00:00hi everyone welcome to the a 16z podcast
00:02I'm Hana and today's episode continues
00:05our ongoing series on how science
00:07becomes engineering and all the new
00:09challenges and opportunities that
00:10presents as people move across fields
00:13and into new mindsets it's a
00:15conversation between a 16-0 partner
00:17Vijay Pandey who heads up our bio Fund
00:20and Bob Langer Institute professor at
00:22MIT whose work has really been all about
00:25the interface of engineering and
00:26materials in biology and medicine so Bob
00:30your work has been a very unusual blend
00:33right from chemical engineering to
00:35medicine to biotech what are some of the
00:38ways or some of the problems that you
00:39thought about an approach differently
00:41given that less traditional background
00:43one of the things that I noticed because
00:45I was working with materials might help
00:47we're how did materials find their way
00:49into medicine and what I'd see is almost
00:51all the time what happened is somebody
00:55was some clinician wanted to urgently
00:58solve a medical problem and what they'd
01:02do is they'd go to their house to find
01:04some object that would kind of resemble
01:06the organ or tissue they want to fix and
01:08then they'd use it in a person amazing
01:10if you want to make artificial heart
01:13what the clinicians did in 1967 is they
01:16said what object in your house has a
01:18good flex life like a heart and they
01:20came up with the idea of a ladies girdle
01:23so they looked at what that was made out
01:24of and it's a poly ether urethane and
01:27then they decided they'd use the exact
01:30same material to make the artificial
01:31heart that was 1967 but now 50 years
01:34later that's still what it's made out of
01:37because once you start down that path
01:38from like a FDA regulatory standpoint
01:41it's hard to change and of course the
01:43artificial heart has run into different
01:45kinds of problems in particular one of
01:47the problems has been when blood hits
01:48the surface of the artificial heart the
01:50lady's girdle material it can form a
01:52clot and that clot can go to the
01:54patient's brain and give them a stroke
01:56and they can die so you know but to me
02:00it doesn't seem that surprising that
02:02something that was designed to be a
02:03ladies girdle isn't the optimal material
02:05to put into contact with blood right
02:07isn't the best heart necessarily why not
02:09ask the question what do you really want
02:11in a biomaterial from a
02:12Engineering standpoint chemistry
02:14standpoint and biology standpoint and
02:16then could you synthesize it first
02:18principles these kinds of things these
02:20are they the way most decisions used to
02:22be made for these kinds of materials or
02:24it was there was there no sense of
02:26choosing optimal material first or was
02:28it always sort of happenstance for most
02:30of the 20th century clinicians would
02:32take off-the-shelf materials and use
02:34them in a patient another example is
02:36breast implants and again they wanted to
02:38go to their house and find what object
02:40would kind of resemble a breast implant
02:41and I mean just that's such a crazy idea
02:44to just go home and like look around
02:46your living room or your bedroom like
02:48what would work I'm gonna pull out my
02:50wife's skirt it's astonishing you're
02:53absolutely right but and then in the
02:55case of breast implants one of those was
02:56a mattress stuffing because it was
02:58swishing how long until that changed the
03:04the mattress that's still one of the two
03:06main breast implant materials one is a
03:09mattress stuffing and the other is
03:10actually a lubricant which is silicone
03:12that theme of taking materials off the
03:15shelf is still been one of the major
03:18themes of biomaterials for the 20th
03:20century when I started my career you
03:23know in the 70s and early 80s then
03:25that's one of the things I started to
03:27realize and began to change it's a major
03:29paradigm shift but it's not a simple
03:31shift material science has blossomed so
03:34much you know as a discipline over the
03:36last 30 40 years I mean in many ways
03:38there weren't material science
03:39departments I know not that long ago
03:41yeah and so it is really a dramatic
03:43shift well that's actually right in fact
03:45when a lot of the material just the
03:47science departments were you know really
03:50aimed at totally different kinds of
03:52materials I'd love to hear some of your
03:53discoveries and what the breakthroughs
03:55that you thought will continue to have
03:57you know really profound implications
03:59going forward when I was much younger
04:01one of the challenges that that we
04:03looked at to try to isolate the first
04:06what I'll call angiogenesis inhibitors
04:08blood vessel inhibitors was we had to
04:10create a bioassay and have a way to
04:12slowly release these substances which
04:15were large molecules which could be
04:17peptides or proteins for a long time in
04:20a way where they would not be destroyed
04:22and that led us to create really the
04:26controlled-release polymer systems for
04:28ionic substances and peptides and
04:31proteins slow-release basically yes new
04:33kinds of systems like Microscan nano
04:36spheres and different kinds of coatings
04:39that enabled you to have release for a
04:42long time there's certain drugs for
04:44example that they use today to treat to
04:45advanced prostate cancer or
04:47endometriosis that are large molecules
04:49and because they're so large you can't
04:52swallow them because they won't get
04:54absorbed and they will get destroyed you
04:56can't take them nasally or anyway and
04:59then if you inject them they're
05:00destroyed in seconds also but but when
05:03they're put in these microspheres you
05:04can give them an injection and they can
05:07last for a month now even six months and
05:10that's led to new ways of treating
05:11prostate cancer and Dmitri OSIS type 2
05:14diabetes' schizophrenia
05:18you know narcotic addiction all kinds of
05:20things there are newer molecules that
05:22also face terrible they're very tough
05:24delivery challenges and short
05:26interfering RNAs and si RNAs messenger
05:30RNA you know new gene editing approaches
05:33DNA and these I think delivery ends up
05:37being so critical because if you can't
05:40deliver them you know probably those
05:41drugs will not work so you have to
05:43figure out a way to get them to the
05:45target that you want so that's a threat
05:47that's probably going through over 40
05:49years of our research it's kind of
05:51amazing that you can think you can just
05:52swallow something or inject some you
05:56know if you think of other analogies
05:57like the postal system or whatever you
05:59know things don't just magically get to
06:01where they're supposed to go and so the
06:03ability to actually start to engineer
06:05this aspect as Bob was alluding to is
06:07very transformative and in some ways are
06:09still a lot that one can do well I mean
06:13the key thing to think about is that
06:14when you take a drug typically goes
06:16everywhere and so let's say you only
06:18need to target one particular part if
06:20you can target one particular part you
06:21could up the dose may be the effective
06:23local dose instead of it going
06:25everywhere like the drug eluting stent
06:26which is a terrific example of what you
06:29just said if you try to take those drugs
06:31like taxall and give the amount that you
06:33needed systemic all over the body you
06:35take it orally or some other ways I mean
06:37it would probably kill somebody but but
06:40locally you put it in a little polymer
06:43and you put it on the stent and it
06:45delivers it locally the systemic dose is
06:47maybe one one thousandth of what it
06:49would be is if you if you swallowed it
06:50so by delivering locally you can totally
06:53change the safety and and dosage profile
06:56so it's not just like personalizing
06:58medicine for one person is like
07:00personalizing it for your liver or very
07:02specific person so I think a fantasy
07:04main people had was this old movie was
07:07it fantastic for you or like you go
07:09inside someone's body a little submarine
07:11and driving around and you're getting
07:14right to where you need to go to be able
07:15to heal I mean that's the fantasy but
07:18this is starting to get much closer to
07:19that and you can imagine if you could as
07:21you get closer and closer that you can
07:23have this surgical strike you know so to
07:25speak you know almost like a SWAT team
07:26coming and doing what it's doing and
07:28there's another I think trend that we
07:30see is that we've got one baseline thing
07:32which is lots of small molecule drugs
07:33and then you've got delivery and you
07:35keep on stacking things on top one thing
07:37makes each other better and better safer
07:39more efficacy so this is such a
07:41beautiful arc because it also empowers
07:43and sort of enables all the other things
07:45that are done how is the drug industry
07:47itself changing as these kinds of
07:49breakthroughs start rolling out into the
07:51world and into markets well I I do think
07:54that the drug industry what we're seeing
07:57you know 40 years ago we saw the
07:58evolution of of protein medicines which
08:01are now you know which have I think
08:03transformed the pharmaceutical industry
08:05and the kinds of drugs we pick like for
08:07example if you look at the top 10
08:09selling best drugs in you know this past
08:12year seven of them were approaching our
08:14protein drugs if you looked at it even
08:17at best it would have been one but now
08:19it's that's really the majority and the
08:22sales are over 200 billion dollars I
08:24think what we're seeing now are ways to
08:26possibly have DNA drugs and RNA drugs
08:29and I think that will be a huge
08:31revolution the great advance in genetic
08:34engineering is people figured out how
08:36you could you know engineer a cell to
08:39make proteins relatively quickly and in
08:43fact even engineer bacteria to do that
08:45and and that was a key advance and that
08:47was the launch of genetic engineering
08:49but you could actually go further back
08:54and maybe effect RNA or affect DNA and
08:57that might even be more advantageous
08:59because that really gets to the heart of
09:01where the problems might occur so DNA
09:05say somebody has an enzyme deficiency
09:08disease gachet's disease as an example
09:10it took years to come up with the drugs
09:12that could help that you might do DNA
09:15therapy gene therapy to actually give
09:17somebody the gene that could make that
09:19enzyme or you might do gene editing to
09:23correct the gene that caused that
09:25problem in the first place right DNA you
09:27actually have to not only get it into
09:29the cell you have to get it into the
09:30nucleus and there so that means the
09:32delivery problems are even tougher with
09:34RNA you you don't need to get it into
09:36the nucleus if somebody has a medical
09:39issue you can shut that issue down by
09:42giving SI RNA that can sort of stop the
09:47RNA from working and basically and then
09:49the protein would would never you know
09:51wouldn't occur and messenger RNA would
09:54be exactly the opposite let's say again
09:56you had an enzyme in deficiency disease
09:58that would enable you to give the RNA
10:01that would make that enzyme and there
10:03you'd have the advantage over DNA that
10:05you wouldn't have to get it into the
10:07nucleus and it'd have the advantage of
10:09over proteins that you can make the you
10:12know it's you don't have to spend nine
10:13months to a year to manufacture the
10:15protein and and also the you don't have
10:18the challenge of protecting the protein
10:20all the way through the body you know
10:21one of the key things that he mentioned
10:23there was that Bob mentioned was this
10:25concept of gain-of-function that you
10:27know there's some activators you know
10:30and and other small molecule drugs that
10:32can do this but this is usually not what
10:34happens most drugs inhibit something and
10:37so on and so sibility to gain function
10:40which maybe was lost for some reason or
10:42even put in a function that was never
10:44there in the first place yeah isn't
10:45incredible that's an incredible shift
10:48and and again speaks to something that
10:50is again more in this or a spirit of
10:52engineering that we've been sort of
10:53alluding to in a couple different
10:54directions biopharma as we have right
10:56now is development small molecules and
10:58protein biologics and follows a given
10:59path and I think what we're seeing is
11:01something which doesn't really have a
11:02name yet it's maybe technology in an
11:05via or something like that Bob how are
11:07you starting to see technological
11:09advances like machine learning or
11:10robotics affect how this kind of
11:12research in the bio space is done do you
11:15use some of these tools to increase
11:16throughput are they game-changing or
11:19they just kind of increasing speed that
11:21I think is definitely game-changing high
11:23throughput you know involves doing
11:26things much much faster by robots and
11:28new technologies like new chemistry's
11:30that we've developed before this if
11:32somebody wants to do what I'll call
11:34formulation you like get the drug have a
11:36rights to have the right solubility or
11:38the right crystal form it took often
11:40many many years and there were some huge
11:42problems we would be sometimes be able
11:44to solve these problems that people
11:46couldn't solve for years we could solve
11:47them in a matter of hours or days the
11:49example that we often give which is a
11:51true story is that just in 1996 Abbott
11:54had this drug called Noor vir
11:56it was an AIDS drug a protease inhibitor
11:58and they had it in what's called crystal
12:00polymorph crystal form one but for some
12:03reason even after it got fda-approved
12:05after about a year and a half it changed
12:07polymorph crystal form too and of course
12:10every time you make a different crystal
12:11form it has a different solubility and
12:14other different properties and so
12:15appropriately the FDA because it changed
12:18told them it became a different thing
12:20exactly exactly and so the FDA told them
12:23to pull it off the market and so they
12:25did yet even after a long time years
12:28they couldn't they they could never get
12:30it back to the right crystal form so
12:32they actually had a so it was off the
12:34market and it was you know worth
12:36hundreds of millions of dollars in
12:37people's lives and then eventually they
12:40just had to make it as a solution
12:41because they could never get the crystal
12:43form back and so it didn't do very well
12:45and wasn't that helpful now seven years
12:48later and what we did isn't just in two
12:50weeks using this high throughput
12:51approach not only created crystal form -
12:54which is where they were abot when they
12:57stopped but we also recreated crystal
13:00form one and discovered three new
13:02crystal forms that had never been
13:03discovered before and like I said that's
13:05in two weeks just because of the power
13:07of the technologies that we created I
13:09have kind of a love-hate relationship
13:12with high throughput methods the love
13:14part you know as everything Bob
13:17is spot-on and you know and you've seen
13:19in other spaces like in protein
13:21crystallography in in in in many aspects
13:23of drug screening tons of things that
13:25used to be about almost like people
13:27really just literally people pipetting
13:29with their hands and a sort of
13:31pre-industrial revolution way now as
13:33automated and then you can do all these
13:34amazing things but there's a
13:36philosophical issue which i think is a
13:38really interesting one is that is there
13:41gonna be a point where biology can move
13:43from something where we really have no
13:44choice but to just empirically try lots
13:46of things versus can we start to
13:48engineer and and and and the question is
13:50in what areas will we see this I mean
13:52it's funny I we would all rather our
13:55micki colleagues understand how to build
13:57bridges rather than doing high
13:59throughput bridge design and then seeing
14:01which ones fail and screening them and
14:02so on and the problem with biology is
14:05that advanced is so complicated and so
14:06some parts will be amenable to serve a
14:09more rational engineering approach and
14:11we're seeing more and more in parts of
14:12it and the parts that can't these will
14:14be the solutions I'm really torn because
14:16I would love to see more of the the the
14:19rational approach but clearly
14:20rationality has had its limits and and
14:23and and so these things can sort of fill
14:25in those gaps well and how do you know
14:27which are the areas that are right for
14:28that kind of design thinking kind and
14:31which are the ones where it's better to
14:32crunch and to stumble on discovery it's
14:35all about can you make predictions so if
14:37you think you can engineer something you
14:38should be able to make ten predictions
14:40and have three work not making a hundred
14:42thousand guesses and seeing what pans
14:44out right people in synthetic biology
14:47are really pushing the envelope for what
14:49you can do in this sort of designed
14:51predicted engineering way and so I think
14:53it's a mistake to think that you know we
14:55can go after anything in biology
14:56rationally right now even when you do
14:59high throughput types of things you
15:01really want to bring in rational
15:02thinking to how you do it best and then
15:04when you get the data you want to really
15:06see if you can use that database as a
15:08way to really understand what's going on
15:11and hopefully allow you to do better and
15:13better before this you couldn't learn
15:16much because you wouldn't have that much
15:17data now there was so much more data you
15:19could start analyzing it and try to make
15:21predictions from the data about how you
15:23do the next generation even of high
15:25throughput things you know that's a
15:27great point is that you know you
15:28when you do high throughput on a hundred
15:30thousand let's say drug drug candidates
15:33you know there's like billions trillions
15:35of things did you in principle could do
15:37in you know just in the chemical in
15:39chemical space it's not even just pure
15:41empirical approach versus a rational
15:43approach it's just to what fraction then
15:45we do proportion yeah how do you use it
15:50as a lever yeah that's right to just be
15:52more efficient than you you could be
15:54just knowing nothing yeah it goes back
15:56and forth I think one thing feeds on the
15:58other if you're able to do the high
16:00throughput things and start to learn
16:01more like I say you can then you know do
16:04better and better because you begin to
16:06understand what you know structure
16:08function relationships or other things
16:10that might be valuable we often look at
16:12what should be done we're so questions
16:16where there's fundamental science that
16:17needs to be done academia is fantastic
16:19for that on the other hand questions
16:21that are about engineering a product and
16:23scaling it up that's great first artist
16:25and maybe not the domain of academia and
16:28so what we're seeing is a lot of shift
16:30in that in areas of biology so much
16:32science has been learned that there's
16:34now new opportunities to think about
16:36biology as being so much more on the
16:38engineering side than ever before I was
16:40curious to get your take on that Bob you
16:41know you've seen this arc where the
16:43areas do you think that are still
16:44science and what parts do you think have
16:46the opportunity now to be novel II
16:47thought of engineering just in the last
16:49few years the timelines that one has an
16:53academia course are very different than
16:55what one might have in an industry and
16:58also the difference in focus I mean in
17:00this case of academia you're often
17:02trying to you know invent things or
17:05discover things but you don't
17:07necessarily need to have a product in
17:09ten years or 20 years or ever but but if
17:12you've learned some things that can be
17:14transformative and if you invent some
17:16things that could be transformative
17:17materials is one big area that
17:20engineering continues to make advances
17:22in like new materials nanotechnology but
17:26there's lots of other kinds of aspects
17:28of of biology I think elite that are
17:32starting to merge with engineering and
17:34you have all these bio engineering or
17:35biomedical engineering departments
17:37starting up so better ways of you know
17:40ways that engineers can contribute to em
17:42- you know - pharmacology neuroscience I
17:48think all those are beginning to happen
17:50more and more a lot of startups
17:53specially in biopharm and still have to
17:54do something scientifically they have
17:56maybe a target or a new technique but
17:59they have to develop a small molecule
18:01and just you know do discovery I think
18:03what at least we're starting to see here
18:06is a shift towards more of these things
18:08being just pure engineering and that
18:10they can sort of get out the gate and
18:11and almost build startups enough sort of
18:14a fundamentally different way than you
18:16would maybe thirty years ago what
18:17happens in academia is you can you know
18:19make some significant advances you can
18:21get a proof of principle and animals
18:24let's say and you can even design
18:27prototypes but there's a lot of things
18:30you can't do I mean I don't think that
18:32the kind of large-scale manufacturing
18:33that ultimately needs to be done to
18:36create say a medical device or drug
18:39delivery system or or even you know this
18:42the synthesis or production of a large
18:44amount of a new pharmaceutical is going
18:47to be done in in academia similarly I
18:50don't think the clinical trials that
18:51need to be done are going to be done at
18:53least in the mi t--'s of the world
18:55there's almost a natural handoff where a
18:58lot of basic research without a timeline
19:01will happen in academia but then more
19:04applied or focused research will
19:07probably happen at a company with the
19:09goal of ultimately getting out products
19:10that can change people's lives and how
19:12do you see that handoff happening now is
19:14it a smooth process or is there still a
19:16lot of challenge and a lot of
19:18opportunities for mistakes and failure I
19:22like to think that when we do it it's
19:23it's reasonably smooth but there's
19:26always enormous mistakes that can be
19:28made and every story is different
19:29failure can happen anywhere and I wish
19:33we were smart enough to know you know
19:34sometimes value can come later with a
19:37clinical trial not working well
19:39sometimes failure comes because you
19:41don't have the right CEOs you know and I
19:43think that you know and they haven't
19:44done a good job of either in the
19:46organization or raising enough money you
19:49know sometimes it happens because you
19:52know of bad partnerships that are set up
19:54and you run into issues
19:56and hopefully you can solve them
19:57everywhere actually I mean there's
20:00almost no way that you can't mess up you
20:04know there's one other shift which is
20:05that academia is trying to be more and
20:07more translational and so I mean while
20:09there's been a Bob's real pioneer in
20:12this in terms of really pushing towards
20:13translation it's starting to become more
20:15common and and in almost incented which
20:18is I think a wonderful thing but also on
20:20the other side for the handoff there are
20:22more more incubators that are nice to
20:24bio incubators and I think it's that
20:26transition part that's really tricky and
20:28there's only so much you can do on each
20:30side and it must also be kind of like a
20:32culture moment like a weird yeah you
20:34know where people have to have a
20:35different mindset and now is the mindset
20:38shift kind of the difference between
20:40discovery to engineering at heart what's
20:43the mindset shift actually and sort of
20:46pure research you know there's an
20:47Einstein quote you know if we knew what
20:49we're doing we wouldn't call it a
20:50research and and the idea is that
20:52there's it's exploratory we just don't
20:55know and and so that can't be done on a
20:57timetable on a roadmap any of those
21:00things but then once it starts all
21:02clicking and I've seen this with people
21:04you know then you start realizing oh
21:06there's something really here right and
21:07and then the mindset changes if you
21:10really want to take it to the next step
21:11what happens in companies now can be
21:13much more engineering than pure
21:15discovery I think that's part of the
21:17shift I do think things are more
21:19translational if I go back to when I
21:21started you know doing this in you know
21:25early 80s that I think in academia it
21:30was somewhat frowned upon of getting
21:33involved with very translational work
21:36and applied work in context and I don't
21:38think that that's and I should say
21:40that's a lot less true today people see
21:42that there's been great value and I
21:45don't just mean monetary value in the
21:47fact that products and companies have
21:49come from you know really the basic
21:51research and now there are hundreds and
21:54hundreds of companies within just a few
21:56blocks of MIT and some of have market
21:59capitalizations and the hundreds of
22:02I'd love to shift gears a little bit and
22:03talk a bit about regulation having
22:06worked on the FDA science board the
22:09more than as is chairman and then also
22:12you know having been involved in
22:14startups and in academia how how did
22:17that change what you thought about the
22:19way regulation happens are there things
22:21that need to change I sort of see two
22:23pivotal time points for me looking at
22:25regulations the first thing was the AIDS
22:28epidemic and I think the eight you know
22:31the AIDS activists I think did a very
22:33good job of convincing the FDA that you
22:37know if they waited too long on some
22:39treatments to be ultra safe then you
22:43know patients would die in the meantime
22:44the second one that I think had a
22:47negative effect was the Vioxx situation
22:49in 2005 and you know there there was
22:53just a small increase in deaths with
22:55this drug but it was so many lawsuits
22:57over it that people that the FDA would
23:00get called on the carpet for approving
23:03it a lot of clinicians I know felt to
23:05take that off the market was wrong
23:07because it really would relieve
23:09suffering and pain that's very
23:10complicated because like I say the the
23:13increase in deaths was very very tiny
23:16whereas the decrease in pain was
23:18these have been sort of pivotal moments
23:20in some way for the FDA now I think it's
23:23it's hard to say you you have to find
23:25the right balance of safety and
23:28cautiousness on the one hand and yet
23:30really trying to get drugs out as fast
23:32as you can if people are dying and
23:33suffering on the other it's interesting
23:36that this concept of the Hippocratic
23:37oath that we want to do no harm is the
23:40guiding principle versus doing the most
23:42good and and I think do no harm make
23:45sense in a ancient Greek world where you
23:49know you understand so little about
23:51biology and health care and most of what
23:53they would do probably would be harmful
23:54create a lot of the solutions optimize
23:57what's best for the population is a kind
23:59of a different thing and there's
24:01different aspects of health care that I
24:02think as we get better at this it's
24:05interesting to even sort of I would say
24:07hold no sacred cows rethinks just how we
24:09think about health care broadly I mean I
24:11think Vijay you have this in term in
24:13this impacts how we think about
24:15everything from diagnosis to treatment
24:17right and as the possibilities shift
24:20towards what we can diagnose and the
24:23vention that we're thinking about how do
24:25how will that play out and yeah you
24:27thinking about regulation we usually
24:29don't talk about therapeutics in a sense
24:33of just trying to keep you healthy we
24:35talk about it as trying to avoid an
24:37indication avoid disease such as you
24:39know making sure you're avoiding getting
24:40type 2 diabetes versus a very different
24:43model where your healthcare
24:45professionals are trying to keep you
24:47right you probably couldn't even get it
24:49through FDA if you didn't have an
24:51indication like staying healthy longer
24:53it's not an indication yeah and so it's
24:56interesting as we see more things like
24:58and there is a longevity in areas of a
25:00prevention that it's an exciting time
25:03when we even just really fundamentally
25:04rethink how we can help people the most
25:07what advice would you have for startups
25:10as they start to think about when do you
25:12start thinking about regulation you want
25:14to start thinking about it early on what
25:16is the path that makes the most sense
25:17we created this aerosol company with
25:19David Edwards air which later became
25:22Civitas basically it all we did was
25:25change the geometry and we were able to
25:27go into clinical trials extremely fast
25:29because there was no you know basically
25:31no new chemistry even though I loved
25:34chemistry but that there we were able to
25:36get into the clinic within a year on
25:38multiple drugs another case was momento
25:41there we were able to lower the bar by
25:44creating a sort of a bio generic in this
25:46case heparin and and that also I think
25:49facilitated you know even though it was
25:52a brand new technology polysaccharide
25:54sequencing for the first time the drug
25:56we picked actually ended up making
25:59things happen faster the work we did
26:02with Henry Bram that Guildford Guildford
26:04initially commercialized invented a new
26:06polymer synthesized a new polymer but we
26:09picked brain cancer as a treatment and
26:11the FDA moved through that very quickly
26:14because that was a lethal disease and
26:16that systems now been used in over 30
26:18countries for the last 21 years what do
26:21you think will fundamentally change in
26:22the next 20 years and how we think about
26:24health care or medical treatment or even
26:27the way we do science
26:28I mentioned genetic medicines more
26:31personalized kinds of medicines I also
26:33think that one of the other exciting
26:36of Medicine and cell therapies of
26:38different kinds you know I think our you
26:41don't have the potential to be
26:42revolutionary we're starting to see cell
26:45based companies you know doing whether
26:48it's car t-cells or they're circulating
26:50red cells and then there's many
26:52companies doing regenerative medicine
26:53those those kinds of things I think at
26:56least over the next 20 years I think
26:57Kent can have a transformative effect on
27:00enabling therapies that you can't now do
27:02with single molecules I think it has to
27:04start with this shift in thinking and
27:06it's too easy to think well once you get
27:10to elderly points and you're 88 plus and
27:13you're going to get Alzheimer's then we
27:15deal with it we're gonna start to see
27:16drugs and some of them are associated
27:18with what we see people talking about
27:20with longevity but really it's not about
27:22living longer it's about just pushing
27:24back those problems further and further
27:27as such that we have a longer longer
27:29span where we're as healthy as possible
27:31what's the hardest problem that you want
27:34to see solved that credit crashed in the
27:36next era being able to make virtually
27:39any tissue or organ that to help
27:41patients and also the other aspect of
27:43that is that it could could
27:45revolutionize drug testing minimize you
27:47know killing animals and minimize
27:50testing on humans to the extent that we
27:52can make tissues their organs in a dish
27:54as authentic as possible we have so many
27:57new ways to read biology where the
28:00talmud genomics proteomics metabolomics
28:01all these different are new assays these
28:04new insights into into biology we didn't
28:07have before but that creates this new
28:09challenge of like what does it all mean
28:10and what can we do with it and once we
28:12understand something that doesn't mean
28:13we know what to do about it and then you
28:15know there's all the generalities and
28:17therapeutic modalities that will come up
28:19we were living in a great time because
28:21we're right at that point where we can
28:23do many things but yet there's still
28:25many things left to do to really truly
28:26have an impact on human health so we're
28:28not building 100 bridges to see what
28:30which ones fall down thank you so much
![How To Succeed As A NEW & YOUNG Realtor [Deals Every Month + Luxury Listings]](/_next/image?url=https%3A%2F%2Fi.ytimg.com%2Fvi%2FrtrRghgTayc%2Fhqdefault.jpg&w=3840&q=75)
