Jan 2, 2019 · 28m · a16z
a16z Podcast | Taking the Pulse on Bio
Jorge Conde · 12m spoken Vijay Pande · 6m spoken Malinka Walaliyadde · 4m spoken Jeffrey Lowe · 2m spoken
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gold bands on the timeline = statements, start to end. Hover to read, click to jump. CC turns on captions
In this episode of the a16z podcast, members of the Andreessen Horowitz bio team discuss how the convergence of computer science, engineering, and biology is transforming medicine from an empirical science into a scalable, tech-driven venture landscape.
How this conversation actually went
Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. How this is scored →
The host as informed peer 2.3 Guest teaching 4.3 Guest disagreement 1.1 The host pushing back 0.1
speaking balance: gold is the host, purple is the guest (3 minute bins)
Sharpest disagreement ▶ 21:30 Jorge reframing regulatory risk as scientific risk
Jorge mildly challenges the conventional view of regulatory barriers by asserting that regulatory risk is actually a euphemism for underlying scientific and experimental risk.
Hardest push from the host ▶ 17:55 Host summarizing and clarifying GTM pathJeffrey Lowe steps in to restate and summarize the step-by-step transition from clinical evidence to reimbursement to ensure clarity.
Biggest teaching moment ▶ 3:40 Jorge contrasting sickle cell anemia and Alzheimer's diseaseJorge provides a structured pedagogical breakdown contrasting engineering known biological targets like sickle cell against taking high science risk in unknown diseases like Alzheimer's.
The host holds their own ▶ 25:33 Host contrasting tech and biotech investment risk profilesJeffrey Lowe demonstrates clear domain expertise by articulating how tech investing focuses on low technical risk with high market risk, while biotech traditionally deals with high science risk and known markets.
the scores for every segment, with the reasoning behind each
| Chapter | Topic | The host as informed peer | Guest teaching | Guest disagreement | The host pushing back | Why |
|---|---|---|---|---|---|---|
| Computational Biomedicine in Diagnostics and Therapeutics | 1 | 4 | 1 | 0 | Host Jeffrey Lowe asks open-ended introductory questions about computational biomedicine. The guests explain how machine learning is applied across diagnostics and therapeutics, citing examples like Freenome. | |
| Shifting Biology from Empirical Science to an Engineering Discipline | 1 | 5 | 1 | 0 | Jeffrey Lowe prompts the guests to define an engineering approach to biology. Jorge Conde provides an extended educational comparison between target engineering in sickle cell anemia and science risk in Alzheimer's. | |
| Non-AI Engineering Approaches: Sequencing, Gene Therapy, and Intelligent Drugs | 2 | 5 | 1 | 0 | The host asks about non-AI engineering methods. Jorge details the convergence of microfluidics, optics, and compute behind next-generation sequencing, while Malinka introduces cell therapy modalities. | |
| Digital Health and Scalable Behavioral Therapeutics | 2 | 4 | 1 | 0 | Jeffrey Lowe introduces network effects in health tech. Malinka and Vijay educate on care coordination friction using PatientPing and explain how data network effects create long-term defensive moats. | |
| Therapeutics Investment Strategy and Modular Biological Tools | 3 | 4 | 1 | 0 | The host asks a focused question regarding whether CRISPR acts as a direct therapeutic or discovery tool. Jorge explains how modular biological platforms replace traditional bespoke drug discovery. | |
| Go-To-Market Strategies for Bio and Digital Health Startups | 3 | 4 | 1 | 1 | Jeffrey Lowe asks about go-to-market channels and summarizes the sales trajectory. Malinka details why early digital health startups targeted self-insured employers over risk-bearing health plans. | |
| Evolving Regulatory Paradigms and Modernizing Clinical Trials | 2 | 5 | 2 | 0 | The host prompts discussion on FDA pre-certification and clinical trial evolution. Jorge reframes regulatory risk as underlying scientific risk and outlines modern solutions like organs-on-chips and social media recruitment. | |
| Bridging Tech and Biotech Investing and the Rise of Dual-Domain Founders | 4 | 3 | 1 | 0 | Jeffrey Lowe demonstrates domain knowledge by accurately contrasting tech and biotech investment risk dynamics, before contributing his own thesis on non-therapeutic CRISPR applications during the lightning round. |
Statements from this episode (23)
Pande: AI early detection could be the missing link to curing cancer
“This is where AI could really be a part of the key missing link towards the cure to cancer.”
Walaliade: AI models outperform human physicians in top 2017 medical journals
“Two years ago, there weren't that many examples of prominent journals publishing AI and healthcare pieces where it was, you know, shown to work in healthcare context, and now it feels like every month there's a new nature paper or something coming out where, y…”
Conde: Biology is transforming from experimental science into an engineered discipline
“It's really just one subset of what we think is the broader theme here, which is the shift away from biology being primarily an empirical or an experimental science to becoming more of an engineered discipline.”
Pande: Genomic diagnostics scale across cancer types via repeatable engineering
“Science is something that you can't schedule creativity or the ability to come through a breakthrough. So if you have understood the science of colorectal cancer, what you've learned about a stool test probably is not going to be very useful for a breast cance…”
Conde: Human genome sequencing cost dropped from $3B to under $1,000
“Today, because of improvements that were born of the application of engineered disciplines and three very specific ones, we can now sequence a human genome in what used to take 13 years in a matter of hours, and what used to cost three billion dollars for less…”
Conde: Illumina's sequencing breakthrough was driven by engineering, not biology
“And really what drove that wasn't some fundamental discovery on the biology or the science. What drove that was Illumina was able to apply Three very specific and distinct engineering disciplines and converge them. One was the use of microfluidics, the, just a…”
Conde: Bio-engineering companies will scale and dominate markets like tech
“One of the very interesting things about this particular space is these companies will look very tech-like in terms of their ability to create new markets and scale and dominate those markets, and those are obviously very attractive and interesting opportuniti…”
Conde: Medicine is on the verge of creating intelligent living drugs
“And I think one of the things that we're seeing is that now when we can start to design cells, we can actually start to design cells that have logic, that will know where to go in the body, what to do when they encounter disease, and how to essentially termina…”
Pande: Digital health enables continuous clinical trials via software A/B testing
“And the intriguing thing is that they can do the equivalent of clinical trials, except in computer land, the clinical trial is A-B testing. And they can do this A-B testing, you know, if they wanted to, once a week at scale. They can constantly iterate to make…”
Walaliade: Hospitals are increasingly taking financial risk for patient care
“Hospitals are increasingly taking financial risk on their patients. They are financially on the hook for excessive care.”
Pande: Data network effects never go off patent like biotech drugs
“Data network effects never go off patent. They just get stronger and stronger and help companies grow even after, even decades after.”
Pande: a16z Bio targets startups with minimal underlying science risk
“We're looking for companies where the science risk has been removed or greatly de-risked. And so that often, ah, sort of removes a lot of traditional type of therapeutic companies. Companies where there's a huge amount of science risk.”
Conde: CRISPR became an indispensable drug discovery tool in just years
“CRISPR is a concept barely registered just a few years ago, and now it's an indispensable tool for drug discovery, for, actually, for understanding biology, as we've seen the cycles of iteration in biology accelerate.”
Conde: Engineering biology will produce tools even more powerful than CRISPR
“As we move biology more and more into an engineer-based discipline, I think we're going to see more powerful modalities like CRISPR.”
Walaliade: Health plans demand cost-saving proof over product engagement
“Health insurance plans care a lot more about saving money than offering an engaging product and so for an early-stage startup, it's a lot harder for them to do the saving money piece, because that takes a long study to prove, and they do it eventually, but it'…”
Conde: FDA will set an all-time generic drug approval record in 2017
“We'll see more generics approved this year than in any year in history previously.”
Conde: FDA advisory panels passed gene therapy and CAR-T unanimously 13-0
“Gene therapy, an area that historically has been considered to be very risky, has been shown to be so effective in this form of treating inheritable form of blindness, That that passed the FDA panel recommendation unanimously, a 13 to zero vote. CAR T similarl…”
Conde: Facebook recruitment reduced Parkinson's trial acquisition costs by 96%
“A great data point that I heard recently was a partnership that Facebook made with the Michael J. Fox foundation to find ways to pilot the use of social networks to recruit patients for Parkinson's disease trial using social media. They were able to reduce the…”
Lowe: Tech VC takes market risk, biotech VC takes scientific risk
“Traditionally, we've seen tech investing go for companies where the technical risk was quite low, but the market risk quite high. They're investing in growth, and they see profits over time. Biotech investors looking at places where a science risk is high, but…”
Pande: Dual-domain biology and computer science founders will be a major trend
“What we're really seeing emerging are new founders, Founders that also live in both of these worlds. Founders that have deep experience in the biology and deep experience in computer science, and actually, for these types of companies, I think that's going to …”
Pande: EDA tools applied to biological circuits will revolutionize biology
“I think what we're going to start to see is the literal engineering of biological circuits inside cells. The ability to design circuits, much like we design electronic circuits. And the reason why this is important is that there's only so much you can do by ha…”
Conde: Biology will expand beyond healthcare to touch every major industry
“Biology is no longer an industry in and of itself. It's something that's going to touch every single industry, and we're already seeing applications in energy, in textiles, in food, of course in health, and in data storage.”
Lowe: Non-therapeutic CRISPR applications like diagnostics are just beginning
“I also think we're going to see a lot of interesting things in the non-therapeutic CRISPR space. So in a therapeutic CRISPR side, there are a bunch of public companies that are going directly after using CRISPR to cure disease. I think it's just the beginning …”