WEBVTT - Safi Bahcall on Why You Need to Take Crazy Risks 0:00:02.240 --> 0:00:06.800 This is Master's in Business with Verry Ridholts on Bloomberg Radio. 0:00:07.480 --> 0:00:10.360 This week on the podcast, I have an extra special guest. 0:00:10.520 --> 0:00:13.039 His name is Safi Pacall and he is the author 0:00:13.080 --> 0:00:17.159 of a fascinating book called moon Shots. Not only was 0:00:17.239 --> 0:00:21.800 he on President Obama's counsel on the Future of Technology, 0:00:21.840 --> 0:00:25.599 but he has consulted for the CIA, the Navy, all 0:00:25.680 --> 0:00:30.240 sorts of organizations, teaching them how to nurture innovation in 0:00:30.320 --> 0:00:34.160 institutions that normally are not very good at that sort 0:00:34.200 --> 0:00:37.760 of thing. He's really a fascinating guy background in physics, 0:00:37.880 --> 0:00:41.320 ran a biotech company and along the way picked up 0:00:41.440 --> 0:00:46.559 lots of insights into what leads to successful moon shots 0:00:46.600 --> 0:00:50.479 as projects and why so much innovation is really just 0:00:51.040 --> 0:00:54.560 smothered in the lab, smothered in the cradle, when it 0:00:54.600 --> 0:00:59.600 has potential to literally change the war. The radar is 0:00:59.720 --> 0:01:03.080 argued with the technology that won the war for the Allies. 0:01:03.320 --> 0:01:07.640 It had been sitting in the Navy for eighteen years unused, 0:01:07.959 --> 0:01:11.680 and had it not been discovered and brought forward by 0:01:11.920 --> 0:01:15.080 van Ouer Bush and other people, there's a very real 0:01:15.160 --> 0:01:18.560 chance the global map would look totally different. So I 0:01:18.600 --> 0:01:22.000 think you'll find this conversation to be absolutely fascinating. My 0:01:22.200 --> 0:01:28.600 conversation with Safie Picoll. This is Masters in Business with 0:01:28.680 --> 0:01:33.319 Barry Ridholts on Bloomberg Radio. My extra special guest this 0:01:33.360 --> 0:01:37.640 week is Safie Picall. He is the former CEO and 0:01:37.800 --> 0:01:41.600 co founder of Sense of Pharmaceuticals. He served on President 0:01:41.680 --> 0:01:47.480 Obama's Council of Science Advisors, and he is the author 0:01:47.840 --> 0:01:51.560 of loon Shots, How to Nurture the crazy ideas that 0:01:51.640 --> 0:01:57.840 wind wars cured diseases and transformed industries. Sofie Picall, Welcome 0:01:57.840 --> 0:02:00.680 to Bloomberg. Thanks very glad to be here. So you 0:02:00.720 --> 0:02:04.400 have a really fascinating background. Both your parents are physicists 0:02:04.480 --> 0:02:08.360 or astrophysicists. You eventually go to Harvard, get a degree 0:02:08.400 --> 0:02:12.160 in theoretical physics, go to Stanford for your PhD in physics. 0:02:12.520 --> 0:02:14.960 How on earth does that lead to a career in 0:02:14.960 --> 0:02:17.600 in biotech. I was kind of a little bit of 0:02:17.639 --> 0:02:20.120 a random walk, but I I spent probably the first 0:02:20.840 --> 0:02:23.559 thirty years of my life kind of on a university. 0:02:23.639 --> 0:02:26.280 And because my parents were physicists, we grew up in Princeton, 0:02:26.360 --> 0:02:28.840 and then I was college and then grad school and 0:02:28.840 --> 0:02:31.000 then post doc and going through the faculty stuff. And 0:02:31.480 --> 0:02:33.919 at some point I realized, and this might be a 0:02:33.919 --> 0:02:38.600 little shocking, that more than that people are not in 0:02:38.639 --> 0:02:41.560 the world, are not theoretical physicist or mathematicians. They do 0:02:41.639 --> 0:02:45.200 stuff other than write papers and go down for inces. 0:02:45.240 --> 0:02:48.360 And I just got curious, So you started looking around. 0:02:48.400 --> 0:02:52.240 How do you go from theoretical physics to stumble into 0:02:52.440 --> 0:02:55.760 via random walk biotech. I was just curious about what 0:02:55.880 --> 0:02:57.680 is it that makes the world go round? And what 0:02:57.760 --> 0:03:00.280 do other people do when they're not writing pay person 0:03:00.280 --> 0:03:02.840 about mathematics or physics. And I actually remember I was 0:03:02.919 --> 0:03:06.320 dating a woman at the time and she had she 0:03:06.400 --> 0:03:08.440 was working as a paralegal, which was a real job, 0:03:08.480 --> 0:03:10.320 and I'd never been to an office, and I remember 0:03:10.360 --> 0:03:13.280 asking her, could you take me in? I was in 0:03:13.360 --> 0:03:15.280 my mid twenty Could you take me into this thing 0:03:15.320 --> 0:03:17.880 you call an office? Did it horrify you? Well, I 0:03:17.880 --> 0:03:19.400 remember she said, well, listen, I can take you in 0:03:19.480 --> 0:03:22.040 Friday happy hour. That's when people sort of stand around 0:03:22.120 --> 0:03:23.880 you could talk. And so I came in Friday happy 0:03:24.000 --> 0:03:26.000 and I said, I said, well, what should I ask? 0:03:26.000 --> 0:03:27.600 And I said, well, look, are you happy doing what 0:03:27.639 --> 0:03:29.480 you're doing? And I went around. It was actually a 0:03:29.480 --> 0:03:31.680 well known law firm in Silicon Valley, and I said, 0:03:31.919 --> 0:03:34.360 are you happy doing what you're doing? I would say, 0:03:34.639 --> 0:03:37.560 of the twenty five people I asked, twenty five said no. 0:03:38.560 --> 0:03:40.560 And I was like, well, that probably set me back 0:03:40.560 --> 0:03:43.360 another five years in the academic world. But I just 0:03:43.400 --> 0:03:46.000 got very curious. And so I heard from another physicist 0:03:46.040 --> 0:03:49.200 friend who had gone into a consulting world, and they 0:03:49.240 --> 0:03:51.640 had sort of they help you transition, they kind of 0:03:51.960 --> 0:03:54.760 from academia to business. Yes, so I went to a 0:03:54.800 --> 0:03:58.600 consulting firm in New York called McKenzie and Joint Company, 0:03:58.640 --> 0:04:01.520 always in the news, US in the news a lot lately, 0:04:02.120 --> 0:04:04.720 and it's kind of like a halfway house for academics. 0:04:04.720 --> 0:04:06.440 It's sort of like they don't want to let you 0:04:06.480 --> 0:04:08.880 loose on the real world, and they sort of coach 0:04:08.960 --> 0:04:10.840 you and the skills you need to survive, how to 0:04:10.880 --> 0:04:12.920 speak to people, how to work on teams, how to 0:04:12.960 --> 0:04:15.320 solve real problems. And so that's how I got a 0:04:15.360 --> 0:04:18.640 sense of kind of how the real world works. And 0:04:18.640 --> 0:04:21.920 then I got a taste for wanting to do something, 0:04:21.960 --> 0:04:25.560 build something, and also bigger than myself, bigger than you know, 0:04:25.640 --> 0:04:28.040 your your own career or your own papers. Or your 0:04:28.040 --> 0:04:32.599 own ideas and bigger than just advising companies. Uh. You know, 0:04:32.640 --> 0:04:35.599 I had friends whose parents were getting sick. I was 0:04:35.640 --> 0:04:39.040 going through some illness in my own family, and I thought, 0:04:39.080 --> 0:04:42.360 how motivating would it be if when I woke up 0:04:42.360 --> 0:04:44.400 in the morning, I was working in something that could 0:04:44.440 --> 0:04:47.400 give people on Earth more time with their loved ones. 0:04:47.760 --> 0:04:51.000 It's just an incredibly exciting and fun way to work. So, 0:04:51.120 --> 0:04:52.400 you know, some part of that is you want to 0:04:52.440 --> 0:04:54.160 do some good, but some part of that is selfish. 0:04:54.520 --> 0:04:56.840 It's a great way to motivate yourself and others. So 0:04:56.880 --> 0:05:00.560 that's really fascinating. So you decide you want to participate 0:05:00.640 --> 0:05:05.400 in something more than just a narrow, little research niche 0:05:05.600 --> 0:05:10.800 that has bigger ramifications for friends, family, society, the whole world. 0:05:11.240 --> 0:05:15.039 So from nine you're in Mackenzie. By two thousand and 0:05:15.080 --> 0:05:19.040 eight your name the Ernstein Young New England Biotech Entrepreneur 0:05:19.040 --> 0:05:22.360 of the Year. What took place in that decade between 0:05:22.440 --> 0:05:26.960 Mackenzie and winning that award, Well, a lot of learning. 0:05:27.000 --> 0:05:29.120 So when I went to start a company after a while, 0:05:29.160 --> 0:05:32.400 I really wanted to start something of my own, and 0:05:32.520 --> 0:05:35.080 I found that I was There was a niche which 0:05:35.120 --> 0:05:37.719 is where scientist I would talk to in the lab, 0:05:37.960 --> 0:05:41.520 or biologists or chemists really enjoyed talking to me because 0:05:41.520 --> 0:05:45.479 I wasn't actually one of some enemy camp for a biologist, 0:05:45.520 --> 0:05:47.960 I wasn't a chemist. For chemist, I wasn't a biologist. 0:05:47.960 --> 0:05:51.239 As a physicist, you're sort of like Switzerland, your neutral, 0:05:51.440 --> 0:05:53.760 and everybody is sort of intrigued and talking to you, 0:05:53.800 --> 0:05:56.800 and you can ask everybody interesting questions and learn and 0:05:56.800 --> 0:05:58.960 it's kind of fun. And I found that I was, 0:05:59.040 --> 0:06:02.240 on the one hand, good at having those discussions and 0:06:02.279 --> 0:06:05.320 getting those people fired up about a big goal. On 0:06:05.360 --> 0:06:08.080 the other hand, I was also good at talking to 0:06:08.160 --> 0:06:11.960 people in the finance community. My mother's Israeli. I lived 0:06:11.960 --> 0:06:13.760 in Tel Aviv and we grew up a little bit 0:06:13.760 --> 0:06:17.160 in Israel, and so talking to traders and investors is 0:06:17.279 --> 0:06:20.040 not much different than walking around a shook in Jerusalem 0:06:20.120 --> 0:06:23.159 or Tel Aviv. People are very focused on the immediate, 0:06:23.200 --> 0:06:26.080 what's the bottom line, How is this gonna help me? 0:06:27.080 --> 0:06:30.040 And I found I could bridge those two worlds pretty well, 0:06:30.080 --> 0:06:32.760 and that was actually pretty interesting. And there were all 0:06:32.800 --> 0:06:35.279 these ideas that seemed to be trapped in the lab. 0:06:36.000 --> 0:06:38.560 They could help people, and they were stuck because there 0:06:38.600 --> 0:06:41.080 was no bridge between those two words you mentioned, trapped 0:06:41.120 --> 0:06:44.200 in the lab. There's a chapter and loon shot that 0:06:44.400 --> 0:06:49.599 I love this heading, Engineers of Serendipity. How do people 0:06:49.800 --> 0:06:53.640 in that line of work R and D research labs? 0:06:54.160 --> 0:06:58.240 Why are so many great discoveries, so much fascinating innovation 0:06:58.520 --> 0:07:02.160 and discovery? Why does that stay trapped in a lab? Well, 0:07:02.200 --> 0:07:04.120 you see this all over the place, and we're talking 0:07:04.120 --> 0:07:07.719 a little bit about biology and biotech or research companies, 0:07:07.760 --> 0:07:10.880 but the same thing is true in tech companies and 0:07:10.960 --> 0:07:14.680 engineering companies and product design companies. And the last few months, 0:07:14.720 --> 0:07:16.720 I've actually spent a lot of time with the Department 0:07:16.760 --> 0:07:20.480 of Defense and national security organizations, all of whom have 0:07:20.600 --> 0:07:24.480 the exact same question. Why do good teams keep killing 0:07:24.520 --> 0:07:27.720 great ideas? Why are all these promising things stuck in 0:07:27.720 --> 0:07:31.400 the lab? And part of that is there isn't this bridge. 0:07:31.440 --> 0:07:33.840 There isn't the bridge between those who are focused on 0:07:33.880 --> 0:07:37.960 the core on how do I improve my operations and 0:07:38.040 --> 0:07:40.760 my execution and those who are working on the new 0:07:41.120 --> 0:07:43.800 and that because of two people. There the two types 0:07:43.840 --> 0:07:46.520 of people who work on those things speak different languages, 0:07:47.080 --> 0:07:49.280 They don't understand each other, and they often don't like 0:07:49.440 --> 0:07:51.560 each other. I'll give you an example. So I was 0:07:51.920 --> 0:07:55.360 meeting with the admiral who's responsible for transforming the Navy 0:07:55.400 --> 0:07:57.640 for the twenty first century, and so I was standing 0:07:57.640 --> 0:08:00.000 on a nuclear submarine about thirty ft from the nuclear 0:08:00.080 --> 0:08:03.120 or engine. And this is exactly what's on their mind, 0:08:03.160 --> 0:08:05.600 what was on his mind and his team's mind. If 0:08:05.680 --> 0:08:08.760 you are a hundred miles from shore, deep underwater, you 0:08:08.800 --> 0:08:12.200 don't want to start hearing clanking noises from your nuclear engine. 0:08:12.480 --> 0:08:15.520 That's the core. But at the same time, you don't 0:08:15.560 --> 0:08:17.760 want to be surprised by a new kind of torpedo. 0:08:18.520 --> 0:08:22.160 That's the new. So for companies, for organizations, for teams, 0:08:22.560 --> 0:08:24.920 it's a matter of p and L. You don't want 0:08:24.920 --> 0:08:27.680 to be surprised by your competitor. But for national security 0:08:27.760 --> 0:08:31.120 organizations it's a matter of life and death. But it 0:08:31.160 --> 0:08:34.040 all comes back to that same question, how do we 0:08:34.080 --> 0:08:36.360 balance the core and the new Why do we keep 0:08:36.400 --> 0:08:39.200 having these battles between here these promising ideas and here 0:08:39.120 --> 0:08:42.160 are these people who are shooting them down? And what 0:08:42.200 --> 0:08:44.160 can we do about it? And so that's behind some 0:08:44.200 --> 0:08:45.920 of the research that led to the loon shots and 0:08:46.000 --> 0:08:49.679 loon shots is all about the dichonomy between the franchisees 0:08:50.320 --> 0:08:54.680 and the innovators. Will continue discussing that shortly. So let's 0:08:54.720 --> 0:08:57.960 talk about the early two thousand's when you were launching 0:08:58.520 --> 0:09:01.600 Center UH and up a little bit. How did you 0:09:01.640 --> 0:09:05.600 meet your co founder and partner? Well around the time 0:09:05.640 --> 0:09:08.240 that I was getting kind of antsy, as after a 0:09:08.240 --> 0:09:10.240 few years as a consultant, I wanted to do something. 0:09:10.280 --> 0:09:13.160 I knew that I wanted to work on helping get 0:09:13.200 --> 0:09:15.440 those promising ideas out of the labs and into the 0:09:15.440 --> 0:09:18.080 real world. And so I spent maybe six months, maybe 0:09:18.080 --> 0:09:22.240 a year, going around universities academic labs where I had 0:09:22.280 --> 0:09:25.320 some connections and talking to promising scientists, and one thing 0:09:25.360 --> 0:09:29.040 led to another. Encountered this guy at Harvard at Dana 0:09:29.120 --> 0:09:33.440 Farber Cancer Institute who just was sitting on like this giant, 0:09:34.160 --> 0:09:38.640 you know, untapped mind, really interesting, really promising ideas, And 0:09:38.679 --> 0:09:40.920 I thought, this is a guy who would be fun 0:09:40.960 --> 0:09:43.520 to partner with. And a lot of people, you know, 0:09:43.640 --> 0:09:46.640 listened to him but just missed all this stuff that 0:09:46.640 --> 0:09:49.199 that he was sitting on, not only him, but people 0:09:49.240 --> 0:09:51.840 he collaborated with. So I decided to partner with him 0:09:51.840 --> 0:09:55.959 and start a new company. And this is landbou chan So. 0:09:56.240 --> 0:10:00.400 In the book, there's a fascinating discussion about the broad 0:10:00.440 --> 0:10:05.560 approaches to looking for a drug to either pure disease 0:10:05.720 --> 0:10:10.880 or manage a disease. And one approach is to work backwards. 0:10:10.960 --> 0:10:13.360 We try and figure out what the mechanism of the 0:10:13.400 --> 0:10:18.080 disease is and find something that halts that mechanism. But 0:10:18.120 --> 0:10:22.679 there was another approach, which was people have invented thousands 0:10:22.720 --> 0:10:26.600 upon thousands of different molecules. Let's just run these molecules 0:10:26.640 --> 0:10:29.319 against all these diseases and see what they do. That 0:10:29.360 --> 0:10:32.040 seems to be his approach, Am I am I getting 0:10:32.040 --> 0:10:35.480 that correct? Yeah? He was. I mean, there's a combination 0:10:35.559 --> 0:10:37.920 of two and if you actually just pick one or 0:10:37.960 --> 0:10:40.640 the other, you will do less well. So if you 0:10:40.679 --> 0:10:43.920 start with, well, here's how the protein works, here's what 0:10:44.000 --> 0:10:46.400 it does in the cell, and here's what we need 0:10:46.440 --> 0:10:49.280 to get done. Let's put that on a computer. It 0:10:49.400 --> 0:10:53.040 sounds very logical. It tends to go very badly, really, 0:10:53.120 --> 0:10:58.959 because people don't realize how important serendipity is in drug discovery. 0:10:59.000 --> 0:11:03.080 Almost all of the major drugs and the vast majority 0:11:03.080 --> 0:11:07.600 of the major breakthroughs that we have in science, but 0:11:07.600 --> 0:11:11.040 but especially in drug discovery, there's always some element of 0:11:11.080 --> 0:11:14.720 serendipity because the body is so much more complex. What 0:11:14.880 --> 0:11:17.199 works in a cell dish or what works in a 0:11:17.200 --> 0:11:20.920 academic paper that you published and submit to prestigious journal 0:11:21.559 --> 0:11:26.240 very often is completely different, sometimes exactly the opposite of 0:11:26.280 --> 0:11:29.360 what works in a giant, complex system in a very 0:11:29.400 --> 0:11:33.040 difficult environment. And so I think what I liked about 0:11:33.080 --> 0:11:35.440 his approach and what resonated and the people that he 0:11:35.480 --> 0:11:37.600 worked with in our approach was that we did both. 0:11:37.960 --> 0:11:41.800 We looked on the one hand for the underlying science 0:11:41.840 --> 0:11:43.959 and the rigor, but on the other hand, we balanced 0:11:44.000 --> 0:11:47.440 that with an understanding of how important serendipity is and 0:11:47.480 --> 0:11:50.920 how important surprises are. And one of the things I 0:11:50.960 --> 0:11:55.080 found really fascinating was the approach, and this was in 0:11:55.120 --> 0:11:59.839 particular with cancer, of not just trying one thing that 0:12:00.280 --> 0:12:03.680 might work, put the disease into remission, and then the disease, 0:12:04.520 --> 0:12:07.920 I don't know if it's evolution or just adaptation, eventually 0:12:07.960 --> 0:12:11.240 comes back because it's figured out how to overcome whatever 0:12:11.240 --> 0:12:15.160 that obstacle is. You write in the book about how 0:12:15.240 --> 0:12:19.080 a one to three four approach left hook, right jab, 0:12:19.280 --> 0:12:23.600 an operacot throwing enough stuff at a particular disease not 0:12:23.640 --> 0:12:26.240 only knocks it out, but it prevents it from adapting 0:12:26.320 --> 0:12:30.439 to whatever that therapy is discussed that a little bit. 0:12:30.640 --> 0:12:32.920 I mean, you can imagine it by example with a 0:12:32.960 --> 0:12:34.960 military and sort of a terrorist. Let's you have a 0:12:35.000 --> 0:12:37.800 city that seems to be taken over by terrorists. If 0:12:37.880 --> 0:12:40.319 you have just one approach for how you're going to 0:12:40.400 --> 0:12:42.760 go fight those terrorists, Let's say it's a sniper, or 0:12:42.800 --> 0:12:45.240 it's an air attack or it's a drone attack, they 0:12:45.280 --> 0:12:47.400 will adapt. They will figure out a way to hide, 0:12:47.480 --> 0:12:50.640 they will figure out how to evade that particular angle. 0:12:50.920 --> 0:12:53.240 And so if you want to succeed, you need a 0:12:53.240 --> 0:12:55.319 shock cannot You need to use the army. You need 0:12:55.360 --> 0:12:57.240 to use the air force, you need to use the navy. 0:12:57.280 --> 0:12:59.679 You need to use drones, you need to use snipers, 0:12:59.679 --> 0:13:03.240 you need to use cyber You have all of them 0:13:03.400 --> 0:13:05.960 at once in order to completely wipe it out. And 0:13:05.960 --> 0:13:08.440 it's the same thing with cancer. Cancer is a rogue 0:13:08.440 --> 0:13:11.480 set of cells operating in your body. They're just growing 0:13:11.480 --> 0:13:14.520 out of control. There is an accelerator pedal that's stuck 0:13:14.520 --> 0:13:17.040 and so it just broke, and there's a brake pedal 0:13:17.200 --> 0:13:20.160 that halts the growth that also broke. That's why cancer 0:13:20.160 --> 0:13:22.720 takes decades to develop. You have to have all these 0:13:22.720 --> 0:13:25.920 systems just break down, whether it's with time or because 0:13:25.960 --> 0:13:28.839 you smoke and you're you're you're messing up the cell 0:13:28.920 --> 0:13:33.080 with the carcinogens and smoke. It takes time to accumulate 0:13:33.120 --> 0:13:36.120 these failures. And after the first break system fails and 0:13:36.160 --> 0:13:38.640 the second break system and the backup system fails, and 0:13:38.720 --> 0:13:41.920 this cancer cell starts growing and doubling and growing and doubling. 0:13:42.760 --> 0:13:45.160 And you can't just attack it with just the army 0:13:45.559 --> 0:13:47.840 or just the navy or just the air force. You 0:13:47.920 --> 0:13:50.720 need to come at it from all directions at the 0:13:50.760 --> 0:13:53.000 same time, and then you have a chance. The few 0:13:53.040 --> 0:13:55.440 cancers that we've cured, and there's a small handful of 0:13:55.440 --> 0:13:58.800 cancels that we've cured, that's what we've done. It's almost 0:13:58.840 --> 0:14:03.080 always some combination and shock attack, and it's the right 0:14:03.120 --> 0:14:06.360 combination at the right time that can actually overwhelm the 0:14:06.400 --> 0:14:09.240 cancer and wipe it out. So how far along is 0:14:09.360 --> 0:14:14.440 humanity in during quote unquote cancer, which we know is 0:14:14.720 --> 0:14:19.040 three hundred or so separate diseases to be fair, right, 0:14:19.080 --> 0:14:22.800 And so the reason people in in UH medicine or 0:14:22.840 --> 0:14:25.040 science on talk so much about curing cancer is because 0:14:25.040 --> 0:14:28.160 it is three hundred different diseases. You don't your diabetes 0:14:28.240 --> 0:14:30.200 at the same time as you cure heart attacks at 0:14:30.200 --> 0:14:33.600 the same time as you cure Alzheimer's, because they're really 0:14:33.640 --> 0:14:36.360 different diseases. And cancer is sort of like that. But 0:14:36.440 --> 0:14:39.280 let's say if you call it roughly three hundred different 0:14:39.280 --> 0:14:42.320 types of cancer, I mean it's you know, less than 0:14:42.400 --> 0:14:46.200 ten that we've made such astounding progress on. You know, 0:14:46.240 --> 0:14:50.920 it's childhood leukemias is one example where it used to 0:14:50.960 --> 0:14:55.640 be mortality rate within six months or a year, and 0:14:55.720 --> 0:14:58.400 now it's more like eight or go on to live 0:14:58.480 --> 0:15:02.600 long lives. That's a stounding and you can see we're 0:15:02.640 --> 0:15:05.440 not there yet with many other cancers. But for example, 0:15:05.480 --> 0:15:09.520 when I started almost twenty years ago, melanoma was a 0:15:09.560 --> 0:15:12.400 death sentence. Every time you ran a melanoma trial for 0:15:12.480 --> 0:15:16.680 probably thirty years clinical trial, the placebo arm or the 0:15:16.720 --> 0:15:20.720 standard care arm and the treatment arm would be identical. 0:15:21.200 --> 0:15:23.680 He'd spent two or three or four years. Everybody would 0:15:23.720 --> 0:15:26.240 put in all this time, and it was always the 0:15:26.320 --> 0:15:31.560 same disappointing result. Now almost so many trials are positive. 0:15:31.960 --> 0:15:34.880 Something turned the corner why is that. Why are we 0:15:34.920 --> 0:15:39.200 now more successful with that form of cancer versus others. Well, 0:15:39.240 --> 0:15:42.200 melanoma turned out to be a type of cancer that's 0:15:42.320 --> 0:15:44.960 very sensitive to the immune system, and we still don't 0:15:44.960 --> 0:15:47.800 know why. There's a lot of theories, but it happens 0:15:47.840 --> 0:15:51.120 to be one of not many, but a small number 0:15:51.160 --> 0:15:53.560 of cancer types. And it may be because it's near 0:15:53.600 --> 0:15:55.800 the skin and the skin is so sensitive to the 0:15:55.800 --> 0:15:57.840 immune system. There are a lot of immune cells there. 0:15:58.000 --> 0:16:01.160 Because when something lands on your skin, you or your cut, 0:16:01.560 --> 0:16:03.880 you have a cut, the immune system rushes over. So 0:16:03.920 --> 0:16:07.560 it may be that melanoma is a special case. But 0:16:07.840 --> 0:16:11.680 in it what was fantastic is when maybe seven eight, 0:16:11.800 --> 0:16:16.000 nine years ago the first trials started showing dramatic effect. 0:16:16.400 --> 0:16:19.640 It's not a cure, but we are so much better 0:16:20.160 --> 0:16:24.040 in that disease. There was a lot of serendipity there. 0:16:24.640 --> 0:16:27.520 Like even the work on the immune system, that's a 0:16:27.600 --> 0:16:31.280 hundred year old idea. People notice that a long time 0:16:31.320 --> 0:16:34.840 ago that sometimes when the immune system is activated, cancers 0:16:34.880 --> 0:16:37.920 go away. You you sneeze on people if you just 0:16:38.160 --> 0:16:40.080 if your treatment is, hey, let's just sneeze on this 0:16:40.120 --> 0:16:43.240 cancer patient. Right, Five out of a hundred or ten 0:16:43.280 --> 0:16:45.400 out of a hundred might have complete remissions of their 0:16:45.400 --> 0:16:48.760 two People knew that. People knew that, they knew that. Actually, 0:16:48.880 --> 0:16:53.360 fifty sixty years ago from the clinics for tuberculosis, we 0:16:53.400 --> 0:16:55.800 don't have those that anymore. These clinics people who had 0:16:55.800 --> 0:16:59.440 tuberculosis used to get sent to, but people who had melanoma, 0:16:59.680 --> 0:17:02.880 and we go to these tuberculous as clinics, a surprisingly 0:17:02.960 --> 0:17:06.520 high percentage of them their cancers would disappear. And that's 0:17:06.560 --> 0:17:09.160 because they were like fighting this infection and the immune 0:17:09.160 --> 0:17:12.160 system was activated. So we still don't understand the signs 0:17:12.200 --> 0:17:14.280 of that. But you said, how far are we We're 0:17:14.320 --> 0:17:17.000 at the beginning of the exponential curve. What's happened is 0:17:17.240 --> 0:17:20.320 about fifteen or twenty years ago we got the tools, 0:17:20.400 --> 0:17:23.919 we sequenced the genome and the biotech knowledgy kind of 0:17:24.119 --> 0:17:27.840 revolution of years ago that allowed us to grow proteins 0:17:27.880 --> 0:17:32.080 in the lab and make those a commercial scale, create 0:17:32.119 --> 0:17:35.600 a new set of tools, and we're just starting. It's 0:17:35.640 --> 0:17:39.800 really just the beginning of using those amazing tools to 0:17:39.920 --> 0:17:43.119 do things like one of those things is getting the 0:17:43.119 --> 0:17:46.360 immune system to fight fight tums. And like I said, 0:17:46.400 --> 0:17:48.480 there was about a hundred years of trying to do that, 0:17:48.600 --> 0:17:51.639 and none of the standard approaches work, and then no 0:17:51.720 --> 0:17:55.399 one exactly knows why someone tried a slightly different angle. 0:17:55.480 --> 0:17:58.960 Let's target this protein, not that immune protein. Boom. It worked, 0:17:59.680 --> 0:18:02.199 and and it wasn't even the original protein that the 0:18:02.280 --> 0:18:05.439 scientists had been thinking about would be the key to 0:18:05.520 --> 0:18:07.840 it all for many many years. Even the scientist who 0:18:07.840 --> 0:18:09.359 win the Nobel Prize, they thought it would be this 0:18:09.440 --> 0:18:12.080 other thing that would be the key. It turns out 0:18:12.080 --> 0:18:15.040 it was this thing, and nobody knew. So there's so much. 0:18:16.359 --> 0:18:21.040 It's really the combination of strong science and an appreciation 0:18:21.080 --> 0:18:23.880 of serendipity. When you can put those two things together, 0:18:24.359 --> 0:18:27.280 the magic can happen. So taking where we are in 0:18:27.320 --> 0:18:30.119 that J curve, starting that that ramp up of the 0:18:30.200 --> 0:18:34.119 hockey stick. UH, is it a fair question to ask, 0:18:34.680 --> 0:18:39.520 will we see cancer the Emperor of maladies? To borrow 0:18:39.560 --> 0:18:42.600 the book title, UH, cured in our lifetime? I think 0:18:42.640 --> 0:18:45.560 we will see certain cancers we've seen three or four 0:18:45.640 --> 0:18:50.479 or five go, you know, well beyond of people who 0:18:50.560 --> 0:18:53.640 are diagnosed with it have more than five or sometimes 0:18:53.680 --> 0:18:57.679 more than ten years survival. So by any reasonable definition, 0:18:57.720 --> 0:19:00.960 you could call that a cure. And slowly, we're getting 0:19:01.000 --> 0:19:03.600 better and better. The survival times in melanoma I have 0:19:03.680 --> 0:19:07.920 gotten longer and longer multiple mileoma. You know, twenty years 0:19:07.960 --> 0:19:11.880 ago that was a death sentence. There was nothing. And then, 0:19:11.880 --> 0:19:15.560 in an almost serendipitous event, there was a woman here 0:19:15.600 --> 0:19:18.840 in New York who was thirty one who called a 0:19:18.960 --> 0:19:20.960 doctor that I actually I used to work with in 0:19:21.160 --> 0:19:24.240 Boston named Judah Folkman, who had this kind of wild, 0:19:24.359 --> 0:19:28.800 crazy idea, Hey, let's fight tumors by blocking blood vessels 0:19:28.800 --> 0:19:31.800 to the tumors. And everybody thought that was the dumbest 0:19:31.840 --> 0:19:36.359 idea they've ever heard, really anti angiogenesis exactly. At the time, 0:19:36.880 --> 0:19:40.760 everybody knew that the only way to fight tumors was 0:19:40.840 --> 0:19:44.080 to bomb them, would keep poison them with chemotherapy like 0:19:44.119 --> 0:19:47.440 a giant bomb, or burn them with radiation. The idea 0:19:47.480 --> 0:19:50.639 that there were these subtle signals that tumors were like 0:19:50.760 --> 0:19:53.200 homes and they were laying down pipes, and if you 0:19:53.200 --> 0:19:55.359 could block those pipes, you could slow the growth of 0:19:55.400 --> 0:19:58.879 those homes. That was considered radical. Judah was asked to 0:19:59.359 --> 0:20:01.520 There was a spe shall committee at his hospital that 0:20:01.640 --> 0:20:03.800 was asked to evaluate his work because it was so 0:20:03.880 --> 0:20:06.920 controversial and it said, well, we don't think there's any 0:20:07.000 --> 0:20:10.280 value here. You need to resign, really stop what you're doing. 0:20:10.440 --> 0:20:14.680 That's astonishing NY. And how did that progress from there? Well, 0:20:14.720 --> 0:20:17.240 he was I remember he was talking to some post 0:20:17.320 --> 0:20:19.440 docs and student who said who was like, oh, I'm 0:20:19.440 --> 0:20:22.119 really depressed. You know, my paper was rejected. And he 0:20:22.160 --> 0:20:25.280 said to her said, well, if you want to understand rejection, 0:20:25.320 --> 0:20:27.440 come to my office. I will show you pink slips 0:20:27.640 --> 0:20:31.919 with the word clown on them. Right, thirty two years 0:20:31.960 --> 0:20:36.200 after he first suggested his idea, on a stage in Chicago, 0:20:36.720 --> 0:20:41.600 a guy got up, a scientist got up, packed auditorium two, 0:20:42.840 --> 0:20:46.119 present the data from the largest study ever run to 0:20:46.200 --> 0:20:50.080 that date, and patients with advanced calling cancer pressed a button, 0:20:50.480 --> 0:20:53.840 flipped the slide. Patients who had received the drug based 0:20:53.840 --> 0:20:58.200 on Judah's ideas lived longer on average, and anyone had 0:20:58.320 --> 0:21:01.000 ever lived with advance It's calling cancer. It was like 0:21:01.000 --> 0:21:04.439 a standing ovation. This was thirty two years after Judah 0:21:04.440 --> 0:21:07.359 first suggested his ideas. It was a standing ovation. I 0:21:07.359 --> 0:21:11.280 remember a speaker said something like, if only Dr Folkman 0:21:11.359 --> 0:21:15.960 were alive to see this, And Judah was actually sitting 0:21:15.960 --> 0:21:18.080 in the back, you know, and turned to his neighbor 0:21:18.119 --> 0:21:21.399 and smiled, and and he didn't raise his hand and 0:21:21.480 --> 0:21:23.960 say still here, I'm still here. No, but it was 0:21:24.040 --> 0:21:27.000 just and you love telling that story, but it's uh 0:21:27.040 --> 0:21:32.160 an example of all these these ideas that are dismissed 0:21:32.200 --> 0:21:34.720 as crazy and so many things that we take for 0:21:34.800 --> 0:21:38.240 granted today, even Facebook. If you remember when Zuckerberg was 0:21:38.240 --> 0:21:40.240 going around to raise money for it in two thousand 0:21:40.240 --> 0:21:44.000 and four, every social network had failed. My Space was 0:21:44.080 --> 0:21:47.200 just failing. Friends to well, my Space was friends to 0:21:47.359 --> 0:21:51.800 was just failing. And every every investment, almost all the 0:21:51.840 --> 0:21:55.080 intelligent investors, said well, there's no money. Social networks can't 0:21:55.119 --> 0:21:57.840 make any money because they're just fats. Everybody goes to 0:21:57.880 --> 0:22:02.200 the next one. Well cool, well they were Well one 0:22:02.240 --> 0:22:04.360