For an onstage conversation at Techonomy Bio 2015 about how science is advancing human progress around the world and where the greatest challenges still remain, Susan Desmond-Hellmann and Marc Benioff might seem an unlikely pair. She’s an oncologist accomplished in biotech, academia, and, now, the nonprofit sector as CEO of the Bill & Melinda Gates Foundation. Benioff is chairman of the customer relationship management software company Salesforce.com. But, as the two agreed here on Wednesday, more crossover between his sector—information technology—and hers—healthcare—are exactly what’s needed for great leaps forward in life sciences.
The duo are long-time collaborators. In her previous role as chancellor of the University of California, San Francisco, Desmond-Hellmann worked with Benioff to establish a children’s hospital with a $200 million gift he and his wife Lynne bestowed. And in the year since Desmond-Hellmann took the helm at the Gates Foundation, the UCSF Benioff Children’s Hospitals announced a $100 million 10-year global initiative, funded jointly by the Benioffs and the Gates, to address the epidemic of premature birth.
But on the topics of digital healthcare and bespoke medical treatments, Benioff and Desmond-Hellmann covered new territory, and agreed that more must be invested and done to advance the field. “There is a lot of exciting stuff happening in biotech and IT, and these two things are accelerating. We need to bring them together to get the next breakthrough,” said Benioff.
He and Desmond-Hellmann share frustration over the pace of the convergence. “The gap between … IT and life sciences is kind of pitiful,” Desmond-Hellmann said. “It feels like we’re just at the start of it, there’s so much more we can and should do.”
For instance, she drew a comparison between the shallow depth of biological information available to type 2 diabetes patients versus anyone’s ability to use Google map to easily navigate the world. Or, she noted, bank customers can deposit checks and move money without stepping foot in a bank, but “I have to go to a doctor to do everything.” Said Desmond-Hellmann, “When people see that what’s possible in daily life with IT is not possible with health it’s frustrating. Our best just isn’t good enough.”
While she hailed great advances in cancer product development and cancer immunotherapy—”we’re talking about amazing, magnificent cures for diseases we’ve never been able to touch before. … That’s real and patients are benefiting”—Desmond-Hellmann said it’s is tougher to determine the benefits of digital health yet to patients, society, or business models. “Is someone really making money at scale off digital health? Reasonable people can criticize digital health,” she said.
Benioff lamented a sector-wide lack of investment in data. Referring to Techonomy Bio speaker Richard Socher, CTO at MetaMind, Benioff said, “He is doing work in deep learning. … To take a series of scans like mammograms and to run them at scale and use his service to predict or guide or assist radiologists in determining what is on the screen they’re looking at is a very good use-case for data. But we can’t do it because we don’t have banks of standardized images that have been created in the right ways with the right level of annotation that gives us the ability to use very strong artificial intelligence and deep learning software that should give us predictive capability.”
Desmond-Hellmann said such situations make clear the need for more common languages in healthcare. “The importance of regulation and data elements and a common language can’t be overstated,” she said. “We have to have some common data elements just like the common elements that made the Internet possible. We have to have standardized data and lots of it and put it into shared databases. Even using the term ‘sharing’ is important to make precision medicine real.”
And both leaders agreed that interdisciplinary skills are more crucial now than ever. Desmond-Hellmann recalled that the term “interdisciplinary” once meant to her “dentists talking to doctors or nurses talking to pharmacists,” but said that today, “the kinds of questions that are important to me when I think of interdisciplinary are much broader and more powerful than the healthcare team.”
The pace of product development in healthcare is another great frustration for the Gates Foundation leader. Recalling her time as director of product development at Genentech, she noted the lag between the discovery of the HER2 oncogene in the late 1980s and Herceptin’s approval in the late 1990s. “I’m not that old, but doing the math, I could only see two more Herceptins in my lifetime,” she said. “That’s awful. That’s not good enough. It can’t be a 20-year horizon.”
Precision medicine and personalized cures hold promise for faster development, however. Desmond-Hellmann said, “Bespoke sounds expensive and futuristic. If you, like me, want to scale things, it sounds nearly impossible. But the work that Carl June [at Penn’s Perelman School] and others are doing to customize immunotherapy for cancer today is bespoke.”
“What if we make that a precision medicine remedy?” she asked. “It may be bespoke for a number of patients, or bespoke in that you manufacture in small cell cultures. But what if you could do it in vivo instead of ex vivo? What if I could do it in you?”
She explained: “The science of vaccines is using mammalian cells—Chinese hamster ovaries—as factories. What if, instead, I use your muscle as a factory? What if I inject a plasmid and you become your own factory for a vaccine? That’s not crazy.”
It’s a possibility that she said the Gates Foundation is interested in. “If you’re in a poor country and have an epidemic and you don’t have a vaccine ready, you wish you had a bespoke vaccine. We all know the flu vaccine this year wasn’t what we wanted it to be. What if instead of customizing a new vaccine every time you have a new pathogen, you could make a bespoke vaccine? When we had a new pathogen we could rapidly make a new one.”
The bottom line for Desmond-Hellmann: “Everything is possible if you can cure people. Everything about how we make, discover, innovate, and manufacture vaccines could be faster and more low cost.”