Dec 15, 2017 · 22m · a16z
Challenges in Healthcare Innovation
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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 keynote presentation at the a16z Summit, Andreessen Horowitz General Partner Jorge Conde examines how the convergence of biology, software, and engineering is disrupting healthcare. He demonstrates how modern technological tools and stakeholder alignment can overcome high drug development costs, systemic complexity, and historical scientific bottlenecks.
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 0.0 Guest teaching 4.7 Guest disagreement 0.8 The host pushing back 0.0
speaking balance: gold is the host, purple is the guest (3 minute bins)
Sharpest disagreement ▶ 17:20 Blaming the referee: Reframing FDA regulatory risk
Jorge challenges the conventional view that the FDA is a primary roadblock, comparing industry complaints about regulators to sports fans blaming referees for losses.
Hardest push from the host ▶ 0:56 Absence of host pushbackBecause the transcript is a solo keynote address, the host offers no pushback or resistance at any point.
Biggest teaching moment ▶ 7:00 Unpacking Alzheimer's trial failures versus Sickle CellJorge delivers an insightful explanation detailing how clinical trial failures stem from a fundamental lack of understanding of underlying disease biology.
The host holds their own ▶ 0:56 Absence of host participationThe host is silent during this monologue recording and does not demonstrate expertise or counter the speaker.
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 |
|---|---|---|---|---|---|---|
| Software Expansion and Big Tech Entering Healthcare | 0 | 4 | 1 | 0 | Because this is a solo monologue presentation, the host does not speak or engage, yielding 0s for host expertise and pushback. Jorge educates the audience on eRoom's law and high biopharma R&D costs while maintaining a collaborative presentation tone. | |
| Unraveling Disease Biology and Historical Hype Cycles | 0 | 5 | 1 | 0 | Jorge breaks down why drug discovery fails by contrasting well-understood diseases like Sickle Cell with unknown disease biology in Alzheimer's. The host remains entirely absent from the audio segment. | |
| Next-Generation Capabilities in Biology Understanding and Engineering | 0 | 5 | 0 | 0 | The guest outlines the historical shift from small molecules to large molecules, living medicines, and upcoming intelligent medicines. Host activity is non-existent during this monologue segment. | |
| Transforming Preclinical Testing and Clinical Trial Efficiency | 0 | 5 | 1 | 0 | Jorge explains organ-on-a-chip technology and how tech partnerships reduce trial recruitment costs by 96 percent. The host does not provide any commentary or pushback. | |
| Aligning Stakeholders Across the Entire Healthcare Value Chain | 0 | 5 | 2 | 0 | Jorge offers mild contrarian reframing around regulatory risk, arguing that complaining about the FDA is like blaming the referee when your team loses. The host remains silent throughout. | |
| Biology as Information Technology and Presentation Conclusion | 0 | 4 | 0 | 0 | The segment concludes with Jorge explaining how DNA can store digital movie frame data using CRISPR technology. There is no host involvement. |
Statements from this episode (18)
Conde: U.S. healthcare spending as a share of GDP will double
“Today it accounts for about 20% of our GDP, and that number is going to double over the course of the next three decades.”
Conde: Biology is shifting from experimental science to an engineered discipline
“As we move beyond software, we're at this point where we're seeing this incredible convergence between biology, computer science, and engineering. And it's this convergence that's going to give us broad new superpowers to understand and manipulate biology. Ess…”
Conde: U.S. biopharma spends $75B annually on R&D
“The U.S. Biopharmaceutical industry spends about seventy five billion dollars every single year in research and development.”
Conde: U.S. drug market generates $500B in annual sales
“The market for drug sales in the United States alone is about a half a trillion dollars annually.”
Conde: Average drugs require $2.5B and 10 to 15 years to develop
“And so when you add all of this up, it takes an incredible two and a half billion dollars and 10 to 15 years of investment to get the average drug to market when you account for all of the failures along the way.”
Conde: Only one in 10,000 drug compounds becomes a product
“In this world, it's one in 10,000 becomes a product.”
Conde: Medicine will cure sickle cell anemia within 10 years
“And so if I had to bet, I would bet that in the next 10 years, we will have solved sickle cell anemia, much like we've solved cystic fibrosis, that had a very similar profile in terms of what we understood about the disease.”
Conde: Poor biological understanding drives most drug discovery failures
“So the real truth is the vast majority of drugs fail and are found ineffective or toxic because we don't understand the underlying disease biology.”
Conde: Broad Institute created a cell atlas to analyze cell dysfunction
“So scientists at the Broad Institute at Harvard and MIT, they've created an atlas of various different cell types, so we can understand how different cells function and dysfunction.”
Conde: Seven of top ten selling drugs are protein-based
“The emergence of the biotechnology industry gave us the ability to coax organisms to make proteins for us, and as a result, seven of the top 10 selling drugs today are protein-based drugs.”
Conde: Future cell therapies will use programmed logic to target diseases
“Well, if we get really good at understanding biology, and we get really good at engineering biology, on the horizon, we have the ability to begin to program cells so that we can imbue them with logic. So we can take a cell and have it understand how to find di…”
Conde: 40% of Phase III drugs fail after a decade of investment
“Up to 40% of drugs that go through a phase three trial fail. 40%. This is after 10 years, a decade, and hundreds of millions of dollars invested.”
Conde: Facebook reduced clinical trial patient recruitment costs by 96%
“So Facebook, for example, as I mentioned earlier, is using their social network to help us identify and recruit patients for clinical trials. And in fact, they did a pilot project with the Michael J. Fox foundation where they were able to reduce the cost and t…”
Conde: FDA regulatory risk is fundamentally scientific risk
“FDA risk or regulatory risk is really just another way of saying scientific risk, of saying we're going to conduct an experiment, and we are not quite sure what's going to happen.”
Conde: The FDA has become an incredible collaborator to industry
“So I think if anything, the FDA has become an incredible collaborator to industry.”
Conde: Healthcare payers are value assessors, not cost cutters
“But the reality is payers aren't cost cutters. They're assessors of value. And if you have transformative drugs, or if you can transform how we think about diagnosing and screening disease, the payers are willing to pay for that value.”
Conde: Biology will function like IT and disrupt non-healthcare industries
“So we're living at this incredible point in time where biology is going to look a lot like information technology, and that it's going to be able to tackle and transform and perhaps even disrupt multiple industries.”
Conde: Scientists used CRISPR to encode and retrieve digital video in DNA
“What scientists were able to do is they were able to take this video, the pixels from this video, and using CRISPR can coax a bacterial cell to ingest the information and store it in its DNA. And on the right, what you're seeing Is scientists' ability to retri…”