Podcast Summary: The Peter Attia Drive - Episode #346

Title: Scaling Biotech and Improving Global Health: Lessons from an Extraordinary Career in Medicine | Susan Desmond-Hellmann, M.D., M.P.H.

Host: Dr. Peter Attia
Guest: Dr. Susan Desmond-Hellmann
Release Date: April 28, 2025

Dr. Peter Attia welcomes Dr. Susan Desmond-Hellmann to The Peter Attia Drive, where they delve into Dr. Desmond-Hellmann's illustrious career spanning medicine, oncology, biotech, and global health leadership. The conversation traverses her early experiences during the AIDS crisis, her pivotal role in biotechnology with Genentech, her leadership at UCSF, and her tenure as CEO of the Bill and Melinda Gates Foundation. Additionally, they explore her perspectives on artificial intelligence (AI) in healthcare, the COVID-19 pandemic, and the broader challenges in public health.

1. Early Career and the AIDS Crisis

Dr. Desmond-Hellmann begins by recounting her upbringing in Reno, Nevada, and her medical training at the University of Nevada, followed by her residency in Internal Medicine at UCSF starting in 1982.

[04:17] Dr. Susan Desmond-Hellmann: "If you read MMWR, that's 1981 was the first indication. In 1982 we knew that there was something happening, especially to gay men... there was so much mystery still involved."

During her residency, she encountered the nascent AIDS epidemic, marked by unusual presentations like Kaposi's sarcoma (KS) and Pneumocystis pneumonia (PCP). The hospital protocols were stringent, mirroring precautions akin to handling Ebola patients.

[07:56] Dr. Susan Desmond-Hellmann: "Absolutely, absolutely."

The emotional toll was immense, with high mortality rates and widespread fear among medical staff. Dr. Desmond-Hellmann reflects on the profound sadness and the determination to aid patients despite the overwhelming challenges.

[25:04] Dr. Susan Desmond-Hellmann: "We had some grand adventures and played tennis, enjoyed friends. We did as much to keep our spirits up as one can."

2. Oncology and Biotech: From Private Practice to Genentech

After completing her residency, Dr. Desmond-Hellmann pursued a fellowship in oncology, driven by a mentor's compassion and intellect.

[09:00] Dr. Susan Desmond-Hellmann: "And after that, I had in my mind this bug about I wanted to be like him."

Her transition into oncology led her to private practice in Kentucky, where she initially felt disconnected from her previous academic environment. However, her expertise caught the attention of Bristol Myers Squibb (BMS), prompting a move to Genentech in 1995.

At Genentech, she was instrumental in the development and post-marketing surveillance of breakthrough cancer drugs like Taxol (paclitaxel) and Rituxan (rituximab).

[33:24] Dr. Susan Desmond-Hellmann: "So I started talking to the statisticians there about how I wanted them to program to get the data we needed for the safety label."

Her role involved ensuring the safety and efficacy of these drugs, navigating challenges such as severe neutropenia caused by Taxol and managing resistance to chemotherapy in various cancers.

3. Leadership at UCSF

Following her successful stint in biotech, Dr. Desmond-Hellmann took on the role of Chancellor at the University of California, San Francisco (UCSF). She focused on transforming UCSF into a leading medical institution by enhancing fundraising initiatives and fostering a culture of excellence.

[82:35] Dr. Susan Desmond-Hellmann: "And I think what resonated for me is that I could see both those points of view."

Her leadership emphasized strategic planning, efficient resource allocation, and maintaining strong relationships with donors and stakeholders.

4. CEO of the Bill and Melinda Gates Foundation

In 2013, Dr. Desmond-Hellmann transitioned to become the CEO of the Bill and Melinda Gates Foundation, overseeing initiatives in global health, development, and education. She leveraged her extensive background in medicine and leadership to drive impactful programs addressing diseases like HIV, TB, and malaria.

[90:05] Dr. Susan Desmond-Hellmann: "It's a couple thousand. It's a big foundation... there was a lot I wasn't surprised by, like, the global health stuff."

Her tenure focused on optimizing the foundation's portfolio management, enhancing operational efficiency, and ensuring that philanthropic efforts translated into tangible health outcomes worldwide.

5. Perspectives on AI and the Future of Healthcare

As a board member of OpenAI, Dr. Desmond-Hellmann discusses the transformative potential of AI in healthcare, particularly in clinical trials and drug development. She advocates for integrating AI to streamline processes, reduce timelines, and enhance the precision of medical research.

[113:27] Dr. Susan Desmond-Hellmann: "If you can make figuring out what you're gonna do much, much faster... it's a start, but I think it's great that they were recognized."

She emphasizes the importance of developing robust biomarkers and leveraging AI-driven models to predict treatment outcomes, thereby accelerating the pace of medical advancements.

6. Reflections on COVID-19 and Public Health Challenges

Addressing the COVID-19 pandemic, Dr. Desmond-Hellmann expresses profound concern over the mishandling of public health responses and the erosion of public trust in scientific institutions.

[101:35] Dr. Susan Desmond-Hellmann: "I am absolutely horrified... it's just weird. I don't get it."

She critiques the conflation of scientific expertise with advocacy roles, advocating for clear delineation to maintain objectivity and trust.

[102:57] Dr. Susan Desmond-Hellmann: "One of the things that I did... is having a broader set of people who we think of as the public health workforce."

Dr. Desmond-Hellmann underscores the necessity of inclusive public health strategies and transparent communication to combat misinformation and enhance pandemic preparedness.

7. Views on Public Health and Misinformation

Using the example of Ivermectin and its unfounded claims as a cancer cure, Dr. Desmond-Hellmann highlights the dangers of misinformation and the need for evidence-based medical communication.

[105:04] Dr. Susan Desmond-Hellmann: "The nature abhors a vacuum... you can't leave a vacuum."

She advocates for proactive engagement with misinformation, ensuring that accurate scientific information is disseminated to the public to counteract false narratives.

8. Conclusion

Dr. Desmond-Hellmann's journey from frontline medicine during the AIDS crisis to leading global health initiatives exemplifies a career dedicated to medical innovation, compassionate leadership, and the relentless pursuit of improving health outcomes. Her insights offer valuable lessons on navigating the complexities of healthcare, biotechnology, and global health governance.

[124:31] Dr. Susan Desmond-Hellmann: "It was fun. I'm delighted to talk with you. Really enjoyed it."

Dr. Peter Attia concludes by acknowledging Dr. Desmond-Hellmann's remarkable contributions and expressing gratitude for her participation.

Notable Quotes:

• Early Days in AIDS Crisis:

  [04:17] Dr. Susan Desmond-Hellmann: "There were fears about the residents and about contagion. But in San Francisco, there was such a wish to help the patients and such a good spirit about playing a role in helping that we all persevered."

• On Transition to Oncology:

  [09:00] Dr. Susan Desmond-Hellmann: "And when I was in Reno, at the Reno VA, I had an attending, Stephen Hall, and he was the oncologist who was teaching me about medicine."

• On Leadership Philosophy at UCSF:

  [82:35] Dr. Susan Desmond-Hellmann: "I think that the thing that I love to mentor... listening to students and hearing what's on their minds."

• On AI in Healthcare:

  [113:27] Dr. Susan Desmond-Hellmann: "If you can make figuring out what you're gonna do much, much faster... if you could just embed enough of the details about decisions that you can make that will make or break you."

• On Public Health and Misinformation:

  [105:04] Dr. Susan Desmond-Hellmann: "The nature abhors a vacuum. So if you say, I'm not going to kick off people... you can't leave a vacuum."

This comprehensive discussion with Dr. Susan Desmond-Hellmann offers profound insights into the intersection of medicine, biotechnology, leadership, and global health. Her experiences underscore the importance of scientific innovation, ethical leadership, and the imperative to address public health challenges with integrity and transparency.