346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine
Peter Attia MDKey Moments
Dr. Susan Desmond-Hellmann shares her career journey in medicine, biotech, and global health, focusing on oncology and AI's future in healthcare.
Key Insights
Early career focused on internal medicine during the AIDS crisis, highlighting the fear and sadness but also the spirit of perseverance.
Pioneered cancer therapies like Herceptin and Avastin, emphasizing the importance of targeted treatments and the evolution of oncology.
Played a key role in global health initiatives, particularly in Uganda during the HIV/AIDS epidemic, underscoring the profound impact of early interventions.
Extensive experience in biotech and pharmaceutical leadership, contributing to drug development, safety surveillance, and market strategies.
Believes AI holds immense promise for medicine, particularly in enhancing clinical trial processes and improving patient safety monitoring.
Discusses the challenges and ethical considerations of drug pricing, accessibility, and balancing innovation with affordability.
Advocates for clear communication and trust-building in public health, criticizing the conflation of science and advocacy, especially during the COVID-19 pandemic.
EARLY CAREER AND THE FIGHT AGAINST AIDS
Susan Desmond-Hellmann began her medical career in internal medicine at UCSF in 1982, coinciding with the early, terrifying years of the AIDS epidemic. Her initial experiences were marked by profound sadness and uncertainty as she treated patients, many of whom were young men presenting with rare opportunistic infections like Pneumocystis pneumonia and Kaposi's sarcoma. The lack of understanding regarding transmission led to stringent protective measures for healthcare workers, yet the prevailing atmosphere in San Francisco was one of dedication and a collective desire to help those affected.
TRANSITION TO ONCOLOGY AND EPIDEMIOLOGY
Following her residency and chief residency, Desmond-Hellmann pursued a fellowship in oncology, drawn by the intellectual challenge and the opportunity to combine compassion with scientific inquiry. She reflects on the state of oncology in the mid-1980s, characterizing it as stagnant with few new therapies. Her interest in cancer epidemiology, particularly the link between viruses and cancer, led her to pursue a Master's in Public Health at Berkeley, aiming to understand the 'why' behind cancer diagnoses and explore preventative strategies.
GLOBAL HEALTH INITIATIVES IN UGANDA
A pivotal experience was her three-year stint in Uganda in the late 1980s, funded by the Rockefeller Foundation to study heterosexual HIV transmission. Facing a lawless environment and immense suffering, she and her husband, an internist, worked to re-establish an STD clinic and manage the adult internal medicine ward. Desmond-Hellmann vividly describes the staggering prevalence of HIV, especially among young women, and the devastating impact of AIDS in the absence of antiretroviral therapy, noting that almost all her Kaposi's sarcoma patients died within six months.
BIOTECH INNOVATION AND DRUG DEVELOPMENT
Returning to the U.S., Desmond-Hellmann joined Bristol Myers Squib, initially as a consultant. She quickly became involved in the development of Taxol and its subsequent approval for breast cancer, highlighting the challenges of drug development and the importance of rigorous safety monitoring. Her career then moved to Genentech in 1995, a pioneering biotech company. Here, she contributed to the development of critical oncology drugs like Herceptin and Avastin, navigating scientific dogma, clinical trial design, and the complexities of bringing novel therapies to market.
LEADERSHIP ROLES AT UCSF AND THE GATES FOUNDATION
In 2009, she transitioned to academia, becoming Chancellor of UCSF, where she focused on strengthening the institution's business aspects and fostering philanthropy during a challenging economic period. Her leadership extended to global health when she accepted the CEO position at the Bill & Melinda Gates Foundation in 2014. During her tenure, she aimed to bring more order and strategic focus to the foundation's vast resources, particularly in global health and development, navigating the distinct passions of Bill and Melinda Gates.
THE FUTURE OF MEDICINE: AI AND GLOBAL CHALLENGES
Desmond-Hellmann is notably a member of the OpenAI board, believing AI holds immense promise for medicine, especially in streamlining clinical trials and enhancing safety monitoring. She is critical of the communication surrounding the COVID-19 pandemic, lamenting the erosion of trust and the conflation of science with advocacy. She advocates for clearer communication, acknowledging mistakes, and preparing for future pandemics. Discussions also touched upon the limitations of current early detection methods and the potential of protein biomarkers, alongside the ongoing challenges in public health workforce development and fostering trust.
Mentioned in This Episode
●Supplements
●Software & Apps
●Tools
●Companies
●Organizations
●Books
●Concepts
●People Referenced
Common Questions
Sue Desmond-Hellmann started her residency in internal medicine at UCSF in 1982, right at the onset of the AIDS epidemic. She witnessed patients presenting with unusual opportunistic infections like Pneumocystis carinii pneumonia and Kaposi's Sarcoma, which led to significant fear and mystery about transmission among medical staff. Despite the fear, there was a strong commitment to help patients.
Topics
Mentioned in this video
The number one diagnosis seen in hospitals for AIDS patients in 1982, indicative of immunosuppression.
A type of cancer whose relationship with Hepatitis B was being studied in the 80s.
A major oncology textbook that Sue reread twice to prepare for her oncology boards after returning from Uganda.
A chemotherapy drug developed by Bristol Myers Squibb, part of their historical oncology portfolio.
A society where significant oncology findings, such as the success of Herceptin and the debunking of bone marrow transplants for breast cancer, were announced.
A condition indicating the rapid breakdown of a large number of cancer cells, which occurred with Rituximab, demonstrating its potent efficacy.
An unusual purple-colored tumor, highly visible externally, and also causing internal organ involvement in HIV-infected patients, serving as a clear indicator of AIDS.
A doctor at the NCI who mentored Peter Attia in medical school, teaching him about the impact of cancer on families.
A Ugandan colleague of Sue's who focused on the pediatric unit during their time in Uganda.
One of the scientists credited with identifying the HIV virus.
A drug Genentech hired Sue to work on, intended to increase platelet count, but proved difficult due to late and excessive platelet elevation.
An antibody drug developed by Genentech that targets VEGF, approved for colon cancer, but faced economic scrutiny due to its high cost and modest survival benefit.
Even better than Pap smears for preventing cervical cancer.
A diagnostic tool for prostate cancer, used to further stratify patients after PSA density and velocity.
A specific type of lymphoma that had been studied in collaboration with the Uganda Cancer Institute.
An anti-retroviral drug in development at Bristol Myers Squibb after AZT.
An antibody drug used to lower cholesterol, highlighting the precision and fewer side effects compared to small molecule drugs like statins.
President of the University of California system during Sue's tenure as UCSF Chancellor.
One of the fathers of understanding the relationship between Hepatitis B and hepatocellular carcinoma.
A pharmaceutical company that recruited Nick, Sue's husband, and later hired Sue as a consultant who became project team leader for Taxol.
Head of research at Genentech in 1995, later CEO, who pushed for Trastuzumab (Herceptin) to enter the clinic.
An antiviral drug for COVID-19, mentioned as an example of a provisional approval that perhaps should have been reevaluated for efficacy post-market.
An organization Nick, Sue's husband, has worked with for 15 years, currently operating in 12 countries in sub-Saharan Africa.
An anti-retroviral drug in development at Bristol Myers Squibb after AZT.
A drug made by Amgen to increase white blood cells.
Co-founder of Genentech, who fostered a culture of publishing scientific findings after patenting to protect IP.
A small molecule drug used to lower cholesterol, described as 'dirty' due to its various off-target effects and side effects.
An effective early detection method for cervical cancer.
A biomarker for prostate cancer, which, when used with density and velocity, can be highly predictive of significant cancer.
An imaging technique used in prostate cancer diagnosis, often after initial stratification with PSA metrics.
A report cited for early indications of the AIDS epidemic in 1981.
An old, reasonably effective chemotherapy drug against Kaposi's Sarcoma, used extensively in Uganda.
A microtubule poison derived from the Yew tree, one of the first new chemotherapy drugs in decades, approved first for ovarian cancer and then breast cancer.
Claimed to be the first biotech company, founded on genetic technology to make protein-based medicines like growth hormone and insulin.
A clinician researcher at Genentech and a clotting expert who pushed for the development of tPA.
One of the people involved in the large clinical studies for tPA.
An antibody drug developed by Genentech that targets the HER2 protein, significantly improving survival for HER2-positive breast cancer patients.
An anti-retroviral drug that was just on the brink of release when Sue was in Uganda.
One of the scientists credited with identifying the HIV virus, noted for having a dispute with Robert Gallo over credit.
An old chemotherapy drug that can be used for Kaposi's Sarcoma, requiring careful use due to pulmonary toxicity.
Genentech's first drug, a recombinant form of growth hormone, which solved the problem of using cadaver-derived hormones with disease risks.
A drug made by Amgen to increase red blood cells.
An antibody drug that targets CD20, a marker on lymphomas, proving highly effective and changing the landscape of lymphoma treatment.
Chief of medicine at UCSF and mentor to Sue, who encouraged her to apply for Chancellor.
A Nobel laureate stepping down as Chancellor of UCSF, creating the opening Sue would fill.
A notable scientist mentioned as attending informal science talks at UCSF's Mission Bay campus.
Another type of cancer seen in AIDS patients, though in smaller numbers than Kaposi's Sarcoma.
An oncologist at the Reno VA who inspired Sue Desmond-Hellmann to pursue oncology due to his compassion and intellect.
Sue felt understanding its relationship with hepatocellular carcinoma was important.
Provided a grant to UCSF to study heterosexual transmission of HIV in Africa.
Former Ugandan dictator whose regime ruined most of the country's infrastructure before Sue's arrival.
A chemotherapy drug developed by Bristol Myers Squibb, part of their historical oncology portfolio.
An enzyme-like molecule developed by Genentech to break down blood clots, revolutionizing heart attack treatment.
A researcher known for his hypothesis that cancers cannot grow larger than a BB without new blood vessels, leading to the development of anti-VEGF therapies.
Co-founder of Chiron, a biochemist who, along with Holly Smith, helped recruit top talent to UCSF to make it a serious medical school.
An old chemotherapy drug used for breast cancer, highlighting the lack of new drugs in the mid-80s.
An existing viral institute in Uganda that provided some pre-existing infrastructure.
Pioneer in cardiovascular medicine, known for initiating large simple trials that Genentech adopted for tPA.
One of the people involved in the large clinical studies for tPA, part of the TIMI study group.
An effective early detection method for colon cancer, preventing progression from polyp to cancer.
An old chemotherapy drug used for breast cancer, part of the standard therapy.
An institution in Uganda with a prior collaboration with the NCI on lymphoma research.
A physician at UCSF associated with the Uganda Cancer Institute collaboration.
A severe, short-duration side effect caused by Taxol that Sue studied.
An Italian OB/GYN who worked at Genentech and developed an antibody to VEGF, forming the basis for Avastin.
A clinical oncology trials expert who was in charge of the anti-VEGF program at Genentech.
Sue's successor as medical officer at Genentech, who ran product development meetings.
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