Roger Stein: A bold new way to fund drug research

47,806 views ・ 2014-01-07

TED


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00:12
So this is a picture of my dad and me, at the beach in Far Rockaway,
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or actually Rockaway Park.
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I'm the one with the blond hair.
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My dad's the guy with the cigarette.
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It was the 60's.
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A lot of people smoked back then.
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In the summer of 2009, my dad was diagnosed with lung cancer.
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Cancer is one of those things that actually touches everybody.
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If you're a man in the US,
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you've got about a one in two chance
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of being diagnosed with cancer during your lifetime.
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If you're a woman, you've got about a one in three chance
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of being diagnosed with cancer.
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Everybody knows somebody who's been diagnosed with cancer.
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Now, my dad's doing better today,
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and part of the reason for that is that he was able to participate in the trial
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of an experimental new drug that happened to be specially formulated
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and very good for his particular kind of cancer.
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There are over 200 kinds of cancer.
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And what I want to talk about today
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is how we can help more people like my dad,
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because we have to change the way we think about raising money
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to fund cancer research.
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So a while after my dad was diagnosed,
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I was having coffee with my friend Andrew Lo.
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He's the head of the Laboratory for Financial Engineering at MIT,
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where I also have a position,
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and we were talking about cancer.
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And Andrew had been doing his own bits of research,
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and one of the things that he had been told
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and that he'd learned from studying the literature
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was that there's actually a big bottleneck.
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It's very difficult to develop new drugs,
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and the reason it's difficult to develop new drugs
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is because in the early stages of drug development,
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the drugs are very risky, and they're very expensive.
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So Andrew asked me if I'd want to maybe work with him a bit,
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work on some of the math and the analytics
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and see if we could figure out something we could do.
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Now I'm not a scientist.
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You know, I don't know how to build a drug.
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And none of my coauthors, Andrew Lo or Jose-Maria Fernandez or David Fagnan --
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none of those guys are scientists either.
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We don't know the first thing about how to make a cancer drug.
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But we know a little bit about risk mitigation
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and a little bit about financial engineering,
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and so we started thinking, what could we do?
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I'm going to tell you about some work
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we've been doing over the last couple years
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that we think could fundamentally change the way
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research for cancer and lots of other things gets done.
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We want to let the research drive the funding,
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not the other way around.
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So in order to get started,
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let me tell you how you get a drug financed.
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Imagine that you're in your lab -- you're a scientist, you're not like me --
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and you've developed a new compound
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that you think might be therapeutic for somebody with cancer.
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Well, what you do is, you test in animals, you test in test tubes,
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but there's this notion of going from the bench to the bedside,
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and in order to get from the bench, the lab, to the bedside, to the patients,
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you've got to get the drug tested.
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And the way the drug gets tested
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is through a series of, basically, experiments,
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through these large, they're called trials,
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that they do to determine whether the drug is safe
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and whether it works and all these things.
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So the FDA has a very specific protocol.
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In the first phase of this testing,
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which is called testing for toxicity, it's called Phase I.
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In the first phase, you give the drug to healthy people
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and you see if it actually makes them sick.
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In other words, are the side effects just so severe
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that no matter how much good it does,
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it's not going to be worth it?
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Does it cause heart attacks, kill people, liver failure?
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And it turns out, that's a pretty high hurdle.
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About a third of all drugs drop out at that point.
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In the next phase, you test to see if the drug's effective,
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and you give it to people with cancer
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and you see if it makes them better.
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And that's also a higher hurdle. People drop out.
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And in the third phase, you test it on a very large sample,
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and you're trying to determine what the right dose is,
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is it better than what's available today? If not, then why build it?
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When you're done with all that,
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what you have is a very small percentage of drugs
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that start the process actually come out the other side.
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So those blue bottles -- those blue bottles save lives,
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and they're also worth billions, sometimes billions a year.
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So now here's a question:
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if I were to ask you, for example,
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to make a one-time investment of, say, 200 million dollars
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to buy one of those bottles,
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so 200 million dollars up front, one time, to buy one of those bottles,
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I won't tell you which one it is,
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and in 10 years, I'll tell you whether you have one of the blue ones.
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Does that sound like a good deal for anybody?
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No. No, right?
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And of course, it's a very, very risky trial position,
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and that's why it's very hard to get funding,
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but to a first approximation, that's actually the proposal.
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You have to fund these things from the early stages on.
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It takes a long time.
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So Andrew said to me, he said,
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"What if we stop thinking about these as drugs?
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What if we start thinking about them as financial assets?"
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They've got really weird payoff structures and all that,
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but let's throw everything we know about financial engineering at them.
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Let's see if we can use all the tricks of the trade
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to figure out how to make these drugs work as financial assets.
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Let's create a giant fund.
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In finance, we know what to do with assets that are risky.
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You put them in a portfolio and you try to smooth out the returns.
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So we did some math, and it turned out you could make this work,
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but in order to make it work, you need about 80 to 150 drugs.
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Now the good news is, there's plenty of drugs
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that are waiting to be tested.
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We've been told that there's a backlog of about 20 years of drugs
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that are waiting to be tested but can't be funded.
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In fact, that early stage of the funding process,
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that Phase I and preclinical stuff,
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that's actually, in the industry, called the Valley of Death
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because it's where drugs go to die.
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It's very hard to for them to get through there,
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and of course, if you can't get through there,
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you can't get to the later stages.
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So we did this math, and we figured out, OK,
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well, you need about 80 to, say, 150, or something like that, drugs.
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And then we did a little more math, and we said, OK,
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well, that's a fund of about three to 15 billion dollars.
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So we kind of created a new problem by solving the old one.
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We got rid of the risk, but now we need a lot of capital,
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and you can only get that kind of capital in the capital markets.
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Venture capitalists and philanthropies don't have it.
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But we have to figure out how to get people in the capital markets,
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who traditionally don't invest in this, to want to invest in this stuff.
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So again, financial engineering was helpful here.
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Imagine the megafund starts empty,
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and what it does is it issues some debt and some equity,
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and that generates cash flow.
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That cash flow is used, then, to buy that big portfolio of drugs that you need,
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and those drugs start working their way through that approval process,
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and each time they go through a phase of approval,
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they gain value.
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Most of them don't make it, but a few of them do,
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and with the ones that gain value, you can sell some,
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and when you sell them,
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you have money to pay the interest on those bonds,
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but also to fund the next round of trials.
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It's almost self-funding.
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You do that for the course of the transaction,
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and when you're done, you liquidate the portfolio,
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pay back the bonds, and you can give the equity holders a nice return.
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That was the theory, and we talked about it,
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we did a bunch of experiments,
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and then we said, let's really try to test it.
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We spent the next two years doing research.
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We talked to hundreds of experts in drug financing and venture capital.
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We talked to people who have developed drugs.
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We talked to pharmaceutical companies.
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We actually looked at the data for drugs,
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over 2,000 drugs that had been approved or denied or withdrawn,
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and we also ran millions of simulations.
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And all that actually took a lot of time.
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But when we were done, we found something that was sort of surprising.
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It was feasible to structure that fund
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such that when you were done structuring it,
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you could actually produce low-risk bonds that would be attractive to bond holders,
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that would give you yields of about five to eight percent,
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and you could produce equity
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that would give equity holders about a 12 percent return.
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Now those returns aren't going to be attractive to a venture capitalist.
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They want to make those big bets
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and get those billion dollar payoffs.
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But it turns out there are lots of other folks that would be interested.
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That's right in the investment sweet spot of pension funds and 401(k) plans
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and all this other stuff.
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So we published some articles in the academic press,
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in medical journals, in finance journals.
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But it wasn't until we actually got the popular press interested in this
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that we began to get some traction.
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We wanted to do more than just make people aware of it.
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We wanted people to get involved.
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So we took all of our computer code and made that available online
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under an open-source license to anybody that wanted it.
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And you guys can download it today
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if you want to run your own experiments to see if this would work.
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And that was really effective,
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because people that didn't believe our assumptions
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could try their own and see how it would work.
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Now there's an obvious problem, which is,
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is there enough money in the world to fund this?
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I've told you there's enough drugs, but is there enough money?
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There's 100 trillion dollars of capital
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currently invested in fixed-income securities.
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That's a hundred thousand billion.
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There's plenty of money.
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(Laughter)
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But we realized it's more than just money that's required.
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We had to get people motivated, involved,
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and get them to understand this.
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And we started thinking about all the different things that could go wrong.
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What are all the challenges that might get in the way?
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And we had a long list.
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We assigned a bunch of people, including ourselves,
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different pieces of this problem.
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And we said, could you start a work stream on credit risk?
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Could you start a work stream on the regulatory aspects?
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Could you start a work stream on how you would manage so many projects?
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And we had all these experts get together and do these different work streams,
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and then we held a conference.
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The conference was held over this past summer.
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It was an invitation-only conference.
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It was sponsored by the American Cancer Society
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and done in collaboration with the National Cancer Institute.
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We had experts from every field we thought would be important,
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including the government, and people that run research centers,
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and for two days they heard the reports
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from those five work streams, and talked about it.
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It was the first time the people who could make this happen
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sat across the table from each other and had these conversations.
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Now these conferences, it's typical to have a dinner,
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and at that dinner, you get to know each other,
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sort of like what we're doing here.
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I happened to look out the window,
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and hand on my heart,
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on the night of this conference -- it was the summertime --
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and that's what I saw, a double rainbow.
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So I'd like to think it was a good sign.
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Since the conference, we've got people working between Paris and San Francisco,
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lots of different folks working on this
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to try to see if we can really make it happen.
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We're not looking to start a fund, but we want somebody else to do this.
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Because, again, I'm not a scientist.
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I can't build a drug.
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I'm never going to have enough money to fund even one of those trials.
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But all of us together, with our 401(k)s,
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with our 529 plans, with our pension plans,
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all of us together can actually fund hundreds of trials
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and get paid well for doing it
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and save millions of lives like my dad.
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Thank you.
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(Applause)
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