The Peter Attia Drive
#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
Mon, 28 Apr 2025
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Susan Desmond-Hellmann is a physician and scientist whose remarkable career has spanned clinical medicine, oncology, biotech innovation, and global health leadership. In this episode, Susan shares insights from her journey training in internal medicine during the early AIDS crisis, treating HIV-related cancers in Uganda, and developing groundbreaking cancer therapies like Herceptin and Avastin. She reflects on her leadership roles at UCSF and the Bill and Melinda Gates Foundation, offering lessons on guiding large-scale health initiatives, navigating uncertainty, and fostering scientific innovation. The conversation explores the promise of precision medicine, the integration of patient care and policy, and the evolving role of artificial intelligence in transforming diagnostics, drug development, and global access to care. We discuss: Susan’s medical training, the start of the AIDS epidemic, and the transformative experiences that shaped her career [3:00]; Susan’s experience working on the frontlines of the HIV/AIDS crisis in Uganda [12:30]; Susan’s time working in general oncology and her transition to biotech where she helped develop taxol—a top-selling cancer drug [26:30]; Genentech’s origins, and its groundbreaking use of recombinant DNA to develop biologic drugs [33:45]; Susan’s move to Genentech, and her pivotal role in the development and success of Herceptin as a groundbreaking therapy in targeted oncology [44:00]; The rise of antibody-based cancer therapies: the development of Rituxan and Avastin [52:15]; The step-by-step drug development process and the scientific and strategic challenges involved [1:01:30]; The ethical and economic controversy surrounding Avastin’s high cost and limited survival benefit [1:12:30]; Susan’s tenure as chancellor at UCSF: leading during a financially strained period, and her strategic approach to fundraising and institutional development [1:14:45]; What Susan learned as CEO of the Bill and Melinda Gates Foundation: strategic processes and decision-making frameworks [1:26:00]; Susan’s philosophy of leadership and how she sought to build an empowering, values-driven culture at the Gates Foundation [1:35:15]; The erosion of public trust in science during COVID, the communication failures around controversial treatments like ivermectin, and the need for better public health engagement and transparency [1:39:30]; The role of AI in transforming medicine: from drug development to cancer detection and beyond [1:53:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
Chapter 1: What inspired Dr. Susan Desmond-Hellmann to pursue medicine?
Hey everyone, welcome to The Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen.
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Chapter 2: What were the challenges during the early AIDS crisis?
Sue is a physician who is board certified in internal medicine and medical oncology. Her impressive career has spanned multiple fields. She has been a leader in the pharmaceutical industry where she helped develop several groundbreaking drugs, worked as the chancellor of the health science campus of a major university system, UCSF, and served as the CEO of the Bill and Melinda Gates Foundation.
She also served on numerous boards of both corporations and nonprofit organizations and She co-chaired the National Academy of Science Committee that pioneered precision medicine and currently sits on the board of OpenAI.
I wanted to have Sue on this podcast to speak about her extraordinary career spanning medicine, oncology, biotech, and global health leadership, and to really explore her knowledge on how scientific innovation and leadership can drive better healthcare outcomes.
In this episode, we discuss her early days in medicine, training at UCSF during the start of the AIDS crisis before people even knew what it was, and the lessons that she learned on handling uncertainty, balancing public health messaging, and accelerating treatment breakthroughs.
The decision that she made to specialize in oncology and how her time treating HIV-related cancers in Uganda reinforced the need for integrating epidemiology patient care and policy to combat global health crises. We spoke about her transition into biotech, helping develop breakthrough cancer drugs like Taxol, Herceptin, and Avastin, and the role of precision medicine in improving outcomes.
Sue talks about her leadership roles at UCSF and at the Gates Foundation, driving innovation in healthcare and global health, and the lessons learned from leading health research institutions and global health initiatives, balancing financial constraints with scientific progress and building culture.
We end this discussion with a perspective on the future of medicine, including AI's role in healthcare, such as the opportunities and challenges in leveraging AI for drug development, diagnostics, and expanding access to high quality care. So without further delay, please enjoy my conversation with Dr. Sue Desmond-Hellman. Sue, thank you so much for making the trip out to Austin.
Really, really was excited to meet you last year. Just an honor to spend part of a day with you and then realize that I could somehow twist your arm into coming on the podcast.
I'm happy to be here. I look forward to it.
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Chapter 3: How did working in Uganda shape Dr. Desmond-Hellmann's career?
You've had just an unbelievable career. You are an absolute giant in many ways. I love to always give people a sense of how someone got to where they got. So if I recall, you grew up in Reno, is that right?
I did.
And you went to high school and college and even medical school all the way through, right?
I went to Catholic school for 12 years in Reno. I explain that when people wonder if I was at a casino for my childhood. And then I went to University of Nevada, both to undergrad and to medical school.
then that you ended up at UCSF for your residency?
You know this with residencies. My dream residency was internal medicine at UCSF, my first pick. And I got my first pick and went to UCSF as an internal medicine resident.
1982.
Okay. So remind me where we were in the AIDS epidemic in San Francisco in 82. What was known?
If you read MMWR, that's 1981, was the first indication. In 1982, we knew that there was something happening, especially to gay men, but there was a sense it was homosexuals, hemophiliacs, and Haitians. Remember that?
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Chapter 4: What breakthroughs did Dr. Desmond-Hellmann contribute to in oncology?
Oh, it was a disease that immunosuppressed patients could get very rarely. Most clinicians had never seen it before. What was also clear is that there were many other infections that were not as obvious or life-threatening as pneumocystis was when we saw it right away. What was interesting from an outpatient perspective was capsic sarcoma.
Tell folks what that is.
Kaposi's sarcoma is a really unusual purple-colored tumor, very visible externally. It caused nodules. In patients with HIV infection, it also caused internal organ involvement, and patients would cough up blood or they would vomit blood. But what was really sad and difficult is the combination of cachexia and Kaposi's sarcoma meant that everybody knew you had AIDS. He sort of wore it.
And what was interesting for me was that this old-fashioned Kaposi's sarcoma was fundamentally different than what we were seeing. We also saw non-Hodgkin's lymphoma in numbers much smaller than Kaposi's sarcoma. But Kaposi's sarcoma was a very big problem in San Francisco. It was very common in gay men, and it was common in the population we saw.
And was there ever a sense of fear among the medical staff that we don't know what this is, we don't know how it's transmitted, and therefore we don't know how to protect each other or ourselves or other patients for that matter? Like, it's hard for me to imagine that given how much we take for granted today.
I think it's probably a reflection of my own personality and my own wish to be a physician, that my memories of those days are much more about sadness, about my patients and about people my age dying or being pretty clear they were going to die.
I mean, a story that brings it to life is many patients started selling their life insurance because they were sure they wouldn't live long enough and they wanted the money now. And then when the antiretroviral therapy came along, they wished they hadn't, which is a good thing to have. But I was just really sad. There were fears about the residents and about contagion.
But in San Francisco, there was such a wish to help the patients and such a good spirit about playing a role in helping that we all persevered. But the first patients I took care of in the hospital, I remember very well in 1982, we were a gown, gloved, masked, had a cap on. It was like we were going into an operating room.
Got it. For all intents and purposes, you were acting like this was Ebola without knowing. Absolutely.
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Chapter 5: How did Herceptin change the landscape of breast cancer treatment?
That's really well said. I love that.
So tell me a little bit about the state of oncology in the mid 80s when you're embarking on your medical oncology fellowship. Help people understand what the world of cancer looked like roughly 40 years ago.
Let me talk about breast cancer. That's a cancer that is such a good example. The common therapy that was used, cytoxan, methotrexate, 5-FU, were very old, decades old. There were no new chemotherapy drugs. Hadn't been in a while. The field was stifled, I would say, in terms of medical oncology. There wasn't a lot going on. I was really interested in cancer epidemiology.
That was something to me that asking the question, why did people get cancer and couldn't we do something about it, seemed really important to me. I wanted in the second year of my fellowship to study the relationship between hepatitis B and hepatocellular carcinoma and to understand that better and to think about the viral link
With cancer, the mentor I was supposed to work with ended up not coming to San Francisco. So I decided to go to Berkeley and get a master's in public health as a backup strategy. I really scrambled because I didn't want to waste a year.
What was the nature of the program? It was a three-year fellowship with a research track on the side, because obviously UCSF is such an academic place.
It's a very academic place, but you could do two or three years. And many people went into the lab. I didn't want to go into the lab. I wanted to do epidemiology. I wanted to learn more about statistics and epidemiology. I thought I wanted to do it because I wanted to be a cancer epidemiologist. And to this day, I still think that is one of the great
opportunities to make a big impact, but you have to be funded. So I'm a pragmatist. The good news was that all that learning at Berkeley and at UCSF in epi and biostat, I brought to drug development. Clinical trials have a lot in common with doing epidemiology.
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Chapter 6: What are the implications of antibody-based therapies like Avastin?
You brought up the example of hep B and hepatocellular carcinoma. Was it understood at the time what we now know?
It was, yeah. Palmer Beasley, one of the fathers of that relationship, was the guy who was supposed to come. There were preliminary papers and something relatively early, but it was emerging science.
Do you recall what the incidence of Hep B was and Hep C back then?
You know, I don't. If you weren't in Asia, it was actually, I think, relatively low, but I believe increasing, which is partly why the vaccines are so important.
Tell me about how you wound up in Uganda.
After I got my master's in public health, I became the oncologist at UCSF in the university hospital for the AIDS clinic.
This is Moffitt?
This is Moffitt. So San Francisco General had a very well-known program run by oncologists for AIDS patients who were in the safety net hospital. But in the university hospital, if you were very sick and you had Kaposi's sarcoma, you saw me. And my husband, because we had just gotten married, we were interns together. He was in the lab in ID doing immunology work.
So two of the chiefs of medicine at UCSF were approached by the Rockefeller Foundation, who had started to become worried about heterosexual transmission of HIV. Remember, I talked about the Haitians and the hemophiliacs and homosexuals. 1H wasn't heterosexual. And so there was a lot of disbelief about African HIV.
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Chapter 7: How can AI transform drug development and diagnostics?
If there's 16 million people, it wouldn't have surprised me if there were a million people who died. I mean, it's that kind of numbers. I'm probably exaggerating, but not by much. And I think the sense of feeling overwhelmed is just really important. What I realized I was doing, I don't know if you've interacted with people in the military much, but if they were on the battlefield, they triage.
Chapter 8: What lessons can be learned from Dr. Desmond-Hellmann's leadership experiences?
I triaged. I triaged in San Francisco. If you didn't need chemotherapy, but you had Kaposi's sarcoma, I didn't see you.
What was the chemo?
The simple one was vincristine. Vincristine is actually reasonably good against KS. I used it in Uganda a lot. It does cause some neuropathy, but if you're careful about how much, and then bleomycin. Again, you have to be careful because of the pulmonary toxicity. Good old-fashioned vincristine and bleo, and then Texel. Texel was approved for Kaposi's sarcoma after I left Uganda.
It wasn't a drug before then. I would see the patient and I would literally ask them and their family, can you walk? If you can walk.
If yes, you're too healthy for me.
You're too healthy. We'll delay. There was triage because I only had on the shelf a certain amount of chemotherapy.
How did you manage the personal toll of the grief and the death of seeing this? I mean, look, I think every doctor to some extent goes through this, where you try to sort of compartmentalize what you're seeing. But the truth of the matter is virtually no doctor can really comprehend what you're describing there. How did you process that?
I have this philosophy, which I don't recommend it for others. It's just my philosophy. I love people. I love interacting with people. I love getting to know the patients who I care for. And it makes me happy to think I'm helping. Helping might be helping them get better. Helping might be helping with their pain or they can talk about dying with me because it doesn't make me scared.
So I get a lot of joy in trying to contribute, even if I feel overwhelmed and if I step back and think, how can we cope with this? My coping is... Is leaning in. Yeah.
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