanted the money now. And then when the antiretroviral therapy came along, they wished they hadn't, which is a good thing to have. But I was just really sad. There were fears about the residents and about contagion.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Because I often heard from people when they're the three out of four patients, suherceptin wasn't for them. If you looked at your stock that day, it also looked really bad. Because all the hype about Avastin was there. But in colon cancer, we had a phase two, got ready on the dose and schedule. And then we went to a phase three study in colon cancer, much more traditional, just plus minus Avastin.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Five of you and the usual suspects, plus minus Avastin. And that succeeded.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Only stage four.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That was a median survival study. Actually, I don't remember all the details of that one.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Probably right. It was the first new thing in colon cancer for a while, too. So people were pretty excited.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You can get it out of pocket, but not through the National Health Service.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So I had 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 things in the Wall Street Journal for the breast cancer study. The headline was, Avastin might help breast cancer patients, but can they afford to take it?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I was shocked that it was the first time I had read, and as long as I had been at Genentech, that somebody couldn't afford one of our drugs. 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 not good.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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, what do you call those, patient support programs or whatever. 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.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And it doesn't help the overall cost because 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. Because that was, like I say, that was not good.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
But in San Francisco, there was such a wish to help the patients and such a good spirit about playing a role in helping that we all persevered. But the first patients I took care of in the hospital, I remember very well in 1982, we were a gown, gloved, masked, had a cap on. It was like we were going into an operating room.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We're in the 90s.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So first of all, on the Genentech side of things, Roche bought us.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That was 2009. Oh, 2009.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
2009, which was not what we wanted.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah. They call it in the business world, a squeeze out. They squeezed us out. So I knew I was going to leave. I knew I was going to do something different. And UCSF, I had been really close with the chief of medicine who was my chief of medicine when I was an intern, Holly Smith. Do you know Holly Smith?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So Holly Smith was a South Carolinian, Harvard-trained doctor. amazing person. And between him and Bill Rutter, who founded Chiron, who's a biochemist, they decided a long time ago that UCSF should not be a backwater medical school and should be a serious medical school.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So Holly on the clinical front and Bill on the scientific front just decided they would start recruiting people to have a great institution, like a pretty amazing thing.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was probably 80s, 70s, 80s. I was still friends with Holly. I just think there's so many wonderful things about Holly that I admired that I was still friends with him. So Holly called me and said, Mike Bishop is stepping down. Of Bishop and Varmus, that bishop.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And you should be chancellor. Of course, I said to Holly, I'm not a professor. And I said, well, if they're interested in me, I'd be open to talking to them. They were. And I went through the interview process.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They have a search committee.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
What I do remember, and I remember, if you remember 2009, was just- Post-apocalypse. Horrible recession and California being particularly in a bad place. So I just talked to them about how I think about managing people, how I think about making sure that you use whatever assets you have maximally.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I admitted that I had never done fundraising, but I had done a lot of work with Wall Street and I could talk.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And I did a massive amount of investor relations because Art didn't like traveling or talking, so.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Mine too. No, we were a good partnership. But I also said, look, if you think about running the faculty meeting, I'm probably not your guy, but that's what the provost does. I think they really thought they wanted somebody who could work on the business aspects of the campus. We needed to finish Mission Bay.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, yeah. And you manage the hospital CEO and it's a big hospital system. There's no undergrads at UCSF. So that was what they were looking for. And I thought, well, why not?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I was really concerned. I was really concerned about it. And I also realized because some of the faculty were pretty negative when I first started.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Absolutely.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I actually think they were just as nervous as I was about money. They weren't convinced that I knew how to get them money. Because, you know, if you're running a program, you need money. It's the mother's milk of doing science.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Almost nothing.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The brand, there's a curriculum thing, there's some things like that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Not that different. I mean, the most important things, you've got clinical income, you've got NIH-driven income, right? You've got other grant income, and you have philanthropy.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Of the money that you use every day, there's this discussion of overheads now. It probably gets up to a third.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Clinical is a lot, but a lot of it goes back to the hospital. You know, it's a not-for-profit. They spend it on the hospital.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I did a chief residency at the university hospital. And I think that was the first that I knew I really liked managing. I really liked interacting with people and helping people succeed. So I did that for a year and then went into my oncology fellowship after that year.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, that's the revenue. And then the tuition is tiny.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Right. Because the number of students is really low. And the really good news at UCSF.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So the funny thing for me is... But you did and you got in.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Well, there's a story there. We talked about me being at University of Nevada. What we didn't talk about is my first year at University of Nevada, my youngest sister was born. So I lived at home and helped my mom in Reno.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah. And number seven was born when I was a freshman. It was kind of crazy. But when I went to medical school, I used to have like this sign on the stairs. Be quiet. I'm studying down here. I was like probably a giant pain. But I wanted to go to San Francisco. My dad was born and raised in San Francisco. My grandma lived in San Francisco.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So even though I was still pretty young in terms of ever living outside the home, I knew San Francisco. I wanted to go. But UCSF had never taken a University of Nevada student because we were a pretty new medical school. I was only in the second four-year class.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah. And I was excited like my head would blow off. Like I wanted to go to UCSF so bad. big time. So I'm going back to UCSF. And the really good news, what saved me as chancellor is philanthropy. It turns out that we needed people to care about the mission and the projects at UCSF right at the same time as the Mark Zuckerbergs of the world and the venture capitalists of the world.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And a lot of people had come into a lot of money Even though the overall economy was bad, it was coming back. And we had some spectacular successes. And my successor, Sam Hogood, continues to have that kind of success. And people are just really generous.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Among other things, one of my New Year's resolutions, I have a mini list. One thing that's always on the list is be more generous. I'm no Mark Zuckerberg, but I can be generous in other ways.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, to this day, I love oncology. If you love medicine, and I do, and you love patients, and I do, it's the combination of, you get to call on your compassion gene and your nerdy science gene. And when I was in Reno, at the Reno VA, I had an attending, Stephen Hall, and he was the oncologist who was teaching me about medicine, third year medical student.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Don't forget the hospital.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The most important donor base is Grateful Patients.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
or people who love science, technology. I hired John Ford, who had retired as the head of Stanford's fundraising. Moved up to the Northeast and he was my head of development. And I talked to John, I said, how do you do this? Teach me how to be a good fundraiser. And he talked about, tell people your hopes and dreams.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Tell people what you're excited about and ask them what they're excited about and see if there's a match. And I think that was really important. And then I also think that because I had been at Genentech and I was sort of gregarious and knew a lot of people, and people knew that I had decent business savvy. I wasn't going to waste their money.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We were very committed to use the money wisely, especially in the hard times, and do special things at UCSF. So I was surprised. I sort of worried that I would be sad if people said no. Yeah. That it would be weird, especially if I knew them well. So I would get myself psyched up for the beginning of it. And then by the end, I'd be like, oh, that's fine.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Next time, if you're in town, let's talk again and maybe it'll change or whatever. But it was actually fun. I got to talk to and meet a lot of great people.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Probably 40% externally, a lot external.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Working with the team.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Provost, CEO of the hospital, lawyer, all the deans. That was really important. And then part of it was monthly we met with all the chancellors, with the president of the university, it was Mark Udoff at the time, and then he stepped down after... a while. But the chancellor's meetings were funny because they all had undergrads. I always felt like I was squirming, like, are we done yet?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I thought it was just really important. My favorite thing, every Friday, lunch, Mission Bay, they had a science talk. And they'd have some pizza, Chinese food, something. And you'd look around the room and it'd be like Bruce Albert's Liz Blackburn. There'd be four Nobel Prize winners in this little cramped room listening to science.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
No, I'd just go over on the shuttle bus, eat a slice of pizza and enjoy. Yeah, amazing. It was really good.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Well, to my surprise, I think I got an email or I think it was an email from Melinda. Did I have time to talk? And UCSF throws a big event every year that's kind of friend-making, fundraising, everything, and we give out awards, recognition to people whose work we respect a lot. So I had invited Melinda the year before and thought, she'll never come. Yeah. You invite people, the throwaway invite.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And she accepted and came, actually came with her mom and dad even better. I thought that was nice. So she sent me an email and she said that she and Bill wanted me to look at being the next CEO of the Gates Foundation. And I was surprised. I had not expected that. And I started having discussions with them. It was actually funny.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I went up to Seattle and they were having all this hush-hush, you know, this was very cloak and dagger. So I went to their house because I had had a meeting with Melinda and I needed to meet with Bill and it was Halloween. The kids are coming and going. It was kind of crazy. And so I had talked to him. And I talked to my husband. You know, my husband worked at the Gates Foundation.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
He led the HIV and TB programs about five years before.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
No, no, he had gone. He was commuting to Seattle, which was dreadful. But he knew the Gates Foundation. So he and I were talking about this. And I was like, oh, God, you know, I've only been at UCSF five years. I just found where the bathrooms are, you know, that kind of thing. And it was going well. I was happy with that. They asked for a teleconference and they got on the phone.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And especially Bill made this big pitch that a lot of people could do the UCSF job with all due respect, 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.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And I loved everything about how he showed up. I loved his compassion. I loved his intellect. And after that, I had in my mind this bug about I wanted to be like him.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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 has been really all over women's issues, all over. And Bill would do another run at polio. It's like the goal broadly that all lives have equal value, which, by the way, I think is a wonderful thing. They share, but they come at it from different ways.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And so I think that the thing that resonated for me is that I could see both those points of view.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yes and no. It's one thing to have enormous resources. It's another to know where one of the most important assets they have is the time and energy of Bill and Melinda. They actually show up, things happen.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I thought that I could add value. I thought I would learn a lot. And I did think that UCSF would be fine without me. I felt like we were back on our feet financially. I thought that Sam Hogood, 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 and that it would be okay.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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. At least the way they showed up with me. Maybe when I wasn't there, they did.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It's a couple thousand. It's a big foundation, big building, big foundation with people all over the world now. There was a lot I wasn't surprised by, like the global health stuff. I knew what they were doing and I thought it was interesting and great.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And the challenge for me was Bill's endless appetite for things like learning things, driving things, funding things, and me feeling like I could get my hands around a strategic plan. It was a little bit like, okay, this staff would be like, Bill's going to love this. Let's present that, you know, it was that kind of feeling and lots of money.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So I kept trying to get my hands around like, okay, what should we do? So it's just a little more orderly and we get a great return on our investment. That was the most important focus. I feel good about that. The funny thing was I sent the finance team to Genentech, and we had this really great portfolio management process that we put in place when I was there, and they still use it apparently.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And because I recommended to Bill, we just have a portfolio management process. Pretty simple. Everybody knows how you make decisions, what money's up, what we'll do, and we can use that here. Doesn't need to be bureaucratic. So we don't need it. It's all in my head. I remember that conversation. And I thought, if it wasn't you, I would think that was a smart ass thing to say.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
But I actually think you're just being honest. So I encouraged him to understand that just because it was in his head didn't mean that the rest of us were there. We had a little more ability to make things orderly, I'd say. It was a wild ride. It was six years of a wild ride.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I would say far the opposite. The things that I felt like I knew about, I felt like really good about. The TB stuff, there's a HIV cure program now that I'm really psyched about. Technically, I felt really good. Probably the hardest thing for me was the people side of things. I have a very strong sense of how people should treat each other and the competencies that managers should have.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And I'm not willing to move on that because you're a technical expert. And I found that if you do move on that, it just changes the culture. And I struggle with that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
No, I think it's because Bill really likes technical experts. And if he likes a technical expert, he doesn't want the CEO to come and say anything. But yes, they are very smart.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They were, yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
No, there's a global health person, there's a global development person, there's an ag person.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah. It's the biggest P&L. And then U.S. education is a pretty big job too.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah. The one that has been ag is now ag financial services for the poor. So it's a pretty broad group.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So much money. It's amazing.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Oh, gosh. I think more the people side of things. I remember there was an employee who was really struggling at Genentech. And her boss, I was his boss. And he kept talking to me about how she was struggling, how she was struggling. Could we do this? Did we need to give her fewer reports, more reports, make her job harder, make her job? We couldn't figure it out. Couldn't figure it out.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And just not acting like she had been. We just couldn't figure it out. And finally, one day she said, oh, I'm getting a divorce. And after a little while, things got better. And I thought, you know, not everything's work. Not everything's work. So I think as a manager, I really care about people thriving at work. I really care about it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And when I went to Gates Foundation, I think I understood better, given Genentech and UCSF, that a very important principle, work never fills in for home. Ever. It never makes up for bad home. So if somebody needs a timeout, I always think, how can I improve work?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And sometimes it's good to just understand that that's not always the case, especially if you're working in global health or global development. You might be in South Africa. You might be in China. It's rough. So just thinking a little bit about how people can show up in ways, it's $8 billion. How do they maximize the benefit of that $8 billion? And what can I do to enable that?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yes and no. One thing about traveling a lot, you have big events or things like that, is you meet people on trips. And that's different people throughout the organization. So I think there are opportunities. I also set up meetings when people would have a grant that needed to be signed. The business process was it would show up on my computer. So I changed the business process.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So I got the group that 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, which I really liked. So I do think it is mostly through your reports, but I think there are ways that at a senior level, you can interact with people culture-wise.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So for me, I define culture in a really specific way that when you come to work, you feel like the atmosphere, the surround sound brings out the best in you and that you have some ownership of tweaking it if it doesn't. So that's something that you feel like you can control.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Because if you're in thousands of people or hundreds, thousands, tens of thousands of people and you're the CEO, you're not going to do that. but that you set up that culture. One of my favorite stories from Genentech was being at a product development meeting that my successor as medical officer, Hal Barron, was running.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And Art and I both attended just because we loved it and we wanted to be there, but we weren't decision makers. We were just attendees.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah. But in this case, there was someone who the discussion was about Herceptin and how well the test to find who was HER2 positive performed. And if you got more patients, you would get more commercial, but you would have patients who wouldn't benefit. And someone who I won't name said, but if we have a test that does like this, we can get more money.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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. Everyone kind of sat down and we weren't the decision makers. But see, that's culture. If you wondered, it's right where the decisions are being made and everything else. That for me is culture.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The other one that because I'm in so many meetings and was in so many meetings at Gates Foundation, I had a practice. 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, in a very tough way. I would look at you. You got that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I can't tell you how many people I actually didn't even know I did it that I would nod.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That's really well said. I love that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Smile, coach. I would also stall. Hey, hold on a minute, Bill. I think he's just getting ready to answer that question. You're talking over him right now. In a nice way, not confrontational. That for me is culture. I want you to succeed. I want you to know I want you to succeed. It's the guy who runs the foundation. It's the two people who are the chairs. So it's going to be scary.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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. That's really powerful.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I had announced that I was leaving and literally pack in the house as COVID hit. Actually a few miles from us, the first case in Washington state, nursing home.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I do not think you're too pessimistic. I am absolutely horrified. Horrified. It's shocking to me that the narrative is in the place it is today. And I'm honestly still processing how we got here from there. 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.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Because trust and the need to have sides and winning and losing, I don't remember health and medicine being winning and losing and sides as I've been in this business for 40 years. It's just weird. I don't get it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Let me talk about breast cancer. That's a cancer that is such a good example. The common therapy that was used, cytoxan, methotrexate, 5-FU, were very old, decades old. There were no new chemotherapy drugs. Hadn't been in a while. The field was stifled, I would say, in terms of medical oncology. There wasn't a lot going on. I was really interested in cancer epidemiology.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Bird flu is working hard on it right now.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think the public would welcome... Look, I just told you about bone marrow transplants for breast cancer. If you tell people, look, here's what we thought. We thought harder treatment was better for people. It's now proven that it's not. Science changes. People know that. But you're right. I think that being honest and open when it changes and how it changes matters a lot. It really does.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I also think you didn't say, but I would add to your recommendation, which I think is a really smart one. The pace of communication, the social media and misinformation or just stuff gets out there really fast. And having something slow doesn't keep up.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Yeah, I don't think it's a matter of kicking people off because actually I think you enhance that and you may be wrong. But being part of the dialogue, I'll give you an example that I've been reading the last couple of weeks. Ivermectin for cancer.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So my point's a simple one. The nature abhors a vacuum. So if you say I'm not going to kick off people, the lab is a good example, but I'm not going to remain silent. Here's what I know about that thing, about the lab. Here's the facts. Here's the publication. You know, I think that the absence seeds that space to people.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I feel like the anti-vax, specifically things like autism, many people have seeded that space on social media because you are kicked in the butt if you don't. So I do think you can't leave a vacuum.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That was something to me that asking the question, why did people get cancer and couldn't we do something about it, seemed really important to me. I wanted in the second year of my fellowship to study the relationship between hepatitis B and hepatocellular carcinoma and to understand that better and to think about the viral link
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It is an impossibility. There's no doubt about it. Every cancer has very specific biologies that allow it to grow and spread and cause humans problems. And that's why you don't go to the cancer doctor. You go for a prostate cancer. You go for a gastric cancer. You go because the biology of each of the cancers is different.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Right. So we use anatomy to describe where the tumors are, but it is not irrational to use different doses of medicines in combination with other doses. The thing that we went over is the preclinical phase one, phase two, phase three is meant to give whatever cancer patient, whether in this case, I think prostate cancer has been talked about a lot,
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
all the information they deserve on both safety and efficacy. Does it work? Does it shrink the tumor? Does it help them live longer? I haven't read anything about ivermectin doing that in patients and what the side effects are and how it could harm patients. So I think patients deserve that kind of information.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
With cancer, the mentor I was supposed to work with ended up not coming to San Francisco. So I decided to go to Berkeley and get a master's in public health as a backup strategy. I really scrambled because I didn't want to waste a year.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They'd be all over this.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And look, there may be human conditions for which ivermectin helps.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Beyond what we know. And I think that's an opportunity for somebody to study it. Good for them.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Well, I think it's a drug that's an anti-smarty pants drug.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That's what it is.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Nothing wrong with that. We've done that for other things.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
One of the things that I've did over the last four years is participate in the President's Council of Advisors on Science and Technology and co-chaired a report on the future of public health. And we ended up thinking that we're focusing on the workforce. One of the remedies for the issue you and I just talked about is having a broader set of people who we think of as the public health workforce.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And I think people who are interested in ivermectin, farmers, people who are up close and personal to some of the things with this bird flu. There are a number of different folks who would be really interesting to involve in public health efforts, and we typically don't.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And so I think that's one of the ways that we can go forward in public health is to think about how do we define public health and what does it look like?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It's a very academic place, but you could do two or three years. And many people went into the lab. I didn't want to go into the lab. I wanted to do epidemiology. I wanted to learn more about statistics and epidemiology. I thought I wanted to do it because I wanted to be a cancer epidemiologist. And to this day, I still think that is one of the great
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
On the surface, it's such a great thing. I think that's why Make America Healthy Again resonates for people. People universally want to be healthy. They want their families to be healthy. This is a universal thing. And how to capture that and make that real, not ivory tower, but real for people who just want their families to have a chance of being healthy. I think that's a real positive.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So I joined the OpenAI board almost a year ago now, when they had had in November of 2023, what they call the blip, which is CEO fired, board changed over. And I have been so impressed by the intellect, the commitment, the sense of responsibility of folks at OpenAI. I hope this is maybe a little crazy, but here's what I hope. If I had a top two things for AI,
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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. You get to make new medicines for people who are sick. You go home and tell your mom and dad that they're happy. 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.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I still want to 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 and paperwork that are actually very important to establishing the safety, especially, but also the efficacy of a drug.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
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 opportunities for that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
If you said the entire clinical trials program for a drug is six years, let's just make that up.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
IND to approval. I would want to cut it down by two years.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think we could be on a path to that. Now, the challenge of it is going to be if you say this example I like to give because it makes sense for people. If I'm changing five-year survival, if this is sort of a mature, established thing, I got to wait five years. I can estimate things and I can work with FDA to make sure if people can benefit.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You can always do that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
opportunities to make a big impact, but you have to be funded. So I'm a pragmatist. The good news was that all that learning at Berkeley and at UCSF in epi and biostat, I brought to drug development. Clinical trials have a lot in common with doing epidemiology.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think that the other thing is you and I both know if you have 500 patients in a trial and you look at safety, that's so limited. If you have a much more AI driven, why don't we follow safety in every patient?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Ongoing. So I think the opportunities in clinical trials are massive. The other thing I would love to see is a change in the things that cause burnout of nurses and physicians and others in the hospital.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Not in clinical trials. This is healthcare. Healthcare should have tools where it's easier to decrease the load, the burden on both caregivers and families. I think that should be doable. It's not that hard.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I'm not close enough to the robotics piece of it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think it is when you're trying to connect all the dots. That's the thing. What AI does so brilliantly is it just takes a lot of data and it comes out with observations. And if there are ways that that can assist at the bedside, that's a massive improvement, especially when people are changing, even me, University of Washington to UCSF. Yeah.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
it's so hard to change caregivers, to change health systems. Those kinds of things can decrease workloads. But I also think it's the kinds of things where clinical observations could be AI-driven.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
These guys, what they did is they made possible, and we talked about preclinical. This is pre-preclinical.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
This is figuring out what you're going to do. If you can make figuring out what you're going to do much, much faster, which they did- You're going to have the opportunity. The way I think of it is you've got like a mountain of opportunity, but it's shown a light on just a limited number of things where you can see the opportunity and take advantage of the opportunity.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think it's a start, but I think it's great that they were recognized.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So far.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So far.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Anything where AI can help us with outcome measures. I told you that my husband's an HIV doc. When we were both at Bristol Myers Squibb, I was doing two by two measurements of tumors on x-rays for Taxol. And he was looking at viral load. Viral load allowed us to have 20 HIV drugs in like five years. It was crazy how good it was. I want a viral load for everything.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
We need a good biomarker for more things. And you were talking about all the different types of breast cancer. So think about what you just talked about with breast cancer, that you have ER positive, ER negative, HER2 positive, triple negative. There's all these. What if actually there's 15?
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So then you're in 15 trials, but you only need 10 patients in each trial because it's so obvious you have the perfect remedy for each of those patients. I always think of it as switch is on, turn it off, and you see clinical benefit. Anything we do that sets up like that, especially if we can not just measure switch on, but switch off. That's why viral load is so powerful.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I have been pretty negative based on the data. I just have not seen the data that suggests to me that we're helping.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was, yeah. Palmer Beasley, one of the fathers of that relationship, was the guy who was supposed to come. There were preliminary papers and something relatively early, but it was emerging science.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So can AI help us? Possibly. The problem is just really hard.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think that appears to be the problem because if they did, I think it would work. So that's the most important problem. The other problem is something that I think we all tend to underestimate because I love the concept of prevention. And I think Make America Healthy Again, in part, is we'll go to preventive therapy and stop all these. And
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I understand that in oncology, we've often celebrated tiny successes, but you can't have big successes before you have tiny successes. I don't think it's easy to do early detection. The only two things that are, well, now three, colonoscopy works for cervical cancer, a pap smear works. Even better, HBV vaccine is my ad. And now you can do a spiral CT for lung cancer.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I'm not even using one handful of fingers. And we've been trying to do early detection as long as I've been an oncologist.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You know what you just said? That's something that if someone wanted to start a company, they could simplify that and make something more turnkey for patients and physicians.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
They shouldn't be on the list.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That's the neat thing is you can just take out the polyp. That's always been the beauty of colonoscopy.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
You know, I don't. If you weren't in Asia, it was actually, I think, relatively low, but I believe increasing, which is partly why the vaccines are so important.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I think it'd be interesting to look at protein.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It would. It would be tremendous.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was fun. I'm delighted to talk with you. Really enjoyed it.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
After I got my master's in public health, I became the oncologist at UCSF in the university hospital for the AIDS clinic.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
This is Moffitt. So San Francisco General had a very well-known program run by oncologists for AIDS patients who were in the safety net hospital. But in the university hospital, if you were very sick and you had Kaposi's sarcoma, you saw me. And my husband, because we had just gotten married, we were interns together. He was in the lab in ID doing immunology work.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So 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 hemophiliacs and homosexuals. 1H wasn't heterosexual. And so there was a lot of disbelief about African HIV.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
And in fact, some people thought it must be gay sex, but people are too embarrassed to admit it. There were other theories, but people just did not understand what was going on in Africa. So the Rockefellers said, we'll give you a grant at UCSF. We'll grant you money to study heterosexual transmission of HIV.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Not going to the lab, but really looking at epi. And particularly, there was a hypothesis that if it was heterosexually transmitted, there was something to do with sexually transmitted diseases. And that there was something about increasing your risk if you had untreated STDs, sexually transmitted diseases. So we were asked to go. UCSF had no global health.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
To put this into context, we had a flat and two Honda Civics. I still remember this. We gave my dad power of attorney. We sublet our flat and we sold our Hondas and moved to Uganda. I'm laughing in part because I had never been east of Chicago. I mean, this was a pretty dramatic thing to do.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
The two of us. That's the team.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
That's the team. And Uganda was a place where, on the positive side of things, the NCI had set up a collaboration with Uganda Cancer Institute, where they did some really great things in lymphoma and Burkitt's lymphoma, if you remember those stories. And one of the physicians at UCSF had been associated with that, John Ziegler. So there was a connection to the Uganda Cancer Institute.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So on the good side of things, there was that. And there also was and is the Entebbe Viral Institute. So there was some infrastructure there. Unfortunately, most of that infrastructure had been ruined by the Idi Amin regime not long before we went to Uganda. So when we went there, it was pretty lawless. There were roadblocks you had to stop at. It was difficult to live there.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
It was really difficult.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
I would say now that I'm used to being in more safe situations and older and wiser, it was probably not that smart the way we lived there. But we weren't reckless. It seemed dangerous when you were in the car to have carjacking or your money go missing or things like that.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
He was gone. But when we were there, he made that attempt to come back from Saudi Arabia and go back to Uganda. But it was thwarted. So that was good news. So Nick, my husband, reestablished the sexually transmitted disease clinic and attended in the internal medicine ward. And I like to say I doubled the population of oncologists in Uganda when I was there.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
So, my colleague, Edward Mbidi, who's Ugandan, put all his focus on the pediatric unit, and I put all my focus on the adult unit, which was so many cases of Kaposi's sarcoma.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
This is 89, 90, and 91.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Not yet.
The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Just on the brink.