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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.

Apr 28, 2025 2h 5m 30 insights
<p><a href="https://peterattiamd.com/susandesmondhellmann/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250428-pod-susandesmondhellmann&amp;utm_content=250428-pod-susandesmondhellmann-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250428-pod-susandesmondhellmann&amp;utm_content=250428-pod-susandesmondhellmann-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250428-pod-susandesmondhellmann&amp;utm_content=250428-pod-susandesmondhellmann-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Susan Desmond-Hellmann is a physician and scientist whose remarkable career has spanned clinical medicine, oncology, biotech innovation, and global health leadership. In this episode, Susan shares insights from her journey training in internal medicine during the early AIDS crisis, treating HIV-related cancers in Uganda, and developing groundbreaking cancer therapies like Herceptin and Avastin. She reflects on her leadership roles at UCSF and the Bill and Melinda Gates Foundation, offering lessons on guiding large-scale health initiatives, navigating uncertainty, and fostering scientific innovation. The conversation explores the promise of precision medicine, the integration of patient care and policy, and the evolving role of artificial intelligence in transforming diagnostics, drug development, and global access to care.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Susan's medical training, the start of the AIDS epidemic, and the transformative experiences that shaped her career [3:00];</li> <li>Susan's experience working on the frontlines of the HIV/AIDS crisis in Uganda [12:30];</li> <li>Susan's time working in general oncology and her transition to biotech where she helped develop taxol—a top-selling cancer drug [26:30];</li> <li>Genentech's origins, and its groundbreaking use of recombinant DNA to develop biologic drugs [33:45];</li> <li>Susan's move to Genentech, and her pivotal role in the development and success of Herceptin as a groundbreaking therapy in targeted oncology [44:00];</li> <li>The rise of antibody-based cancer therapies: the development of Rituxan and Avastin [52:15];</li> <li>The step-by-step drug development process and the scientific and strategic challenges involved [1:01:30];</li> <li>The ethical and economic controversy surrounding Avastin's high cost and limited survival benefit [1:12:30];</li> <li>Susan's tenure as chancellor at UCSF: leading during a financially strained period, and her strategic approach to fundraising and institutional development [1:14:45];</li> <li>What Susan learned as CEO of the Bill and Melinda Gates Foundation: strategic processes and decision-making frameworks [1:26:00];</li> <li>Susan's philosophy of leadership and how she sought to build an empowering, values-driven culture at the Gates Foundation [1:35:15];</li> <li>The erosion of public trust in science during COVID, the communication failures around controversial treatments like ivermectin, and the need for better public health engagement and transparency [1:39:30];</li> <li>The role of AI in transforming medicine: from drug development to cancer detection and beyond [1:53:00]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights

1. Separate Science and Advocacy

To maintain public trust during health crises, separate the roles of scientific communication (impartial reporting of facts) and public health advocacy (driving policy), as combining them can erode confidence.

2. Cultivate Empowering Culture

Strive to create a workplace culture where the atmosphere brings out the best in employees and empowers them with ownership to tweak the environment if it doesn’t meet that standard.

3. Uphold Ethical Values

Consistently uphold and vocalize core ethical principles and company values in all decision-making processes, even if not the primary decision-maker, to reinforce a strong and principled organizational culture.

4. Prioritize Self-Care, Avoid Martyrdom

To sustain well-being in demanding roles, avoid the mindset of martyrdom and actively prioritize self-care through breaks, travel, and social activities, ensuring spirits are kept up.

5. Lean Into Helping Others

When faced with overwhelming sadness or difficult situations, cope by actively ’leaning in’ to help others, finding joy and purpose in contributing to their well-being, even if it’s just providing comfort or a listening ear.

6. Develop Specific Biomarkers

Focus on developing specific biomarkers for disease subtypes, similar to viral load for HIV, to enable highly targeted clinical trials with fewer patients and more obvious clinical benefit from personalized remedies.

7. Streamline Trials with AI

Utilize AI to streamline the labor-intensive aspects of clinical trials, like report generation, to accelerate drug development and ensure that the time taken is focused on patient benefit rather than administrative tasks.

8. AI for Continuous Safety Monitoring

Use AI to enable continuous, ongoing safety monitoring for every patient on a drug, vastly expanding safety data beyond the limited scope of initial clinical trials.

9. Reduce Burnout with AI Tools

Implement AI-powered tools in healthcare to decrease the administrative and cognitive load on caregivers and families, aiming to reduce burnout and enhance the overall care experience.

10. Integrate Health Crisis Combat

To effectively combat global health crises, integrate epidemiology, direct patient care, and policy-making, as demonstrated by the lessons learned from treating HIV-related cancers in Uganda.

11. Balance Finance, Science, Culture

In leadership roles at health research institutions or global health initiatives, balance financial constraints with scientific progress and actively work on building a strong organizational culture.

12. Fundraise with Shared Excitement

To be an effective fundraiser, share your hopes and dreams, express genuine excitement about your mission, and actively ask potential donors about their passions to find common ground.

13. Build Trust Through Prudence

Cultivate a reputation for business acumen and a commitment to using resources wisely, as this builds trust with donors and stakeholders, particularly during difficult financial periods.

14. Fill Information Vacuums

Do not leave an information vacuum in public discourse; actively engage and provide factual information to prevent misinformation from taking root, especially on social media platforms.

15. Be Transparent About Science Changes

When scientific understanding evolves, be honest and open about what has changed and how, as this transparency is vital for building and maintaining public trust.

16. Coach and Support Team

In leadership, actively support team members during challenging interactions by offering non-verbal encouragement, subtly intervening to create space, and demonstrating a clear desire for their success.

17. Prioritize Colon, Prostate Screening

Advocate for and utilize effective screening and early detection methods for colon and prostate cancer, as these diseases are largely preventable and should not be among the leading causes of cancer death.

18. Utilize Proven Early Cancer Detection

Actively engage in proven early cancer detection methods such as colonoscopy, Pap smears (and HPV vaccination), and spiral CT scans for lung cancer to improve health outcomes.

19. Simplify Complex Medical Algorithms

Look for opportunities to simplify complex but effective medical algorithms, such as prostate cancer stratification, into user-friendly, turnkey solutions for both patients and physicians, potentially forming the basis of a new company.

20. Broaden Public Health Workforce

To improve public health efforts, broaden the definition of the public health workforce to include diverse individuals like farmers and community members who have direct experience with relevant issues.

21. Frame Health Universally

To gain broad support for public health initiatives, frame them around the universal desire for personal and family health, making the message real and accessible to everyone, not just an ‘ivory tower’ concept.

22. Establish Patient Registries

For new treatments, especially in novel areas, establish comprehensive patient registries to track long-term outcomes and safety, providing robust data for regulatory scrutiny and ongoing understanding.

23. Leverage Diverse Skills

Understand that skills gained from diverse academic backgrounds, such as epidemiology and biostatistics, can be highly valuable and transferable to other fields like drug development and clinical trials.

24. Develop Backup Strategies

When a primary career or research plan falls through, proactively seek alternative educational or professional paths, like pursuing a master’s degree, to ensure continuous progress and avoid wasted time.

25. Be Resourceful, Self-Teach Skills

When faced with a lack of resources, be resourceful by teaching yourself necessary skills, such as SAS programming, to overcome limitations and achieve your objectives.

26. Identify Career Enjoyment

Pay attention to early career experiences, like a chief residency, to identify what you truly enjoy, such as managing and helping people succeed, as this can be a strong indicator for future career paths.

27. Listen to Mentees, Value Serendipity

When mentoring, actively listen to students to understand their thoughts and remind them about the important role serendipity can play in shaping their career paths.

28. Attend Informal Science Talks

Make time to attend informal science talks or learning events, as this allows you to stay engaged with scientific progress and fosters a culture of continuous intellectual curiosity.

29. Understand Pharma Profit Motive

Recognize that pharmaceutical companies would eagerly pursue and patent any truly curative, broadly effective drug, as such an innovation would generate immense profits, countering claims of suppression.

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