Kirkpatrick: Mark and Sue, please join me onstage.  Sue Desmond-Hellmann is CEO of the Bill & Melinda Gates Foundation, which is the largest pool of capital ever assembled for philanthropy. Before being at the Gates Foundation, she was Chancellor of the University of California at San Francisco, UCSF, and helped create one of the greatest—turned it into a really great research university, some of whose faculty we saw earlier today, quite impressively.

Mark is Salesforce CEO, a good friend of Techonomy, and I’m really happy to turn it over to him to interview Sue.

Benioff: Okay. Thank you, David. And, what we’d like to do here, as I guess we’re batting cleanup here at the end, which David has had me do now twice in this conference. I don’t really know why …

Kirkpatrick: You’re not boring.

Benioff: I’m not boring. Right. So what we’re going to do is, we’re going to ask Sue a few questions, then try to turn it over to all of you to ask her a few questions.

Benioff: In the last panel, we heard this really kind of interesting comment, which was that it’s more important right now to tell Silicon Valley to work on elder care than on digital health. And it seemed to me like that was a very interesting juxtaposition. And I kind of understand where that comment is coming from, but what’s your perspective of that? Where are we today on digital health, and kind of the combining of my industry and your industry coming together? What is happening?

Desmond-Hellmann: Well, I understand the comment, and I think the spirit of the comment is that if you look at what’s really happening now, and the context of that comment was today, where there’s enormous debate in life sciences, is this about—

Benioff: They were also denigrating my Fitbit, which I did not appreciate.

Desmond-Hellmann: Yeah, which you’re wearing.

Benioff: Yeah.

Desmond-Hellmann: But right now, there’s a lot of talk about whether or not we’re in a bubble. And inarguably, on the therapeutic side, if you look at therapeutics and my area in cancer product development, with cancer immunotherapy that was talked about in that panel as well, it is so exciting. And we’re talking about cures! We’re talking about amazing, magnificent cures for diseases we’ve never been able to touch before. And so the advances in hepatitis, the advances in cancer, the serious advances in things—rheumatic diseases—these are real, and patients are benefiting. So that doesn’t feel like a bubble. On the other hand, in the digital health area, there’s a lot of talk, a lot of companies, and in terms of either really clear benefit to people who aren’t sick or people who are sick—so, either patient benefit or societal benefit, or frankly business model—is somebody really making money at scale off digital health? It just feels a lot harder.

So, I think that reasonable people can criticize digital health. My friend Bob Wachter, who I know you know, just wrote an Op-Ed in the New York Times. And what Bob talked about was how much clinicians in the hospital hate electronic health records. And, there’s famous cartoons where the doctor is shown with a parent there, and the doctor turned the other way, typing frantically in the computer, not looking at the child or the parent. So, electronic health records haven’t brought a lot of—

Benioff: Not at UCSF, I hope.

Desmond-Hellmann: Never at UCSF, you and I know that. But the electronic health records haven’t yet demonstrated the promise all of us hoped for.

Benioff: Yes. Is that the problem, though, is that we think about digital health as EMR, when it’s really not? When, you know, we really are at an incredible threshold with the whole concept of data. And we just haven’t invested enough—whether it’s at UCSF or probably maybe any institution that I know—in data. I know there was a speaker this morning, Richard Socher, who is doing very exciting work in deep learning, and he wanted to be able to take a series of scans—it could be mammograms, it could be, you know, some other type of image, and be able to kind of run those images at scale, and be able to use his service to predict, or to guide, or assist a radiologist in determining what was on the screen that they were looking at. You know, very good use case, actually, for data.

Desmond-Hellmann: Yes.

Benioff: And we can’t do it, because we don’t have banks of standardized images that have been created in specialized ways with the right level of annotation that gives us the ability to use what is very strong artificial intelligence deep learning software that should give us this predictive capability, but we can’t do it. So is the issue data? Is the issue that we’re too—we were very EMR-centric—what are we looking at?

Desmond-Hellmann: Well, I think there’s a couple of things that came through today really clearly. One is that we have to have some shared understanding of the data elements. We have to have some common data elements just like the kinds of common data elements that have made the Internet possible. We have to have those elements and a global alliance for precision medicine is now starting to look at data and the way we put data in databases, so I think some of that language issue—

Benioff: We’re not going to have precision medicine without standardized data, right?

Desmond-Hellmann: We have to have standardized data, and—

Benioff: And lots of it.

Desmond-Hellmann: Lots of standardized data, put into shared databases, and even using the term “sharing” is something that increasingly is important in to make precision medicine become real. But I think there’s another thing, and that is the regulatory underpinnings of this. What we need to protect the quality and the believability and the confidence people have in health, while balancing something that came up in the issue about who owns your data.

Benioff: Right.

Desmond-Hellmann: It’s my data—

Benioff: Sure.

Desmond-Hellmann: But when you make a claim that you can teach me something about my data, that’s regulated.

Benioff: Sure.

Desmond-Hellmann: So the importance of regulation, and data elements, and a common language can’t be overstated.

Benioff: And there’s one other element, actually, which is like, you know, when someone like Richard, who has this platform, goes to an institution like UCSF and UCSF either takes—you know, you go to prostate cancer, and they have all these rectal ultrasounds, but then they also have all this pathology, okay? And this type of technology can work on either one. Now you run the server, it looks at all this, it comes up with a conclusion, “Oh, you guys haven’t really checked this, look at this, when this happens, then that’s true”—who owns that?

Desmond-Hellmann: Right.

Benioff: I mean, that’s a third construct that is, we’re creating new data.

Desmond-Hellmann: Right, right. And making sure that that’s valuable, because in the end, an entrepreneur needs something to sell. So is there value in diagnostics, is there value in data analysis, is there value in connecting those dots? And looking at different ways that people can create that value? Having a regulatory system and a payment system that will pay for that value is part of it.

Benioff: So when we talk about precision medicine, does that also need to include this conversation on data as well?

Desmond-Hellmann: It must include the conversation on data.

Benioff: Because it does feel like sometimes when we talk about precision medicine, we default into genomics.

Desmond-Hellmann: Yes.

Benioff: And we’re not circling in all the other aspects that precision medicine is going to really require, which is a lot of other data sets besides the genomic data sets.

Desmond-Hellman: That’s right. Well, one of the most powerful things that I think all of us see in medicine—and the speaker who was here before you and I was talking about mental health. I was happy to co-chair the National Academy of Sciences report on precision medicine in 2010 with Charles Sawyers from Memorial Sloan Kettering, and what Charles and I did with our committee is: we talked about all the data elements, including behavioral science, so people really being able to look at behavior, environment, using mapping. Mapping is an incredibly powerful tool that we underuse in medicine. And so when you take all those things together with genomics—because people hear “precision medicine” and think “genetics” or “genomics,” but it’s the entire panoply of it.

Benioff: We saw, we saw that with Apple’s health kit announcement or their research kit, or whatever they call it, where they’re generating all this new data—

Desmond-Hellman: Right.

Benioff: —based on the apps that are running on mobile devices that are profiling people in real time, so people might not even know. They’re walking around with their phone, and their physical and mental health is being profiled.

Desmond-Hellman: Right. No, it’s—

Benioff: That’s quite unusual.

Desmond-Hellmann: It is both powerful and scary. I learned something about data in Silicon Valley that made me smile. So, as part of working at the Gates Foundation, we were asked to help out with Ebola. Really scary, really tremendously big challenge that remains a huge challenge to West Africa and was thought for a while to be a potential challenge for the globe. And so I talked to a lot of my friends in Silicon Valley about what was needed. And one of the key things we needed was improved systems globally for disease surveillance.

Benioff: Right.

Desmond-Hellmann: Well, if you’re in Silicon Valley, you don’t want to use the world “surveillance” after NSA. So I started to call it “disease tracking.” So “disease tracking” is what we need help with, and that is using all these systems to look at where index cases of important epidemics happen.

Benioff: But again, that’s just one data—

Desmond-Hellmann: One asset called data.

Benioff: That’s just one spoke on the wheel, right?

Desmond-Hellmann: Right.

Benioff: Because there’s genomics, there’s proteomics, there’s the labs, pathology. It’s the scans, the images. I mean, we could keep going down on and on and on. And all these data sets today do not really take into consideration that one day there would be advancements on the information sciences.

Desmond-Hellmann: Right.

Benioff: And I keep saying that, I think, pretty soon, we’re going to see that information scientists are the ones who are going to really start to have the big breakthroughs on the biological sciences. Do you think that’s going to—is that true, do you think, or do you think that we’re not at that point?

Desmond-Hellmann: Oh, I think we’re at that point and more. Today, the immense power that a clinician, that a researcher, or that an educator has in using data—if I compare now to when I went to medical school, it’s unbelievable how much you can learn on the fly about anything. I can be literally in the middle of Ethiopia, and I can use Google Scholar, and I can look up something, and in an incredibly powerful way, I can learn that, I can apply that, I can ask the right questions. When I was in medical school, I mean, we didn’t know half of the molecular biology that’s known today. And I would go to the library and find a book, which I now realize was all outdated the day I looked at it in text. So, the information cycle, the information turns we can use, and part of that is how we learn, how we communicate, how we collaborate, are all vastly different and changing and improving all the time. It’s exciting to see that and it’s exciting to see the kind of things that we saw today. And I think the most powerful thing, and it’s evidence by some people making connections here, is when you hear something and a lightbulb goes off because you didn’t know until you saw online or connecting with people, what was possible in a different space.

Benioff: Yeah. Now, you’re really—

Desmond-Hellmann: That’s all of that data.

Benioff: Well, you’re really hitting that, to make these advancements happen, we need a much greater interdisciplinary skill set than ever before.

Desmond-Hellmann: In ways that—until I started a year ago at the Gates Foundation, even at UCSF when I talked about interdisciplinary, it was the dentists talking to the doctors, or the nurses talking to the pharmacists. Now, for me, interdisciplinary is: “I really want to understand people who think about roads. I want to think about city planning. How do you decide how streets are laid out? How do you decide where farms are?” The kinds of questions that are important to me now. And when I think of interdisciplinary, it is much broader and more powerful than the healthcare chain, which is powerful in and of itself.

Benioff: Now there’s a juxtaposition against that, because we had talked about what Carl June has done with this kind of T-cell therapy. What that potentially could do. That’s still not primetime, right? It’s still pretty bespoke. You know, I think about my own world at Salesforce, we had three employees die last year of glioblastomas. When you get that phone call, you know—at UCSF, we have a great program with Mitch Berger, and it’s great to refer somebody into the best care possible. But that’s a diagnosis that you just don’t want today. And maybe that T-cell therapy will get there on that diagnosis, but today that’s not where we are.

Desmond-Hellmann: So here’s the thing I’m excited about, and let me tell you a rich-world application and a poor-world application. So you used the word “bespoke.”

Benioff: Yes.

Desmond-Hellmann: And that’s a word that sounds expensive, that sounds futuristic, and if you, like me, want to scale things, it sounds nearly impossible. But the work that was cited before that Carl June and others are doing to customize immunotherapy for cancer, today is bespoke, but what I like about being able to cure people is, everything’s possible if you can cure people. So it’s bespoke today but what if we make that a precision medicine remedy? Well, it may be bespoke for a number of patients. It may be bespoke in the way that you have to manufacture it in small, little cell cultures, but what if you could do that and instead of doing it ex-vivo, what if you could do it in-vivo? What if I could do it in you?

So, it’s bespoke if it has to be done in ways that are manufacturing, and the way we do it now is more a research tool than something you do every day. It’s the difference between doing a bone marrow transplant and an autologous stem-cell transplant. That was incredibly difficult, incredibly expensive. It’s still expensive and difficult, but it can be done at scale. And it’s done globally now. So I think the things that are being done in cancer immunotherapy, while bespoke, and special, and precise, could be scalable—and should be scalable. And if the cure rates are what I hope they’ll be, they will be scalable.

Benioff: Now, is that a 10-year vision, or a 20-year vision, or a 30-year vision? Where are we?

Desmond-Hellmann: Oh, I think it’s a 10-year vision. I think this is—we’re on the brink in cancer immunotherapy—

Benioff: Because it’s been 40 years of molecular biology, and we haven’t had that breakthrough yet.

Desmond-Hellmann: It’s been 40 years in the desert, so I think it’s good to be skeptical but there are human beings today who I never thought we would be talking about—lung cancer, some of the most difficult leukemias—where the results are nothing less than spectacular. So I think that it isn’t my opinion, not hype. Now talk about a poor country. So, if you’re in a poor country, and you have an epidemic, and you don’t have a vaccine ready, you wish you had a bespoke vaccine. Right? We all know the flu vaccine this year wasn’t what we wanted it to be. What if instead of customizing a vaccine every single time we have a new pathogen, what if you could make bespoke vaccines, because vaccine technology, vaccinology, was such that when we have a new pathogen, we could rapidly make a new one. So everything about how we make, discover, innovate, and manufacture vaccines could be faster and more low-cost. Now, that’s today “bespoke,” but if you do that at scale, what Ebola taught us and what the threat of global pandemic flu teaches us over and over again, is we need to have more rapid product development. And it’s bespoke in the sense that each pathogen is different.

Benioff: So is that what’s slowing us down, is it this product cycle just is not fast enough?

Desmond-Hellmann: The product cycle is way too slow.

Benioff: I mean, you know that, right, from your time at—

Desmond-Hellmann: —at Genentech we learned that. I gave a talk to people right before I left Genentech and I was serious, knowing that I was going to go back to academia, the talk was about Herceptin. And the talk was about Bishop and Varmus, the discovery of HER2, the oncogene, Dennis Slamon’s work that he published in the late ’80s. And we had Herceptin approved in the late ’90s. So, doing the math, you know, I’m not that old, but I could see two more Herceptins in my lifetime.

Benioff: Right.

Desmond-Hellmann: That’s awful! That’s not good enough.

Benioff: Right.

Desmond-Hellmann: It can’t be a 20-year horizon!

Benioff: Well, you have a similar story with Avastin as well, right? I mean that’s one of your great success stories from Genentech.

Desmond-Hellmann: It has to go faster. It has to go faster.

Kirkpatrick: Concretely, what are you doing at the Gates Foundation about that? I think I’d like to just hear specifically things that maybe you’ve put additional emphasis on since you’ve got there, or—talk about the Foundation’s actual work right now.

Desmond-Hellmann: So, the Foundation has got three major areas of focus. One, that you read about a lot in the US, which is US education. We do education K through 12, and post-secondary, only in the US The second one is global health, what you would normally at a company call R&D. All about innovation. And the third is global development. And so, global development is getting that last kilometer, getting that last hundred kilometers. For example, our polio eradication program is in global development. We have a vaccine, we have two vaccines that work. We just need to get them to people. So what we’re doing in a tangible way to solve these problems—we love vaccines. For poor people, vaccines are a beautiful thing. For the globe, vaccines are a beautiful thing. They have a great return on investment, they’re very cost effective—

Benioff: Evidently in Marin County, though, vaccines are not a beautiful thing [LAUGHTER].

Desmond-Hellmann: Well, we can talk about that. So, we’re investing in companies, we’re investing in companies that are using RNA in completely new ways. We’re investing in companies that I’m really excited about, where you say, “Gee, Recombinant DNA technology and the science of biotechnology requires big factories like Genentech’s factory out in Vacaville. Or Amgen’s factories in Thousand Oaks.” Well, the science of biotechnology is using mammalian cells as factories—Chinese hamster ovaries. Why can’t I use your muscle as a factory? So, instead of ex-vivo, making a product, what if I inject a plasmid, and you become your own factory for a vaccine? That’s not crazy. So we’re really interested in scalable, novel ways to look at rapid turnaround-and what if you skipped the entire ex-vivo process?

Kirkpatrick: Right.

Benioff: So is this the next generation of the Gates Foundation that you see yourself doing this type of funding?

Desmond-Hellmann: So we’re now, increasingly, we have two different areas in the Gates Foundation that I think are under-recognized in R&D. One is product development partnerships. So, we’ll partner with anyone from a tiny lab in academia where something great is going on, to GlaxoSmithKline and Sanofi and Merck. Because we really care about great product development that’s solving problems in vaccine development.

We’re collaborating with a number of diagnostic companies. Diagnostics are a huge, huge problem globally. I would say they’re a problem in rich countries as well as poor countries. What’s a scalable, rapid throughput diagnostic approach? And then we have product development investments. So, we’re actually investing in companies, and just made a big investment in a company to look at a completely novel way of understanding the immune system. So, if we have insights into immunology, we could make better vaccines. If you take a three-dose vaccine and make it into two doses, that’s an extraordinarily powerful thing for compliance. So those are the kinds of investments you’ll see the Gates Foundation make.

Kirkpatrick: The Gates Foundation also does a bunch of other stuff, and you were talking before about thinking holistically. Is there any way you’re sort of trying to think of the healthcare work of the Gates Foundation in combination with, or, kind of mashed up with the work in education and other things, or is that just sort of a stupid question?

Desmond-Hellmann: No, it’s not a stupid question at all. One of the most powerful things that I’ve recognized since being at the Foundation is how much across the various projects we have, there’s shared learning. So, I’ll give you an example. We have a huge investment in global agriculture at the Gates Foundation. We invest in smallholder farmers and the vision is to double farm productivity, so Africa could feed itself.

That’s a great vision. That’s a really great vision, and that’s a powerful thing. We have a big nutrition program, because we don’t want children to go hungry, to die, or to have stunting. And have less opportunity in their life as a result of malnutrition. And we have a maternal and child health program that thinks about things like breastfeeding. So, for those projects to work across—

Benioff: And preterm birth.

Desmond-Hellmann: And we have a huge investment in preterm birth, with Marc and Lynne. There are so many learnings that one project has that are applicable to another. So, I heard about something today that I thought, there’s an opportunity. So we have a water sanitation and hygiene program, and part of our water sanitation and hygiene program is attempting to do something we’ve seen with cellphones. So, most people in poor countries never had a landline. There was a leapfrogging right straight to cellphones. People skipped landlines in sub-Saharan Africa largely. So most poor cities don’t have sewer systems. So, we would love to see a leapfrogging, so that countries go from cities that are just horrible—and all of us have been in those very poor cities that don’t have sewer systems. If we invest in toilet and processor technology, what if you leapfrog the sewer system and have Omni Processors that process human waste, and come up with renewables? Well, what I thought about today is, what if you could make a brick out of that?

Kirkpatrick: Ah!

Desmond-Hellmann: Maybe there’s something there. I’m actually, I’m not kidding, these bio-bricks were really interesting to me. So, there’s a lot of things that are going on that I think people in Silicon Valley don’t hear about. Problems that we’re trying to solve that are really basic: water, sanitation, vaccines, the opportunity for a woman to have access to modern family planning. Our goal is 120 million more women will have access to modern contraception by 2020.

Kirkpatrick: Wow.

Desmond-Hellmann: So all of these are problems we’re working on, but the people who we’re trying to serve make less than $1.25 a day. So the solutions have to be appropriate and scalable for people who meet that criteria.

Kirkpatrick: I definitely want to hear from the audience, but I wanted to ask you, Marc, explain the thing you just described before, this maternal thing, and how—is that something part of UCSF that you’re now working with Gates, or is that something separate? And I’d also like you to explain why it is that you got so excited about UCSF when she was running it, that you made some of the biggest philanthropic gifts ever in healthcare, or in almost any field? You know, 200 million dollar gifts. Talk a little bit about why this area engages you, and what you’re doing in it.

Benioff: Well, I read the New Yorker magazine, and there’s this great writer, Atul Gawande, I’m sure everyone has read his articles. And he wrote a great article called “Slow Ideas,” which basically talked about how we know a lot about how to deal with preterm birth. If a preterm birth happens, we know how to increase survival rates. We don’t know a lot about why preterm birth happens—which is amazing. The Gates Foundation has done an amazing job in one huge contribution to the whole world, which is the number of kids that die under five years old has been dramatically reduced.

Desmond-Hellmann: It’s gone down by half.

Kirkpatrick: Because of immunization, mostly.

Benioff: From twelve to six.

Desmond-Hellmann: Yes.

Benioff: So, from twelve million to six million. Of the six million, about half of those that die, I think—I might not have the data exactly right—are in the preterm birth category. So, you know, I put those two things together, where I’m reading the article, I’m also listening to Bill and Melinda and reading their reports and I’m like, why are we not working on this three million?

So, I had a conversation with Bill about it, and he was not as interested, so I appealed to Melinda [LAUGHTER] and she was very interested in it. And I said, I’ll put up $50 million, you put up $50 million, and we’ll create the first global preterm birth center at UCSF.

Kirkpatrick: Wow.

Benioff: There’s never been a global preterm birth center—

Kirkpatrick: What a nice synthesis of things.

Benioff: Well, there’s never been a global preterm birth center before in the world. Which is kind of this bizarre thing to me, that, you know—what happens is, even at UCSF, if your child is born preterm, they take you, as the parent, they put you in the NICU, they take your shirt off and put your child on your chest, and that’s called kangaroo care. But kangaroo care, that seems pretty simple, pretty low-tech, but dramatically increases survival rates. The child kind of feels the epigenetics or whatever the thing is [LAUGHTER], you know—

Desmond-Hellmann: He’s good.

Benioff: Whatever happens, you know—

Desmond-Hellmann: That’s good—epigenetics!

Benioff: Whatever you’ve taught me. But, you know, all of a sudden, the child’s like, “Oh, I have a reason to survive, I’ve got somebody protecting me, and I’m going to go for it.” So, that’s one thing we don’t even do that well with kangaroo care in the United States, much less in the parts of the world where she and her husband spend a huge amount of time. And you take that, or you take steroids—the other thing they’re going to do is, if you’re about to have a preterm birth, they’re going to shoot you with some steroids to develop the baby’s lungs. That’s another huge survival opportunity.

And that is something that’s not well done in the United States and hard to get those steroids out into the field, the last mile, all the great things that Gates has done. How do we get those steroids out in stocks so that there’s ready to go if there’s a preterm birth? Now, there’s a lot of other issues on preterm birth survival rates and then cost of and implications of children who come out of a preterm birth situation. That’s a whole other track. We’re just talking about getting through, and increasing the survival rates, and creating that healthy child.

Number three is, now, we don’t know why preterm birth happens. So how about this thing called research? Which our federal government seems to have a lot of problems doing, by cutting back NIH, cutting back NSF. Sue was just at the White House with the president, talking about all the cuts that have happened over the last three or four administrations, just in basic research. So, it’s the role of philanthropists to come in and to say, “Okay, let’s do some basic research now, just on this.” And if we want to drive—and I think Bill Gates’s and Melinda Gates’s vision of driving down the death rates of children under five years old is very worthy. And so here’s this next piece. So that’s how that—I’d already put in the money with Sue on the children’s hospital. That’s now up and operational in San Francisco. We have the second one underway in Oakland. This is the third piece. The total program is $250 million dollars. But the third piece is preterm birth, which I think is a really key piece, and it’s coming out of what we’re talking about. Now there’s a lot of other things—

Desmond-Hellmann: What’s nice is that what Marc and Lynne and Bill and Melinda enabled is really a first of its kind program that looks at preterm birth as a global issue. So, it’s an issue in Oakland, it’s an issue—the UCSF children’s hospital in Oakland—

Benioff Oh, it’s a huge issue in Oakland. It’s a huge issue in every—

Desmond-Hellmann: —in every community in America. It’s an issue. And it’s an issue in poor countries. So thinking about the different environments that you’re operating in as a clinician or a researcher, and really looking at the biology of preterm birth, which is poorly understood, is a huge opportunity.

Kirkpatrick: Well, that was more interesting than I even expected.

Benioff: Thank you, David [LAUGHTER]

Kirkpatrick: Go ahead, let’s hear some audience people.

Timpson: Theral Timpson of Mendelspod. Marc, is this an interview strategy, or are you really this down on bio?

Benioff: What’s that?

Kirkpatrick: You mean up?

Benioff: Oh, when I was challenging her?

Timpson: Right.

Benioff: You know, I challenged her because, look, the reality is there’s a lot of exciting things that are happening—

Kirkpatrick: Was this in a different session?

Benioff: Just right now. You know, the reality is that, number one, there is a lot of exciting stuff happening in biotech, and in information technology. And these two things are accelerating. So we have a huge acceleration in tech, period—bio, information, whatever. Okay. And what we want is those—in my opinion, what needs to happen is we want those two things to come together a little bit more so that we get that breakthrough. You know, just going out and getting your gene sequenced is not necessarily going to help you live a longer, healthier life, right? Am I right?

Desmond-Hellmann: You know, I think that—right.

Benioff: Have you had your genes sequenced?

Desmond-Hellmann: I have not had my genes sequenced.

Benioff: You have not had your genes sequenced? So here she is—you know, she has not had her genes sequenced. That’s a pretty big statement.

Desmond-Hellmann: And I’m here to tell the story.

Benioff: So—but let me finish. [LAUGHTER] I have to answer the question.

Desmond-Hellmann: I know you do. I’m waiting to hear the answer.

Benioff: And the point is that information technology and biotechnology have made huge strides and gains over the last three or four decades. We need to bring those two sciences together I think to get to the next big breakthrough. That was my kind of take on where digital health actually I think is the link. But the reality is that in the big killers in the United States—and if you go to UCSF and you end up at, in prostate cancer, in brain cancer, in breast cancer, you know, we’re getting modest increases in survivability in some of these things, but we’re still waiting for the big leap forward where we have the commercial application where we can say, or Sue can say, when you walk in, “Oh yeah, here’s the great new T-cell therapy on glioblastoma”—you know, she said in HER2, you get in HER2, we’re still—yes, she did a great job with that drug that she went through, okay? But the HER2 world is not where you want to be today, and we haven’t had that breakthrough.

So that’s where I’m like just in reality that, as someone who has a large employee base—and I get calls every single day, this employee has this issue or that issue or whatever. The reality is that, hey, we have some great treatment. There’s no place you’d rather be than UCSF, believe me, on all those three cancers specifically, because of the work she did. But the reality is we’re still waiting—

Desmond-Hellmann: But it’s not good enough.

Benioff: It’s not good enough and we’re still waiting for the big breakthroughs. And I hope she’s right that she turns my body into a lab and I’m going to start spitting out, you know, God knows what. But we’re not completely—we’re not totally there. That’s my point.

Desmond-Hellmann: But I actually think—I think Marc’s skepticism is appropriate—

Benioff: And I think information technology is the answer. Okay.

Desmond-Hellmann: So because I’ve spent so much time on precision medicine, I think the gap between where we are and where Marc is pushing us—which is why I’ve always loved working with Marc, because he’s pushing us—is twofold. One is this link between information technology and life sciences is kind of pitiful. I mean it just feels like we’re just at the start of it but we have so much more that we can do and should do. And when I was writing the precision medicine report, I made the—the difference between thinking about a patient with type 2 diabetes today and what we can tell them about our deep understanding of the biology versus my ability to use Google Maps when I come out of BART and want to walk anywhere in San Francisco and it’s constantly adjusted and updated and everything else. It just makes me crazy. Or that I don’t have to go to a bank, but I have to go to the doctor to do everything. So those two worlds are just—I think when people see what’s possible in daily life with information technology that’s not possible in health, it’s frustrating. And even more frustrating when you’re somebody like Marc, who cares deeply about his employees. And if you’ve had a couple of employees with a brain cancer, it’s staring you in the face that our best just isn’t good enough.

Benioff: Another example is, let’s say you go in and, you know, you’re a woman getting your normal mammogram treatment. The first thing they have to do is—or the doctor is probably going to say to you, at UCSF or someplace else, “I know the perfect radiologist to bring in on this.” Have you ever heard that phrase before?

Desmond-Hellmann: Yes.

Benioff: “Oh, I’ve got the person who’s going to really read the scan, don’t worry. Oh, you have the CT scan? I’ve got the person to bring in the scan.” That is pretty crazy in 2015, in my opinion, based on what we know about the information sciences, that we still have lexicons like that in major universities. I think that that is where the big advancements can come. And that’s on my mind. It’s weird, I think. Really weird.

Weiser: Hi, I’m Diane Weiser with W2O Group. I actually had the pleasure of working with Sue and her team on the public relations launch of Avastin. So it’s great to see you. But just on the personalized medicine front, I’m interested in your take on Roche’s recent investment in Foundation Medicine and if you think that is the convergence that we’re looking for in terms of the genomics side and the pharma-biotech side. Did they get that right? Are we going to see more of that, and what does that future look like?

Desmond-Hellmann: Well, I can’t say what was behind the scenes at Roche because I’m not at Genentech anymore. But I think that what you see with companies like Roche and their investment in Foundation Medicine is the recognition that the best medicine in the future will all be precision medicine, so that you have access to the best possible information about the drivers of that person’s illness, about what you’d like to dial up and down at scale. And particularly in cancer this is true, but increasingly it’s true beyond cancer, and that any patient, any clinician, any care team will want as much information as possible on the precise nature of that illness and what that patient needs, the right therapy at the right time, and in combination and adjusted up and down. And so I think when you look at the companies that do that well, they deal with complexity, they deal with data, and they have a feedback loop, which is really hard to do in real life in the clinic, that is just on time for the clinician for decision making. Because if it’s not actionable, it may as well not even be there. It doesn’t matter if it’s not actionable.

Benioff: Let me give you a story on that specific topic, which is that I have a friend of mine who has brain cancer, he has a glioblastoma, and he’s had surgery twice to reduce the size of the tumor. And on the second time—he’s being operated on in a rural hospital. I said to the neurosurgeon—who’s a very good neurosurgeon who actually graduated from UCSF, which is—I found the surgeon for my friend. And I said, “Okay, well are we going to type this cancer?” So when we basically said she hasn’t sequenced her genes, but sequencing cancer is pretty cool. And by the way, how did we get to where we are with Ebola? We sequenced it, which was the Broad folk’s sequence. They used that sequencing technology to figure out what was going on with Ebola. So the sequencing technology is amazing. And then I said, “Why don’t we get Foundation Medicine to sequence your cancer and see what’s going on?” And I had to push and prod and be the patient advocate that Sue would say that I had to be for my friend, and got Foundation Medicine to sequence his cancer, and we found a marker that we can do exactly what she said, dial up—we don’t need it yet, thank God, but at some point in the future, he’s going to have a life extension because of a biomarker that we found that we know that we can adjust with an FDA approved product. So that is why I think companies like Foundation Medicine and other companies that are doing that type of sequencing work on cancers is very important.

Jorgensen: Hi, Ellen Jorgensen from Genspace Community Bio Lab. There’s been a lot of talk recently about how one of the things that slows down the pace of biomedical research is that the current systems don’t reward people for sharing data in real time, so the IP system, tenure systems. Is the Gates Foundation doing anything—first of all, do you think that is a real problem, and second of all, is the Gates Foundation doing anything about that?

Desmond-Hellmann: Yes, and we recently announced we have an open access publication policy that we’ve just put in place, so we’re giving people a glide path, but we definitely both believe in open access, and then when we make investments, we also are looking to the people we’re funding to make sure that, if they have tiered pricing strategies or low cost for poor countries, that we can use that. One of the really beautiful things is the use of new tools. So one of my favorite tools is a volume guarantee, so if someone’s making a new vaccine and they can get it at a certain cost and quality, we’ll backstop them, so we’ll say we’ll use our capital to insure them. We think it’ll get bought by countries and ministries of health and the like, but we can actually guarantee that. So not only sharing data, your point, but anything we can do to get products and product development done for the poor at scale, that’s in our wheelhouse.

Kirkpatrick: I have to ask something about that. Is it pathetic that a private philanthropy has to be in the position of doing that? Why shouldn’t governments be doing that? I mean wouldn’t we be better off if we had governments that figured that stuff out and were actually doing it at a global—well, the UN should be doing that, right? I mean it’s a great thing the Gates Foundation exists, but—

Desmond-Hellmann: Everything we do is in collaboration, so we often do funding—the countries where we’ve worked in most successfully, I’ll give you two examples, India and Ethiopia. We’re working very closely with the government, with the ministries, and with the states. In India, you know, it’s not one country. We’re working in Bihar and Uttar Pradesh. With those states, there’s about 300 million people living in poverty. So we definitely work with governments. We work with ministries of health. What we’re trying to solve is often—and in those cases, it’s not a government failure; it’s a market failure. So the markets don’t work when people can’t see a return on investment. So if we can use our capital to create the conditions where the markets can work, we think that’s a scalable solution, but we do that, in the best cases, in collaboration with government.

Benioff: And I think that government’s role in basic research cannot be overstated. That’s number one, that our government needs to step it way up on NIH and NSF funding. These thing are mission critical for my industry, for her industry, and our company would not exist without the basic research that happened 30, 40 years ago sponsored by the federal government.

Kirkpatrick: On the Internet—you mean to create the Internet?

Benioff: Yes. And also the US government has done—and that’s why we have great universities here. But that’s not true for all countries. You know, the United States, this is pretty unique that the United States has funded so much research. If you go around the world you’re not going to see—I don’t know, which country would you say is number two in terms of the amount of basic research that’s been done?

Desmond-Hellmann: Well, traditionally, the UK has been a terrific supporter of basic research. But keep your eye on China.

A: Good evening, Marc and Sue. My name is Vince from Design Innovators. My question is, Marc, as you have such a deep caring personality, what is one thing you can actually be a role of philanthropic person at a very young age—how can you inspire young people in Silicon Valley to be more philanthropic?

Benioff: Well, I do that, I slap a lot of guys around in terms of—

Kirkpatrick: You hit a nerve with that question.

Benioff: Yeah, I feel like that’s a very important role for me. You know, one of the things that—you know, UCSF this year will raise about $550 million dollars in philanthropy. And I think, you know, if we were five years ago, Sue and I were in her office, you know, on Parnassus Avenue, and I was telling her that we’d be raising $550 million dollars, she would like, you know, saying it’s not possible. And we’ve had a huge shift, and a lot of that has come out of Silicon Valley, where you can look that this new building that we opened is not just a great children’s hospital, but it’s a great women’s hospital, which is Gordon and Betty Moore, the founders of Intel have been involved, the great cancer hospital, Barbara Bass Bakar, you’ve got Brook Byers Hall across, you’ve got Genentech Hall. You’ve got a lot of very exciting—Ron Conway just put in $40 million dollars. And a lot of these young CEOs, our message to them is, hey, just don’t build great products, build great companies. And the way to build a great company is to build a company that’s not just about your shareholder, but about your stakeholder. And one of the key stakeholders in today’s world is our communities. And you know, we are trying to pivot and open the hearts of these entrepreneurs, as they generate huge amounts of personal wealth and also wealth for their employees and shareholders, to push that wealth into great institutions like UCSF, or the Gates Foundation as well, and also to not only use their money, which is very important, but also their employees. We have 5,000 of our 16,000 employees in downtown San Francisco. A huge amount of volunteerism goes on at UCSF or through the public schools. That’s very important. And number three is we run over 25,000 nonprofits and NGOs for free on our data centers, which takes up between 1–2% of our revenue, which is very aggressive. But that’s been our mission from the beginning, and it’s part of our 1/1/1 program, which is, you know, 1% of our employees’ time, 1% of our profit, and 1% of our equity goes back into the community.

So this is I think very important. I don’t think you can have a successful company today without having a message that you’re also giving back. And a lot of entrepreneurs I think feel a level of pressure on them to have a program and maybe five or ten years ago they didn’t, and the beneficiaries should be organizations like this and others, some represented in this room, who need the support of organizations like ours. And when I work with young entrepreneurs who are starting companies, my message for them is—and I try to model it for them—that if you want to build a multibillion-dollar company with a huge valuation, build a great company, and a great company is not just a culture of free food. That used to be—like, “Oh, we have a cafeteria, so that makes us a great company. That must make us a Fortune number one best place to work because we have free food and we have, whatever, dry cleaning on site”—to a company that really is doing great things in the world and that is not only building great products, but also is deeply integrated with their communities. And that is what will create a great company, and that’s what I’m trying to model for these next-gen entrepreneurs. I hope that answers your question.