Hard Drugs, my new podcast with Jacob Trefethen, and the story of a drug that could end AIDS.
How to speed up medical innovation, how to scale it up, and how to make sure lifesaving tools reach the people who need them the most.
Today, I’m launching a podcast with Jacob Trefethen called Hard Drugs. Our first episode is called Lenacapavir: the miracle drug that could end AIDS.
Sometime last year, when I talked to Sam Bowman, he suggested starting a science podcast through Works in Progress. The only way I could imagine doing a podcast was with a co-host, so we thought about it for a while and who to work with.
The person who came to mind for me was Jacob Trefethen. He works at Open Philanthropy and leads their science and global health R&D funding team, and he’s just fantastic. I had talked to him over the phone before that, but then in September, when I was visiting San Francisco for the Progress Conference, he very kindly offered that I could stay at his place, and I took him up on it!
He’s also a really lovely person and so fun and nice to talk to. His blog, which he started just last year, includes several posts I’m jealous I hadn’t thought of — and his first post is one I still think about all the time.
One evening, when we were at a bar with his friends near his place, before I had the chance to suggest it, he spontaneously said he’d had a vision that we would start a podcast together. So we both independently thought of starting a podcast together at roughly the same time, and that just felt perfect. And now here we are.
We’ll talk about medical innovation, how to speed it up, and how to scale it up. Roughly speaking, each episode will be about a technology, how it was developed and where we go from here; or about a disease that we currently lack good tools to prevent or treat, and how to make progress against it.
Many people think of medicines as if they’re not a form of technological innovation. Once they’re around, we take them for granted and don’t remember what life was like before them.
We also find it hard to imagine that new technologies might be around the corner to treat diseases that are untreatable today. And unfortunately, many that are newsworthy are hyped up, or lacking any real basis. But some real breakthrough technologies do already exist, and are waiting to be tested in trials right now, sometimes slogging through them for over a decade. We rarely celebrate the people, incentives, or tools that made them possible. We assume that it’s not possible to speed up (or slow down) the process of doing good science and developing medical technology. But it is.
The podcast will be about how it happens. How specific medical technologies were developed, the struggles the scientists faced, where we are today, what’s blocking more progress, and some ideas for how to take things forward from here.
Both of us write about medical innovation, and we often focus on diseases of global poverty, like malaria, tuberculosis, and AIDS. We believe there’s a huge amount of progress that can be made on neglected diseases with better technology. There’s so much low-hanging fruit waiting to be picked. Sometimes the technologies to address them are out there already, but are waiting to be scaled up, to reach everyone who needs them.
But we’re also very excited by innovation at the frontier — progress in protein structure prediction and design, all the recent breakthroughs in gene-editing technology, and many more. And there’s still much progress in health that can be made in wealthier countries, in treating dementia, cancer, addiction, and other conditions that I want to see become preventable and curable in my lifetime.
In my view, there isn’t actually a big distinction between research at the “frontier” and ways to tackle ancient diseases; they come together in many ways. Breakthroughs in research tools, like electron microscopy or genome sequencing, for example, make it possible to make far more progress in testing and research against neglected diseases.
It feels ambitious to have a podcast about all those topics together, but I think they’re all part of the same picture. Innovation isn’t worthwhile if it doesn’t reach the people who need it, and bridging that gap is often the motivation for further innovation — to find better, easier, safer, cheaper, more scaleable ways to solve problems; to build the infrastructure and networks to provide it, and develop the incentives to make innovation happen faster and be delivered at scale.
All in all, we have about... fifty episode ideas on our wishlist.
The first episode is about lenacapavir — the new breakthrough HIV drug I wrote about in December. It’s given as an injection only once every six months, and almost completely protects people from infections. It could effectively function as a vaccine despite actually being a small-molecule drug. And there are even more long-acting HIV drugs in the pipeline, which could improve on it further.
We also talk about the scientific journey leading up to this point, and how HIV was transformed from a near-certain death sentence to a manageable condition.
There’s now an opportunity to scale up these new drugs widely and change the course of the AIDS epidemic worldwide — but only if we take it.
Subscribe here:
You can subscribe wherever you get your podcasts. Listen to or watch our first episode here:
Or wherever you get your podcasts
You can also read the full transcript online, and our show notes with links and other material.
Our podcast is brought to you by Works in Progress and Open Philanthropy.
We have a lot of people to thank, especially Aria Babu, an editor at Works in Progress who’s responsible for getting it all going and organizing podcasting; Adrian Bradley, our great on-site producer and editor; Anna Magpie for fact-checking; Abhishaike Mahajan (AKA the great Owl Posting) for our cover art design; David Hackett, music composer; Atalanta Arden-Miller, for art direction; and Sanela Rankovic, a researcher at the Institute for Protein Design we talked to about lenacapavir and HIV capsid inhibitors.
One more episode request from EA you could put on your list, Short-Sleeper drugs & therapies:
https://forum-bots.effectivealtruism.org/posts/nSwaDrHunt3ohh9Et/cause-area-short-sleeper-genes