Roger Stein: A bold new way to fund drug research

譯者: NAN-KUN WU 審譯者: Yi Fei

So this is a picture of my dad and me, at the beach in Far Rockaway,

這是一張我和我父親的合照

在Far Rockaway海灘上

那裡叫做Rockaway公園。

or actually Rockaway Park.

I'm the one with the blond hair.

我是金髮的那個。

My dad's the guy with the cigarette.

我父親是拿著香菸的那個。

It was the 60's.

當時正值60年代， 那時候很多人抽煙。

A lot of people smoked back then.

2009年夏天，

In the summer of 2009, my dad was diagnosed with lung cancer.

我父親被診斷出罹患肺癌。

Cancer is one of those things that actually touches everybody.

癌症是是和人人都有關係的東西。

如果你是一個男性的美國人，

If you're a man in the US,

you've got about a one in two chance

你這一生將會有一半的機會被診斷出癌症。

of being diagnosed with cancer during your lifetime.

你這一生將會有一半的機會被診斷出癌症。

If you're a woman, you've got about a one in three chance

如果你是女性，

of being diagnosed with cancer.

你會有三分之一的機會被診斷出癌症。

每個人都會認識一些被診斷出癌症的人。

Everybody knows somebody who's been diagnosed with cancer.

每個人都會認識一些被診斷出癌症的人。

Now, my dad's doing better today,

好，我父親現在好多了。

and part of the reason for that is that he was able to participate in the trial

有一部分的原因是他可以參與 一種實驗性新藥的測試

有一部分的原因是他可以參與 一種實驗性新藥的測試。

of an experimental new drug that happened to be specially formulated

有一部分的原因是他可以參與 一種實驗性新藥的測試。

這種藥對於他所得的特定癌症非常有效。

and very good for his particular kind of cancer.

這種藥對於他所得的特定癌症非常有效。

癌症有超過200種。

There are over 200 kinds of cancer.

And what I want to talk about today

我今天所要說的是 我們如何能幫助更多像我父親一樣的人。

is how we can help more people like my dad,

我今天所要說的是 我們如何能幫助更多像我父親一樣的人。

because we have to change the way we think about raising money

因為我們必須要改變我們對於 癌症研究募款的想法。

to fund cancer research.

因為我們必須要改變我們對於 癌症研究募款的想法。

So a while after my dad was diagnosed,

我父親被診斷出後不久，

I was having coffee with my friend Andrew Lo.

我和我的朋友Andrew Lo一起喝了杯咖啡。

He's the head of the Laboratory for Financial Engineering at MIT,

他是麻省理工學院財務工程實驗室的負責人

where I also have a position,

而我也是這個實驗室的其中一員。

and we were talking about cancer.

我們談論著癌症，

Andrew也做了他的研究：

And Andrew had been doing his own bits of research,

and one of the things that he had been told

有人告訴他

and that he'd learned from studying the literature

並且他也從閱讀文獻得知，

was that there's actually a big bottleneck.

現在有個很大的瓶頸 --

It's very difficult to develop new drugs,

新藥很難研發出來，

and the reason it's difficult to develop new drugs

而此原因在於研發的早期階段

is because in the early stages of drug development,

而此原因在於研發的早期階段

研發的藥物風險很大，

the drugs are very risky, and they're very expensive.

也很昂貴。

So Andrew asked me if I'd want to maybe work with him a bit,

所以Andrew問我是否有意願跟他合作，

所以Andrew問我是否有意願跟他合作，

work on some of the math and the analytics

在數學以及分析上面著手

看看我們能否找到我們能改變什麼。

and see if we could figure out something we could do.

我並不是一名科學家，

Now I'm not a scientist.

You know, I don't know how to build a drug.

所以，我並不了解怎麼做出一種藥。

And none of my coauthors, Andrew Lo or Jose-Maria Fernandez or David Fagnan --

我的任何一位同事，Andrew Lo，

Jose Maria Fernandez，或是David Fagnan--

none of those guys are scientists either.

沒有任何人--是科學家。

We don't know the first thing about how to make a cancer drug.

我們不知道製造癌症藥物的第一步是什麼，

But we know a little bit about risk mitigation

但是我們知道些許和降低風險有關的事，

還有一點點財務工程。

and a little bit about financial engineering,

然後我們開始思考， 我們究竟能做些什麼？

and so we started thinking, what could we do?

我將告訴你們我們過去數年在做的事 --

I'm going to tell you about some work

we've been doing over the last couple years

我將告訴你們我們過去數年在做的事 --

我們相信這會在根本上 改變癌症研究以及很多其他事情的做法。

that we think could fundamentally change the way

我們相信這會在根本上 改變癌症研究以及很多其他事情的做法。

research for cancer and lots of other things gets done.

We want to let the research drive the funding,

我們想讓研究主導資金，

not the other way around.

而不是反過來。

So in order to get started,

首先，讓我告訴你們如何幫一種藥籌措資金。

let me tell you how you get a drug financed.

首先，讓我告訴你們如何幫一種藥籌措資金。

Imagine that you're in your lab -- you're a scientist, you're not like me --

想像你在一間實驗室裡--

跟我不一樣的是，你是一名科學家--

你是科學家，而你研發出了

and you've developed a new compound

一種你認為能夠治療癌症病患的新物質。

that you think might be therapeutic for somebody with cancer.

一種你認為能夠治療癌症病患的新物質。

Well, what you do is, you test in animals, you test in test tubes,

嗯，你所要做的，就是在動物身上測試，

在試管裡測試，

but there's this notion of going from the bench to the bedside,

但是有個從實驗桌到臨床的概念：

但是有個從實驗桌到臨床的概念：

and in order to get from the bench, the lab, to the bedside, to the patients,

而為了從實驗桌、實驗室，到臨床、給病人使用，

而為了從實驗桌、實驗室，到臨床、給病人使用，

you've got to get the drug tested.

你必須要測試這種藥。

And the way the drug gets tested

藥物測試基本上就是一系列的實驗。

is through a series of, basically, experiments,

藥物測試基本上就是一系列的實驗。

透過這些被稱之為臨床證驗的大型實驗，

through these large, they're called trials,

來決定這種藥是否安全或有效等等。

that they do to determine whether the drug is safe

and whether it works and all these things.

來決定這種藥是否安全或有效等等。

So the FDA has a very specific protocol.

因此美國食品藥物管理局有一套特定的準則。

In the first phase of this testing,

在這個測試的第一階段，

which is called testing for toxicity, it's called Phase I.

稱為毒性測試，

叫做第一期。

In the first phase, you give the drug to healthy people

在第一期中，會給健康的人用這些藥，

and you see if it actually makes them sick.

看是否會讓他們不適。

In other words, are the side effects just so severe

換句話說，不論藥物帶來多少好處

that no matter how much good it does,

副作用都可能讓這種藥物要失去它的價值。

副作用都可能讓這種藥物要失去它的價值。

it's not going to be worth it?

它會引發心臟病嗎？會致命嗎？

Does it cause heart attacks, kill people, liver failure?

會引發肝衰竭嗎？會引發類似問題嗎？

事實證明，這是個頗高的障礙。

And it turns out, that's a pretty high hurdle.

大約有三分之一的藥跨不過這道障礙。

About a third of all drugs drop out at that point.

In the next phase, you test to see if the drug's effective,

在下一期， 測試的是這種藥的效能。

and you give it to people with cancer

你要做的是讓癌症病患使用這種藥，

and you see if it makes them better.

看是否能讓他們好些。

這又是另一道更高的牆， 很多會被淘汰

And that's also a higher hurdle. People drop out.

第三期你將會在很多的樣本上做測試，

And in the third phase, you test it on a very large sample,

目的是確認正確的劑量。 同時

and you're trying to determine what the right dose is,

同時確認它是否比現存的藥物好。

is it better than what's available today? If not, then why build it?

如果沒有，那為什麼要生產它呢？

When you're done with all that,

當這些事情都做完了以後，

what you have is a very small percentage of drugs

只有一小部分的藥物能通過整個程序。

that start the process actually come out the other side.

只有一小部分的藥物能通過整個程序。

So those blue bottles -- those blue bottles save lives,

這些藍色小瓶子能夠救人一命

同時，它們價值數十億，

and they're also worth billions, sometimes billions a year.

有時候一年就能賺進數十億。

So now here's a question:

問題來了：

if I were to ask you, for example,

例如我問你是否願意做個一次性的投資，

to make a one-time investment of, say, 200 million dollars

例如我問你是否願意做個一次性的投資，

例如說，兩億

to buy one of those bottles,

來買這些瓶子的其中之一，

so 200 million dollars up front, one time, to buy one of those bottles,

先一次性的付兩億，

來買某個瓶子，

I won't tell you which one it is,

我不會告訴你你買的是哪一個--

and in 10 years, I'll tell you whether you have one of the blue ones.

十年之後，我再告訴你是哪一個。

Does that sound like a good deal for anybody?

對你們來說是筆好生意嗎？

No. No, right?

不是。不是，對嗎？

And of course, it's a very, very risky trial position,

這當然是個風險非常、非常大的情況，

而這也就是為什麼融資如此困難。

and that's why it's very hard to get funding,

但是大致上來說，

but to a first approximation, that's actually the proposal.

提案就是這樣子。

在一開始你就得為這些事情籌錢， 這會花很多時間。

You have to fund these things from the early stages on.

在一開始你就得為這些事情籌錢， 這會花很多時間。

It takes a long time.

So Andrew said to me, he said,

所以Andrew對我說：

"What if we stop thinking about these as drugs?

「如果我們別把它們看作藥呢？

如果我們把他們當做資產呢？」

What if we start thinking about them as financial assets?"

They've got really weird payoff structures and all that,

它們有著很詭異的報酬結構，

但就把它們放進我們所知的財務工程裡吧！

but let's throw everything we know about financial engineering at them.

但就把它們放進我們所知的財務工程裡吧！

來瞧瞧我們是否能用交易的把戲 來把這些藥物變成資產？

Let's see if we can use all the tricks of the trade

來瞧瞧我們是否能用交易的把戲 來把這些藥物變成資產？

to figure out how to make these drugs work as financial assets.

來瞧瞧我們是否能用交易的把戲 來把這些藥物變成資產？

Let's create a giant fund.

讓我們創造一筆巨額資金，

在金融界，我們知道要如何處理高風險資產：

In finance, we know what to do with assets that are risky.

在金融界，我們知道要如何處理高風險資產：

把他們當做投資組合，

You put them in a portfolio and you try to smooth out the returns.

然後試著讓所得趨於平緩。

因此我們做了點運算，結果是可行的。

So we did some math, and it turned out you could make this work,

但是為了讓它可行，

but in order to make it work, you need about 80 to 150 drugs.

你需要80到150種藥。

Now the good news is, there's plenty of drugs

好消息是，有很多的藥正等著被測試。

that are waiting to be tested.

好消息是，有很多的藥正等著被測試。

有人告訴我們有積壓了20年的藥等著被測試， 但是卻找不到資金。

We've been told that there's a backlog of about 20 years of drugs

有人告訴我們有積壓了20年的藥等著被測試， 但是卻找不到資金。

that are waiting to be tested but can't be funded.

有人告訴我們有累積了20年的藥等著被測試， 但是卻找不到資金。

In fact, that early stage of the funding process,

事實上，融資的早期階段

也就是第一期測試還有臨床前測試，

that Phase I and preclinical stuff,

that's actually, in the industry, called the Valley of Death

在業界被稱之為死亡幽谷。

因為這是許多藥物的葬身之地。

because it's where drugs go to die.

It's very hard to for them to get through there,

要跨過這道障礙非常困難，

當然，跨不過這道障礙也就無法前進到下一階段。

and of course, if you can't get through there,

you can't get to the later stages.

我們做了運算，找出了，好

So we did this math, and we figured out, OK,

嗯，你知道的，你需要大約80到150種藥，

well, you need about 80 to, say, 150, or something like that, drugs.

嗯，你知道的，你需要大約80到150種藥，

然後我們再做了其它運算，

And then we did a little more math, and we said, OK,

好，那大約需要30到150億的資金。

well, that's a fund of about three to 15 billion dollars.

好，那大約需要30到150億的資金。

So we kind of created a new problem by solving the old one.

所以我們為了解決舊的問題， 似乎製造了另外一個問題：

所以我們為了解決舊的問題， 似乎製造了另外一個問題：

We got rid of the risk, but now we need a lot of capital,

我們可以降低風險，但現在我們需要很大一筆資金。

只有一個地方能拿的到那麼多資金，

and you can only get that kind of capital in the capital markets.

就是資本市場。

Venture capitalists and philanthropies don't have it.

風險投資者沒有那麼多錢， 慈善家沒那麼多錢，

但是我們得想出辦法讓平常不投資 這類玩意的人們進入資本市場，

But we have to figure out how to get people in the capital markets,

但是我們得想出辦法讓平常不投資 這類玩意的人們並進入資本市場，

who traditionally don't invest in this, to want to invest in this stuff.

並願意投資。

財務工程又再度派上用場了。

So again, financial engineering was helpful here.

想像巨額資金從零開始，

Imagine the megafund starts empty,

and what it does is it issues some debt and some equity,

它發出了一些債務以及一些產權，

它發出了一些債務以及一些產權，

and that generates cash flow.

而它們會讓現金流入。

That cash flow is used, then, to buy that big portfolio of drugs that you need,

流入的現金會被用來購買你所需要的巨型投資組合，

流入的現金會被用來購買 你所需要的巨型投資組合，

and those drugs start working their way through that approval process,

藥物也開始進行核准程序

藥物也開始進行核准程序

每次進到核准的下一階段，

and each time they go through a phase of approval,

藥物都會增值。

它們大部分撐不到最後，

they gain value.

Most of them don't make it, but a few of them do,

但是有一些會，

而你可以賣掉一些增值的藥物，

and with the ones that gain value, you can sell some,

你賣掉它們的同時，

and when you sell them,

就可以用這些錢來償還債券利息，

you have money to pay the interest on those bonds,

而且還有錢可以支付下一輪的試驗。

but also to fund the next round of trials.

完全的自給自足。

It's almost self-funding.

你會在交易的過程中這麼做，

You do that for the course of the transaction,

and when you're done, you liquidate the portfolio,

完成了之後你就可以清算這個投資組合，

清償債券，而你可以

pay back the bonds, and you can give the equity holders a nice return.

給股東們一筆大回報。

以上就是這個理論，我們為此進行過一些討論，

That was the theory, and we talked about it,

我們做了一堆的實驗，

we did a bunch of experiments,

我們的結論是，實際測試看看吧。

and then we said, let's really try to test it.

We spent the next two years doing research.

我們花了接下來的兩年做研究。

We talked to hundreds of experts in drug financing and venture capital.

我們和數百位藥物財務以及風險投資專家談過。

我們和數百位藥物財務以及風險投資專家談過。

We talked to people who have developed drugs.

我們和藥物研發人員談過。

We talked to pharmaceutical companies.

我們和藥廠談過。

We actually looked at the data for drugs,

我們親自看過藥物的資料，

over 2,000 drugs that had been approved or denied or withdrawn,

超過2000種被核准、拒絕或中途退出的藥，

超過2000種被核准、拒絕或中途退出的藥，

and we also ran millions of simulations.

我們也跑過數百萬次的模擬。

這些全都要花很多時間。

And all that actually took a lot of time.

But when we were done, we found something that was sort of surprising.

但當我們完成的時候，發現了相當令人驚訝的事。

如此建構資金是可行的 --

It was feasible to structure that fund

such that when you were done structuring it,

當你完成建構的同時，

你也就製造了會吸引持有人的低風險債券。

you could actually produce low-risk bonds that would be attractive to bond holders,

你也就製造了會吸引持有人的低風險債券。

你會得到5％到8％的收益，

that would give you yields of about five to eight percent,

and you could produce equity

你也會製造能夠給予股東大約12%回報的產權。

你也會製造能夠給予股東大約12%回報的產權。

that would give equity holders about a 12 percent return.

這些回報不足以吸引風險投資人，

Now those returns aren't going to be attractive to a venture capitalist.

這些回報不足以吸引風險投資人，

風險投資人喜歡砸重本來獲取數十億的利潤。

They want to make those big bets

and get those billion dollar payoffs.

風險投資人喜歡砸重本來獲取數十億的利潤。

But it turns out there are lots of other folks that would be interested.

但事實證明，還是有很多人很有興趣，

這完全命中養老基金、401(k)退休福利計劃 還有其他東西的甜蜜點。

That's right in the investment sweet spot of pension funds and 401(k) plans

這完全命中養老基金、401(k)退休福利計劃 還有其他東西的甜蜜點。

這完全命中養老基金、401(k)退休福利計劃 還有其他東西的甜蜜點。

and all this other stuff.

So we published some articles in the academic press,

因此我們在學術媒體上發表了一些文章。

我們在醫學期刊上發表了文章，

in medical journals, in finance journals.

在財金期刊上發表了文章，

但是在大眾媒體感興趣之前 我們並沒有得到太多的關注。

But it wasn't until we actually got the popular press interested in this

但是在大眾媒體感興趣之前 我們並沒有得到太多的關注。

但是在大眾媒體感興趣之前 我們並沒有得到太多的關注。

that we began to get some traction.

畢竟我們想要做的並不只是讓人們察覺到，

We wanted to do more than just make people aware of it.

We wanted people to get involved.

我們想要人們參與其中。

我們所做的是，把所有的程式碼放到網路上，

So we took all of our computer code and made that available online

我們所做的是，把所有的程式碼放到網路上，

under an open-source license to anybody that wanted it.

任何想要的人都擁有這個原始碼的使用權。

任何想要的人都擁有這個原始碼的使用權。

And you guys can download it today

如果你想實驗看看這是否可行的話，

if you want to run your own experiments to see if this would work.

你們今天就可以去下載。

這真的很有效，因為不相信我們的假設的人

And that was really effective,

可以試試他們自己的假設是否可行。

because people that didn't believe our assumptions

可以試試他們自己的假設是否可行。

could try their own and see how it would work.

現在有個顯而易見的問題，

Now there's an obvious problem, which is,

那就是全世界是否 有足夠的資金來支持這個玩意？

is there enough money in the world to fund this?

我已經告訴你們有足夠的藥，

I've told you there's enough drugs, but is there enough money?

但是有足夠的錢嗎？

There's 100 trillion dollars of capital

有100兆的資本投資在固定收入證券上

currently invested in fixed-income securities.

有100兆的資本投資在固定收入證券上

That's a hundred thousand billion.

那可是十萬個十億啊，

There's plenty of money.

真多錢。

(Laughter)

（笑聲）

但我們所了解到需要的不只是錢，

But we realized it's more than just money that's required.

We had to get people motivated, involved,

我們得讓人們有動機參與其中。

and get them to understand this.

人們也須要了解這一點。

And we started thinking about all the different things that could go wrong.

所以我們開始思考可能發生錯誤的每個環節。

做這件事情可能遭遇到的挑戰有哪些？

What are all the challenges that might get in the way?

我們列了很長一串， 而我們所做的事把這些問題分配給一群人，

And we had a long list.

We assigned a bunch of people, including ourselves,

我們列了很長一串， 而我們所做的事把這些問題分配給一群人，

different pieces of this problem.

包括我們自己。

And we said, could you start a work stream on credit risk?

我們自問，能夠开始建立在信用風險的工作流嗎？

Could you start a work stream on the regulatory aspects?

能夠建立法規相關事務的工作流嗎？

能夠建立管理眾多規劃的工作流嗎？

Could you start a work stream on how you would manage so many projects?

能夠管理眾多規劃的工作嗎？

所有的專家合作進行各種工作流，

And we had all these experts get together and do these different work streams,

所有的專家合作進行各種工作流，

然後我們進行了會議。

and then we held a conference.

這場會議在夏天舉辦，今年夏天。

The conference was held over this past summer.

只有受邀者能參加，

It was an invitation-only conference.

會議是由美國癌症學會(American Cancer Society)贊助

It was sponsored by the American Cancer Society

以及和美國國家癌症研究所 (National Cancer Institute)合作。

and done in collaboration with the National Cancer Institute.

以及和美國國家癌症研究所 (National Cancer Institute)合作。

We had experts from every field we thought would be important,

我們有各個我們覺得重要的領域的專家，

including the government, and people that run research centers,

包括政府，包括經營研究中心的人，以及其他種種，

包括政府，包括經營研究中心的人，以及其他種種，

and for two days they heard the reports

在兩天之中，他們齊聚聽著這五個工作流報告 並加以討論。

在兩天之中，他們齊聚聽著這五個工作流報告 並加以討論。

from those five work streams, and talked about it.

那是第一次

It was the first time the people who could make this happen

人們把這變成了現實 --

在桌邊面對面並進行這些對話，

sat across the table from each other and had these conversations.

在桌邊面對面並進行這些對話，

Now these conferences, it's typical to have a dinner,

現在這些會議通常會是晚餐會的形式，

and at that dinner, you get to know each other,

在這頓晚餐裡，

你會認識彼此，

sort of like what we're doing here.

就像我們現在在這裡一樣。

I happened to look out the window,

我曾經看著窗外，

and hand on my heart,

把手放在心前，我看著窗外

on the night of this conference -- it was the summertime --

就在會議舉辦的當晚--那是夏天--

這就是我看到的，我看到了兩道彩虹。

and that's what I saw, a double rainbow.

我認為那是個好兆頭，

So I'd like to think it was a good sign.

Since the conference, we've got people working between Paris and San Francisco,

自會議結束，來自巴黎以及舊金山的人們互相合作，

自會議結束，來自巴黎以及舊金山的人們互相合作，

lots of different folks working on this

很多人同心協力嘗試能否實現它。

很多人同心協力嘗試能否實現它。

to try to see if we can really make it happen.

We're not looking to start a fund, but we want somebody else to do this.

我們並不是在融資，

這種事讓別人來做吧。

因為，再次說明，我不是科學家。

Because, again, I'm not a scientist.

I can't build a drug.

我沒辦法做出藥。

I'm never going to have enough money to fund even one of those trials.

我永遠也不會有足夠的錢

來支付任何一個試驗。

But all of us together, with our 401(k)s,

但是只要我們合力，有了401(k)退休福利計劃、

with our 529 plans, with our pension plans,

529教育儲蓄計劃、退休計劃

all of us together can actually fund hundreds of trials

就可以支付數百個試驗

and get paid well for doing it

並得到可觀的報酬，

and save millions of lives like my dad.

然後拯救數百萬像我父親一樣的生命。

謝謝。

Thank you.

(Applause)

（掌聲）