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  • Tech Book of the Month
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July 2021 - Genentech: The Beginnings of Biotech by Sally Smith Hughes

This month we dive into the birth of the biotech industry and learn about Genentech, a biotech company that was built on the back of novel recombinant DNA research in the 1970’s. The book covers most of the discovery and pre-IPO story of the company, weaving in commentary about political, social, and fundraising challenges the company faced.

Tech Themes

  1. Education & Profits. The biotech industry creates an interesting symbiotic relationship between universities and businesses. Genentech was founded by an out-of-work venture capitalist named Bob Swanson and an exuberant scientific genius named Herb Boyer. In 1973, Boyer and a colleague, Stan Cohen, had conceived of the idea of using restriction enzymes to cleave DNA fragments, allowing the scientists to insert and express almost any gene in bacteria. In 1977-78, Boyer, Riggs, and Itakura showed that the recombinant DNA process could create somatostatin and insulin. Because of the unbelievable economic potential of their findings, Stanford (where Cohen worked) and UCSF (where Boyer worked) decided to file a patent on the recombinant DNA procedure. The patent process sparked a massive debate about the commercialized use of their procedure, with several scientists, like National Academy of Science Chairman Paul Berg, calling for an investigation and formal rules. As Hughes notes, “The 1970s was notably inhospitable to professors forming consuming relationships with business, let alone taking the almost unheard-of step of founding a company without giving up a professorship.” This challenge of balance incentives: helping society, contributing all biological research back to the world for free, and personal financial and celebrity gain is hard. Many of the world’s leading researchers are motivated not only by deep investigative science but also by the notoriety of being published in the world’s leading journals. Today, several of the world’s leading AI researchers face a similar dilemma. In 2012, Geoff Hinton, a former Unversity of Toronto professor, auctioned off his AI algorithm and job between Google, Baidu, and Microsoft for a one-time £30M payout. Databricks, a big data company, recently raised money at a $38B valuation - their CEO, Ali Ghodsi, conceived of the idea for Databricks as a Ph.D. student at UC Berkeley, where he remains an adjunct professor. The twisted and complicated world of Academia and corporations continues!

  2. IP. One of the big challenges of Genentech’s unique academic heritage was a massive intellectual property battle that would last for years. In 1976, Bob Swanson set out to negotiate an exclusive license to the Boyer-Cohen patent from Stanford and UCSF. He was rebuffed by the administration, trying to avoid the politically heated topic of recombinant DNA research. Things were made even more complicated in 1978. On New Year’s eve at 12:00 am, soon-to-be new employees Peter Seeburg and Axel Ulrich broke into their former UCSF lab to take research specimens related to contract research work they were performing for Genentech. In 1999, after years of patent disputes, Genentech finally settled the patent infringement for $200M, one of the largest biotech settlements ever. With such enormous sums of money at stake, the question of who owns the invention and how that invention is used is hotly debated and contested - pharmaceutical companies have seen larger and larger misuse settlements.

  3. Regulation & Action. An often forgotten aspect of commercial industry change is regulation, perhaps because it is complicated and slow to develop, but the effects can be enormous. iN 1983, in reaction to chronic under-investment in drugs serving small patient population sizes (“Rare Disease”), the Department of Health and Human Services and FDA helped enact the Orphan Drug act of 1983. “That law, the Orphan Drug Act, provided financial incentives to attract industry’s interest through a seven-year period of market exclusivity for a drug approved to treat an orphan disease, even if it were not under patent, and tax credits of up to 50 percent for research and development expenses. In addition, FDA was authorized to designate drugs and biologics for orphan status (the first step to getting orphan development incentives), provide grants for clinical testing of orphan products, and offer assistance in how to frame protocols for investigations.” A further revision to the Act in 2002 specified a rare disease as a disease affecting a patient population of <200,000 people. Coupled with these amazing incentives was the ability to price drugs in response to the exclusivity received for performing the research that led to the drug’s discovery. Such exclusivity has led to much higher prices for rare disease drugs, causing anger from patients (and insurance groups) who need to pay for these effective but high-priced drugs. Some economists have even studied the idea of “fairness” in orphan drug pricing - considering whether a rare disease drug that cures 90% of patients with the disease should be priced significantly higher than those that cure a smaller percentage of the population. These incentives have produced a massive influx of investment into the space, with 838 total orphan drug indications and 564 distinct drugs created to help patients with rare diseases.

Business Themes

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  1. Partnerships. The biotech industry thrives off of partnerships. This is primarily due to the enormous cost of bringing a drug to market, with a recent paper pinning the number for just R&D costs at greater than ~$1B. Beyond the cost of FDA Phase 1, 2, and 3 trials - $4M, $13M, and $20M median - companies often have to deal with many failures and re-directions along the way. On top of that, companies have to manufacture, sell, and market the drug to patient populations and physicians. Genentech was one of the first companies to establish partnerships with major pharmaceuticals companies. Genentech considered many different partnerships for different parts of its drug pipeline (something that is still done today). In August of 1978, Genentech partnered with Kabi, a Swedish pharmaceutical manufacturer, to produce human growth hormone using the Genentech approach. The deal included a $1M upfront payment for exclusive foreign marketing rights. Three weeks later, Genentech partnered with Eli Lilly to start making human insulin using the recombinant DNA approach - the deal was a twenty-year R&D contract with an upfront fee of $500,000 for exclusive worldwide rights to insulin; Genentech received 6% royalties and City of Hope (an education institution) received 2% of product sales. In January of 1980, Genentech signed a deal with Hoffman-La Roche to collaborate on leukocyte and fibroblast interferon - a chemical that was believed to be a potential cancer panacea. All of these deals were new back then but are now commonplace today - with marketing, R&D, and royalty partnerships the norm in the biotech and pharmaceuticals industry.

  2. The Perils and Beauty R&D. Pharmaceutical and Biotech companies face a very difficult challenge in bringing a drug to market. Beyond the costs detailed above, the success rate is so low that companies often need to have multiple scientific projects going on at once. The book details this challenge: “By the second quarter of 1979, the company had four new projects underway, all but one sponsored by a major corporation: Hoffman-La Roche on interferon; Monsanto on animal growth hormone; Institut Merieux on hepatitis B vaccine; and a Genentech fund project on the hormone thymosin.” This was all in addition to its Kabi and Eli Lilly deals! This brings up the idea of S curves, whereby product adoption reaches a peak and new products pick up to continue the growth of the organization. This is common in all businesses and markets but especially difficult to predict in biotech and pharma where drug development takes years, patents come and go, and new drug success is probabilistically low. This is the double-sided challenge of big pharma, where companies debate internal R&D spending or external M&A to drive new growth vectors on a company’s S-Cuve. It’s something that Genetech is still trying to figure out today.

  3. A Silicon Valley Story. While the center of the biotech industry today is arguably Cambridge, MA, Genentech was an original Silicon Valley - high risk/high reward bet. Genentech was funded by the historically great Kleiner Perkins - a silicon valley VC born out of the semiconductor company Fairchild Semiconductor (where Kleiner was part of the traitorous eight). Kleiner was joined by Tom Perkins, who worked at Hewlett Packard in the 1960s, and brought HP into the minicomputer business. As one of the earliest venture capitalists, with a great knowledge of the Silicon Valley semiconductor and technological innovation boom, they hit big winners with Compaq, EA, Amazon, Sun Microsystems, and many others. A lot of these investments were speculative at the time and the team understood more risk at the earlier stages meant more reward down the line. As Perkins put it: “Kleiner & Perkins realizes that an investment in Genentech is highly speculative, but we are in the business of making highly speculative investments.” After weeks of meeting with Swanson and a key meeting with Herb Boyer, Perkins took the plunge, leading a $100,000 seed investment in Genentech in May of 1976. Perkins commented: “I concluded that the experiment might not work, but at least they knew how to do the experiment.” Despite the work of raising billions of dollars for Genentech’s continually growing product and partnership pipeline, Perkins commented years later on his involvement with Genentech: “I can’t remember at what point it dawned on me that Gentech would probably be the most important deal of my life, in many terms - the returns, the social benefits, the excitement, the technical prowess, and the fun.” Perkins stayed on the board for 20 years and Kleiner Perkins led several investments in the company over the years. Genentech eventually got acquired by Hoffman-La Roche (now called Roche), when they bought 60% of the company for $2B in 1990 and the rest of the company for $47B in 2009. Genentech was the first big biotech win and helped establish Silicon Valley’s cache in the process!

Dig Deeper

  • An Overview of Genetic Engineering (the tech underpinning Genentech)

  • The History of Insulin - 100 Years of Innovation by Dr. Daniel Drucker

  • How Drug Prices Work by the Wall Street Journal

  • How to Value Biotech Stocks by the Biotechnology Innovation Organization

  • Wonderful Life: An Interview with Herb Boyer

tags: Biotech, Genentech, Eli Lilly, Orphan Drug Act, Bob Swanson, Paul Berg, National Academy of Science, Stan Cohen, Herb Boyer, Stanford, UCSF, Geoff Hinton, Databricks, Ali Ghodsi, UC Berkeley, Pharma, FDA, Rare Disease
categories: Non-Fiction
 

June 2020 - Bad Blood by John Carreyrou

This month we review John Carreyrou’s chilling story of the epic meltdown of a company, Theranos. We explore bad decision making, the limits of technology and the importance of strong corporate governance. The saddest thing and the reason Bad Blood hits so hard is that Theranos was a startup that seemed to have everything: a breakthrough blood analyzer, tons of funding, excellent board representation, and a smart, visionary female CEO. But underneath, it was a twisted cult of distrust with an evil leader.

Tech Themes

  1. The limits of technology. Sometimes technology sounds too good to be true. Theranos’ Edison and miniLab blood analyzers were supposed to tell you everything you could ever want to know about your blood. But they didn’t work and never had a shot to work. Stanford professor Phyllis Gardener even told Elizabeth Holmes (Theranos’ founder/CEO) early-on that an early patch-like design of the product would never work: “[Holmes] just kind of blinked and nodded and left. It was just a 19-year-old talking who’d taken one course in microfluidics, and she thought she was gonna make something of it.” It was debunked by almost every scientist as wild fantasy even prior to its commercial use and subsequent fall from grace. There is something so human about wanting to believe there are no limits to technology. In today’s day of fake technology marketing, it’s easy for messaging to slowly take over a company if left unchecked. Think about Snap’s famous declaration, “Snap Inc. is a camera company.” or Dropbox’s S-1 mission statement: “Unleash the world’s creative energy by designing a more enlightened way of working.” These statements ignore what these businesses fundamentally do - advertising and storage. Sometimes there are massive leaps forward, like the transistor, networked computing, and the internet, but even these took many many years to push to fruition. When humans hear a compelling pitch, it is natural to want to remove those limits of technology because the result is so astounding, but we have to remain skeptical or risk another Theranos.

  2. The reality distortion field. Elizabeth Holmes was obsessed with Steve Jobs. Mired in this deep fixation, she also managed to subscribe to one of Jobs’ interesting habits: the reality-distortion field. While we’ve discussed the reality distortion field before in relation to Jobs, Holmes seemed to take it to a new level. Jobs would demand something incredible be done and a lot of times his amazing team could come up with the solution. Holmes also believed this but failed to consider two things: fundamental biology and her team. Biology, at its core, is just not as flexible as the hardware and software that Apple was building. Jobs demanded an excellent product, Holmes demanded a biological impossibility. Beyond searching to enable a biological impossibility, which to be frank, can pop up after years of research (see CRISPR), Holmes operated the Theranos cult as a dictator, ruthlessly seeking out dissenters and punishing or firing them. While Jobs challenged his team repeatedly while being a huge asshole, the team, for the most part, stayed in tact (Phil Schiller, Tony Fadell, Jony Ive, Scott Forstall, and Eddy Cue). There were certainly those who got fired or left, but Holmes active rooting out of non-believers severely limited the chances of success at the company. The additional levels of secrecy were even extreme for a stealth technology startup. Startup founders need to drink the kool-aid sometimes, it comes with being visionary, but getting so drunk on power and image can only lead to personal and business demise as was the case with Theranos.

  3. When startups turn bad. Tons of startups fail, but only a few turn truly malicious. Theranos was one of those few. The company tested people’s blood and gave individuals fake, untested medical results, including indicators of cancer diagnoses! Even when reviewing other major business failures and frauds - Jeff Skilling at Enron and Bernie Madoff’s Ponzi Scheme - nothing compares to Theranos. While it could be argued that Enron and Madoff’s schemes did more and broader financial hurt to society, at least they were never physically endangering individuals. The only comparisons that may be warranted are Boeing and the Fyre Festival. The brainchild of famous clown, Billy McFarland, the Fyrefest certainly endangered people by marooning them on an island with little food. Furthermore, Boeing’s incredibly incoherent internal review process which knowingly led to the production of a faulty airline software system, also endangered people - including two flights that crashed because of its system. Did Elizabeth Holmes set out to build a dangerous device, knowingly defraud investors, and endanger the public? Probably not. It was one decision after another. It was firing CFO Henry Mosley who called out fake projections; it was hiring Boies Schiller to pressure former employees; it was enlisting Sunny Balwani to “run” the company. It was what Clayton Christensen calls marginal thinking - the idea that the incremental bad decision or the incremental costs of doing something frequently outweigh the full costs of doing something. The incremental cost of firing the CFO who wouldn’t make fake numbers was simply easier than facing the difficult reality that the product sucked, and they had pushed through too much investor money to start again. When things turn bad, at startups or other businesses, a trail of marginal decision making can normally be found.

Business Themes

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  1. The Pressure to Succeed. Stress seems to be a part of business, but the pressure can sometimes get too big to handle. Public companies, in particular, face growth targets from wall street analysts and investors. One earnings miss or even a more modest beat than expected can completely derail a stock (See pluralsight and alteryx graphs to the right). Public company CEOs and CFOs can be fired or have compensation withheld for poor stock performance. So when a young hot biotechnology startup wanted to launch a partnership with Walgreens, Dr. J and the Walgreens team were more than ready to fast track the potential partnership. Despite not being allowed to use the bathroom, see the lab or see a partial demo of the product, Walgreens pushed through a deal so that longtime competitor, CVS, wouldn’t get the deal. As then head of the Theranos/Walgreens pilot said, "We can’t not pursue this. We can’t risk a scenario where CVS has a deal with them in six months and it ends up being real.” When the partnership was announced, even the press release sounded oddly formulaic: “Theranos’ proprietary laboratory infrastructure minimizes human error through extensive automation to produce high quality results.” There was no demo. There was no product. There was only pressure at Walgreens to beat CVS and pressure at Theranos to make something from a fake device.

  2. The Importance of Corporate Governance. Corporate Governance has historically rarely been discussed outside of academic settings but has come into sharper focus over the past few years. Some have recently tried to bring some of the prominent corporate governance issues such as member compensation and option grants for executives to the forefront. Warren Buffet even commented on boards in his 2019 annual shareholder letter: “Director compensation has now soared to a level that inevitably makes pay a subconscious factor affecting the behavior of many non-wealthy members. Think, for a moment, of the director earning $250,000-300,000 for board meetings consuming a pleasant couple of days six or so times a year. And job security now? It’s fabulous. Board members may get politely ignored, but they seldom get fired. Instead, generous age limits – usually 70 or higher – act as the standard method for the genteel ejection of directors.” Boards are meant to help guide the company through strategic challenges, ensure the business is focused on the right things, and evaluate the CEO. Theranos’ Board of Directors was a laughable hodgepodge of old white men: George P. Shultz (former U.S. Secretary of State), William Perry (former U.S. Secretary of Defense), Henry Kissinger (former U.S. Secretary of State), Sam Nunn (former U.S. Senator), Bill Frist (former U.S. Senator and heart-transplant surgeon), Gary Roughead (Admiral, USN, retired), James Mattis (General, USMC), Richard Kovacevich (former Wells Fargo Chairman and CEO), and Riley Bechtel. The average age of the directors in 2012 was ~72 years old and few of these men could offer real strategic guidance in pursuing novel biotechnology. On top of that, as Carreyrou points out, “In December 2013, [Holmes] forced through a resolution that assigned one hundred votes to every share she owned, giving her 99.7% of the voting rights.” George Shultz even said later in a deposition, “We never took any votes at Theranos. It was pointless. Elizabeth was going to decide whatever she decided.” The episode brings more clarity to those CEOs and companies who hide behind their Board of Directors, who promise governance for investors, but rarely deliver on anything beyond pandering to the CEO’s whims. In another ludicrous comparison, Apple and Steve Jobs specifically have also been accused of shoddy corporate governance. In 2007, Apple famously backdated Jobs options, allowing him to make an instant profit, and did not even bother to report that it had issued the options. The best companies are not immune, and investors and employees should be aware of the qualifications and monetary interests of a company’s board members.

  3. Search and Destroy. Only the Paranoid Survive, right? Wrong. There is such thing as too much paranoia. When you combine that paranoia with a manipulative persona, you get Elizabeth Holmes. It’s hard to believe that any startup or founder would need the level of security and secrecy that dominated the culture at Theranos. The list of weird security and legal gray areas include: personal security for Holmes, laboratory developed tests (instead of FDA approved tests), copious and vigorously enforced NDAs, siloed teams with no communication, and false representation in the media. Organizations are often secret and many startups operate in stealth to not give away details to competitors. Some larger companies launch new divisions in separate locations from their office, like Amazon a9. The Company hired private investigators (through its powerful law firm Boies Schiller) to threaten and track former employees including Erika Chung and Tyler Schulz. Tyler Schulz, grandson of board member George Schulz, was one of the key informants to author John Carreyrou. After he accused Elizabeth and Sunny of lying and potentially harming patients, he resigned and tried to convince his grandfather that it was all a sham. His grandfather agreed to speak with him one-on-one and at the end of the conversation surprised Tyler with two attorneys from Boies Schiller who almost forced Tyler to sign a confidentiality agreement. Tyler refused, which eventually led to the publication of Carreyrou’s first article. As early board member Avie Tevanian put it, “I had seen so many things that were bad go on. I would never expect anyone would behave the way that she behaved as a CEO. And believe me, I worked for Steve Jobs. I saw some crazy things. But Elizabeth took it to a new level.” Again, sadly, while Theranos may be the pinnacle of secrecy, paranoia and threatening behavior, eBay recently fired six employees for threatening online reviewers. On top of sending live spiders to the reviewers’ household, eBay team members would knock on their doors day or night, to scare the reviewers. How could these employees think this was ok? How could Elizabeth partake in this threatening and manipulative behavior? As Organizational Behavior professor Roderick Kramer reminds us: “‘Reality’ is not a fixed entity but rather a tissue of facts, impressions, and interpretations that can be manipulated and perverted by clever and devious businesses and governments.” Theranos’ fake Edison tests are reminiscent of Enron’s fake trading floor, where 70 low level employees once pretended to be busy to impress wall street analysts. Paranoia and secrecy are powerful weapons when left unchecked, and clearly Theranos' wielded those weapons to the fullest extent.

Dig Deeper

  • HBO Documentary: “The Inventor: Out for Blood in Silicon Valley” has many interviews and deep analysis on Theranos

  • When Paranoia Makes Sense by Organizational Behavior Professor Roderick Kramer

  • Theranos criminal trial set to begin March 9, 2021

  • Ex-Theranos CEO Elizabeth Holmes says 'I don't know' 600-plus times in never-before-broadcast deposition tapes

  • Holmes’ famous Mad Money Interview: “First they think you're crazy, then they fight you, and then all of a sudden you change the world.”

  • Theranos’ still active Twitter account

tags: Theranos, Elizabeth Holmes, Sunny Balwani, Apple, Steve Jobs, Snap, Dropbox, Stanford, Reality distortion field, Fyre Festival, Boeing, Billy McFarland, Jeff Skilling, Enron, Boies Schiller, Clayton Christensen, Walgreens, CVS, Warren Buffett, George Schulz, batch2
categories: Non-Fiction
 

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