Viruses, cancer and wellness: A chat with Sue Desmond-Hellmann

Submitted by Noah MacCallum

The following post is a summary of the key points from the talk, and has been edited for brevity and clarity.

Intro

Dr. Sue Desmond-Hellmann has had a spectacular career impacting human health. Previously she was the CEO of the Bill and Melinda Gates Foundation, the (first female) Chancellor of UCSF, and President of product development at Genentech. She completed her training as an oncologist at UCSF, and aspires to decrease suffering and enhance people’s ability to enjoy their life. In this wide-ranging discussion, we cover possible pathways out of the pandemic, big opportunities in healthcare and tech, and the importance of stepping outside of our bubble.

COVID: Next Steps

According to Desmond-Hellman, the Biden administration deserves credit for speeding up the vaccine rollout; they quickly pushed beyond 1M vaccines/day and it’s increasing every day. It’s likely we’ll hit high levels of coverage by the end of summer. However, she says that variants are more likely when large numbers of people are infected. So we should continue to wear masks, distance, and get vaccinated. If needed, the industry should be able to develop a vaccine booster.

If it is established that vaccines protect against transmission, and we reach high levels of population vaccination, life should go back to normal. Vaccine hesitancy is the major risk to this. Of course vaccinating the global population is just as important for reducing variants, and the Gates Foundation and WHO are helping with funding for lower-income countries.

On her personal journey

Desmond-Hellman says her hardest career decision was to move from oncology practice to private industry. She was worried it represented a moral compromise, but found that it was fast-paced, impactful, and interesting work. She ended up loving it.

But some of her most formative experiences came early in her career. While at UCSF, she moved from living in the heart of SF to Kampala, Uganda, where she lived without running water or electricity for two years. This was really eye-opening. She says we all become spoiled and selfish in our everyday bubbles, but getting out and seeing up close what life is like for most people makes you better, more thoughtful, and more generous.

Her biggest regret at the Gates Foundation was that the public health community wasn’t able to end polio. We were so close, but were stymied by unrest in Afghanistan and Pakistan and outbreaks in the horn of Africa. Desmond-Hellman plans to attend the party when it finally does end up happening.

How can tech help?

SPC members wanted to know how technologists can best help advance health. For those in the startup world, she advises paying close attention to reimbursements, especially for diagnostics. Go where the money is. Genentech made a companion diagnostic for Herceptin because the drug was generously reimbursed, which made it possible to capture some of that value. Otherwise nobody’s going to pay for it.

In general, she would love to see folks in Silicon Valley focusing more on health and education. Especially education, since there are so many kids that need help catching up after the pandemic. On health care, she thinks we can bring down healthcare costs by standardizing, doing more routine care with non-specialists or technology, and saving doctors for the situations where they’re really needed.

And while she pays close attention to privacy, big centralized databases can help coordinate care and provide major insights about health. The NHS in the UK demonstrates this well.

What’s unfortunate is that the cost of technology goes down over time, while the cost of healthcare and education have gone up over time. This is likely because the latter involves humans, and humans are expensive. We should ask ourselves, what part of healthcare and education can we digitize? This is our best opportunity to bend the cost curve.

New biology

On the controversial question of whether we can solve all diseases in our lifetime, Desmond-Hellman is skeptical. Diseases are always adapting and outsmarting us. She prefers the goal of helping people have a longer, more productive life. In the next decade, she’s most excited about CRISPR and rapid gene editing technologies, mRNA platforms, and new cell therapies for cancer. These technologies are much faster and more precise. But manufacturing for cell and gene therapies is still a cost bottleneck, which is limiting the number of people and diseases that can be treated with these approaches. Some other exciting ideas:

• Liquid biopsy should enable early detection of signs of cancer, and, eventually, simply turning down the problematic cancer signal could avoid disease progression.
• Precision medicine has made significant inroads in oncology; it’s now business as usual. It hasn’t made as much progress in metabolic disease, immunology, Alzheimer’s, and other areas. The key difference is that these diseases don’t have clear roadmaps, with clear stages, measurements, and endpoints that tell you whether an intervention is working. We need to crawl before we walk, so to speak.
• A lack of roadmap is hampering serious biology research on aging as well.

Finally, Desmond-Hellman hasn’t seen as much progress in wellness as she’d like. From early adulthood, she thinks we should be able to use technology to chart our own risks for disease, and be empowered to have as healthy and enjoyable of a life as possible. The Apple Watch is a start, but rather than just recording your runs, it should provide a holistic, customized wellness experience.

How to have impact in nonprofits

While we talked a lot about pharma and biotech, Hellman has a long career in non-profit organizations as well. She says it’s easy to get overwhelmed with the scale of need for some social challenges, but making a difference is more dependent on determination and getting started than money. She advises people to find a social challenge that excites you, looking around your world and community to get inspired. After the onset of COVID, she couldn’t believe people in her own country were standing in line to get food, so she moved some of her personal philanthropy towards organizations that feed people. She advises us to stay focused on the people on the ground who need help.

For those looking for philanthropic funding from the Gates Foundation, she says the website lays out exactly what each program is looking for. If you are looking for help, or want to pitch an idea to help achieve one of their goals, they’d love to hear from you.

So what is SPC? We’re a self-organizing community of technologists, tinkerers, and domain experts based in San Francisco. We are building new (and sometimes unorthodox) ventures — ranging from enterprise startups and consumer apps, to open source ML and civic-tech projects. We come together, virtually and in the physical world, to learn from each other, challenge ourselves, and validate new ideas.

Our members also host a recurring events series. Our goal is to bring new and exciting ideas and technologies into the community as well as valuable learnings from those who have first-hand experience building their life’s work. In the past we’ve hosted Silicon Valley VCs and CEOs like Reid Hoffman and Mike Kreiger, leaders like CEO of U.S. Digital Response Raylene Yung and SF Mayor London Breed, and domain experts like Nobel laureate Dr. Saul Perlmutter, experimental physicist Dr. Rana Adhikari, and Howard Hughes Investigator Wendell Lim, amongst many others.

Our on-the-record talks are posted to the SPC Youtube channel. You can also sign up for our events mailing list or newsletter to stay in the loop.