Today Dr. Awesome sits down with Dr. Ron Cohen to discuss the biotech industry. With almost 40 years in the industry, Dr.Cohen is able to provide great insights into the unique challenges and opportunities in this field. Join them as they discuss gene therapy, mRNA technology, and AI in drug development. Learn more about the challenges of drug pricing and the need for systemic reform in healthcare and get inspired by the significant advancements Dr. Cohen predicts will happen over the next 25 years.

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The Future of Biotechnology – A Conversation with Dr. Ron Cohen

Hey, everybody. Welcome back to the Futurist Society, where as always, I’m your host, Doctor Awesome. And we are talking in the present, but we are talking about the future with Doctor Ron Cohen, who is the CEO and president and founder of Acorda Therapeutics and really an all around leader in the biotech industry. Ron, thank you so much for joining us. And tell us a little bit about how you got to where you are. I know that you were a practicing physician for a while and kind of made the transition, which is something I’m sure that a lot of the physicians in the viewership are interested in hearing about.

Well, thanks for having me, Doctor Awesome. It’s a pleasure to be here. So I started out as a doctor of internal medicine. I did practice for a few years after my residency, and then really by pure serendipity, I wound up in the biotech industry.

Getting Started in Biotech

I had no background at all in it. I had no background drug development or business school, anything like that. But a couple of my friends from medical school who married each other had another married couple as friends. They were PhDs at NYU med school, and they had developed a technology for growing organ tissues three dimensionally outside the body in a dish. And they wanted to grow bone marrow for bone marrow transplants and skin and all kinds of things. So they started a little tiny company. It was basically a nothing company. It was two scientists, a nurse who was doing bone marrow polls in the office from volunteers, and a dentist who was a friend of the family who was putting in the angel investment, a couple of hundred thousand dollars. So that was the company.

And they asked my friends to find them a doctor who could do the clinical stuff that they needed to have done, because they were PhDs, not physicians. So my friends call me about this, and I was completely bewildered. I said, “Why are you calling me? I mean, why me? I have no business background. I don’t know anything about tissue engineering.” And they said, ”Well, our friends were very specific. They asked if we could find a doctor who could present well publicly to investors and other doctors and scientists and so on.” And my friends knew that I also had a theatrical background. I had done theater all my life, since first grade on. And in fact, it was a toss up between acting school and medical school. And I finally chose medical school to the delight of my parents. So I told them, look, that’s the worst job description I’ve ever heard in my life. But as a favor to you, I’ll meet them, and that’ll be it.

And then I met them. I spent 4 hours, half a day with them. They were taking me through the technology, and I’m a science geek so I thought, wow, this is really cool. And then the woman of the two was the entrepreneur. Her name was Gail. And she sits me down and she says, “What do you think?” This is after about half a day, and I said, wow, it’s very cool, terrific. And she goes, “Great. I want you to work with me.” Just like that. I thought, wow, this is weird and I said something like, “Great. I’m so flattered. Why don’t we talk next week?” And she points at me and goes, ”You don’t understand.” And she opens up the drawer, pulls out a piece of paper, and she slides it across the desk at me. And now it’s in front of me, and I’m reading it. It’s an employment agreement. And my name is already typed at the top.

And so I said to her, “I don’t understand. My name is already typed here. I’ve been with you all morning. When did you do this?” And she said, “I typed it last night.” And I said, “You didn’t know me last night.” And she said, “Well, our friend sent me two videotapes, VCR tapes that they recorded of you appearing on tv. And based on that, I immediately knew that we were going to work together.” So it’s totally weird. And I said something like, “Wow, I’m really flattered. Now let me take this home, and we’ll talk next week.” And once again, she stands up and lowers over me, points at me, and goes, “You don’t understand. I want you to sign.” And she points across the table at the signature line. And to this day, I don’t know what happened. I picked up the pen, I said okay, and I signed. And that was my introduction to the biotech industry.

You got strong-armed into it.

Exactly. But, you know, it was also a matter of being in the moment. They teach you that in theater as well. You got to be in the moment. And when the moment arrives, you have to recognize it. And if there’s something in your gut that says, go, don’t talk yourself out of it. Your gut is always right.

And so I’ve never looked back. And it’s been an incredibly exciting ride. I did that company for six and a half years. We grew it. I was doing clinical trials with a skin, a cultured human dermis that they were developing. It got approved to heal the very difficult-to-heal skin ulcers that people with diabetes get because they have no circulation. So that’s on the market. It’s called Dermagraft.

And then I wound up kind of taking off for a year. I didn’t know I was going to do that. I learned a lot. I studied accounting. I didn’t know why, I thought I should know finance, so I studied that. And then eventually, I came up with this idea for a company that would restore neurological function to people with spinal cord injuries and other neurological damage, like stroke and MS and Parkinson’s and so on. My dad was the neurologist in the family.

And by the way, funny little sidebar, when I signed here and I joined that little nothing company that was called Advanced Tissue Sciences, eventually. I went to my parents that weekend, and I walked in on Sunday. They’re reading the Sunday Times in the living room, and I tell them this whole story that I just told you about. And they knew that I had wanted to go to acting school versus medicine. But at this point, I was back in New York. What I didn’t tell you was I was back in New York practicing medicine, but also trying to be an actor professionally. So I was living a dual career. And now I tell him this whole story, and I say, “Mom, dad, I’m going to give up the medicine. I’m giving up the acting. I’m going to work for this little biotech company. What do you think?” And my dad said one of the funniest things he has ever said to me, he turns around after absorbing it, turns around, looks at me and says, “Son, are you sure you don’t want to reconsider the acting career?”

But, having said all that, I started this company, Acorda Therapeutics, and it’s been 30 years, and we got two drugs to market. One of them restores walking function to people with multiple sclerosis. Another one restores functionality to people with Parkinson’s when their regular drugs wear off in the middle of the day – which they often do, and then they’re stuck because their symptoms come back and so on.

I’ve gotten to grow up with the industry, and I’ll tell you, I’ve seen it grow from 1986 to today… So what is that, 30 years? No, almost 40 years, right? 38 years… It’s growing at a logarithmic pace. When I look back at where we were in the early nineties and where we are today, it’s almost frightening, except in a good way.

When you say the industry is growing, do you mean in regards to market share or just the ability for the industry to help people?

The latter. The level of technology that we have now, it’s like the science fiction of not only 30 years ago, but even ten years ago. Almost every week, like this week, there was another breakthrough. There are major breakthroughs in our ability to understand the causes of diseases that we never understood before. And if you understand the cause now, you’re able, intelligently, to try to figure out how to address it, how to make it better, how to cure it. And then the technologies that allow us to intervene, either by making new proteins or antibodies, or inserting new genes or repairing genes in the genome or stem cells, it’s mind boggling.

So, you know, obviously, the breakthroughs that you’re talking about… as a passive observer, I think that I’m seeing it. I think that the general public is seeing it. I think that we’re seeing it in the newspaper. Like the cure for sickle cell anaemia. My God, what an amazing time to be able to cure a genetic disease like that, right? And I think that the public sees that and, wow, that’s great. But I think you have a really different insider track into this. What do you think is the biggest jump that we’re going to make in the coming years? I know that CRISPR is being talked about, different therapeutics are being talked about, tissue engineering. What are you most excited about?

That’s a tough one, because depending on the disease state, the answer is different. So it depends on which diseases you’re most concerned about or interested in and so on. I would say, generally speaking, it’s gene therapy. It’s the ability to intervene at the most fundamental level of life. And at that level, most diseases or many diseases… other than infectious diseases and poisons or toxins… but fundamental diseases, Alzheimer’s and MS and various cancers and heart disease, fundamentally, they start at the level of your genes. Yes, they are influenced in many cases by the environment and what you’re exposed to and so on. But fundamentally, they start at the level of the genes.

Gene Therapy

And if you go back to the 1950s, when Watson and Crick first described the double helix, everyone was going, “Oh, my God, it’s going to be a miracle and in the next five years, we’re going to have all of these therapies.” Well, no. And even when the human genome was sequenced, which was in 2000 or so, same thing. There was this… look at the headlines. Well, we’ve solved it. We’re going to… Well, here we are almost 25 years later, and now it’s happening. Now, it seems like every other week, we’ve got a new technology that allows us to have better and better control of what we’re doing in our genomes and how we’re able to identify genes that are responsible for disease and then change them so that they become essentially healthy genes.

So I think a lot of people in your audience know about CRISPR, right? It has been around for ten years, won the Nobel Prize for Jennifer Doudna and her colleague (Emmanuelle Charpentier) who identified it. But we’re still learning how to use it. And I think the first CRISPR therapy, if I’m correct, was just approved, or at least is about to be approved.

It takes time to figure out how to change a gene and make sure you’re not doing any damage. Make sure that you’re changing the right gene. Make sure that it’s doing what you think it’s supposed to, that it’s durable, and so on. There’s a lot of issues. So all of these things take time.

It takes time to figure out how to change a gene and make sure you’re not doing any damage. Make sure that you’re changing the right gene.

But just this week, there was a new breakthrough published out of a lab in California, which looks to be even better than CRISPR. So CRISPR, you can take a single gene and correct a mistake in that code. Now, they’ve discovered a technology using bacteria… actually bacteria that do this naturally, where bacteria in some cases have what are called jumping genes. Where they actually jump out of the bacteria or a copy jumps out of the bacteria and then integrates into the genome of whatever the bacteria is infecting, the host. What they discovered is that the way these bacteria do it is, there’s a particular technology that now will allow you to change an entire gene just at one time. And very specifically. So I predict that that’s also going to take a fair amount of time, 10-15 years, to reach fruition. But it’s the sort of incredible progress that we’re making. That enables us to modify a gene that is not a great gene, that’s a disease gene, and turn it into something that allows us to be healthy.

mRNA and Cancer Treatments

The other thing is related, mRNA. Everyone has heard about the Moderna and Pfizer vaccines, the mRNA vaccines. So rna is what enables DNA to be translated into the proteins and the substances that our bodies use to survive and thrive. mRNA is a way of causing a cell to make a particular protein.

It’s being used now not just for Covid, but for other vaccines, like flu, for example. And it’s being used to develop vaccines against certain cancers. Where they take something that is specific to the cancer. It’s coded for in the mRNA, and then they inject it, your cells make a lot of that protein, and your immune system identifies it and gets trained to kill whatever cell is expressing that protein. And if it’s a cancer cell, it’s another way of allowing your body to kill a cancer cell.

There are so many technologies we could talk about. We could talk about keytruda and the similar drugs that rev up our T cells so that they can fight cancer. And in some cases, certain cancers are being cured that could never be cured before.

Ex-president Jimmy Carter had melanoma. Melanoma is one of the deadliest cancers known, or at least it was.

My dad passed away from melanoma. I know firsthand how deadly it can be.

I remember very well when I was an intern at University of Virginia, a young man in his early thirties came in with metastatic melanoma. We couldn’t do a thing, and it was awful, and he never left the hospital. Now Jimmy Carter has it, and they give him these immune therapies and, as far as we can tell, he’s cured. It’s been years, and he hasn’t had a recurrence. Not everyone is cured. And we’re getting better and better. But these are the kind of things that I’ve seen in just the last 35 plus years. And it seems like every few years – it’s not incremental, it’s not like climbing a ladder – it leaps. It’s a leap and another leap and another leap.

AI and Unravelling Protein Structures

The other big game changer now is AI – Artificial intelligence/machine learning. Scientists have already used AI to actually unravel the structure of a protein.

Now, if your listeners and viewers think about it, proteins are incredibly complicated. If you unravel them, they’d probably go miles. It’s a string of amino acids, each one is coded for by a gene and so on. But it’s not a string. What happens is it self-assembles into this giant ball of yarn, basically, and in a very specific way, that allows it to do the things you want it to do. So if it’s an immune system protein, it does your immune system. If it’s a protein that does work in your liver, then that’s what it does. And we’ve got gazillions of these proteins. Unraveling that and figuring out… if I want to make a protein that will attack a cancer, I have a good idea of what I want to attack, but I don’t know how to make that string so that it self-assembles exactly the way I want it, because it’s impossibly complex. With AI, now they can do it. Now they can actually predict the structure of a protein that they want to make that’ll fit exactly in a particular place in the cell or in the body by using AI. That’s also going to open up an incredible new frontier of developing new, effective drugs that are much more effective than we have now.

I love the commentary on the advances in genetics. My background is in craniofacial surgery and, you know, a lot of these young people come in with these genetic syndromes that are unable to really function with society, and we have to do surgery on them to make them more functional. When is the going to be the time when we can intervene and that those things will be a thing of the past? Do you feel like that’s happening right now? Because I know that…

Are you talking about genetic malformations?

Exactly, yes. So, for example, cherubism. So cherubism is a craniofacial disorder, they know the gene that causes it, they know the defective protein that causes it. As a person grows throughout their life, this builds up, and it causes these benign tumour-like growths in their head and neck. To the point where it can be really bracing, just from an aesthetic standpoint, but also it can close off your airway… it can make eating difficult, breathing difficult, that kind of stuff. And I’ve always wondered, you know, this is something that we know so much about – we know the defective gene, we know the defective protein – when is that going to get to people like that?

So, if I knew, I’d be set for life.

Yeah, but I just, I wonder. Like when they cured sickle cell, I had somebody on that was a PhD in genetics and tissue engineering, and she was telling me about the history of gene therapy and how there were high profile deaths in the early days of gene therapy. And so there was a lot of pushback from a regulatory standpoint. Do you feel like we’re still up against that? And also, if we’re talking about logarithmically, how fast can a company find a solution to these kind of genetic issues?

Yeah. The famous one was a young man named Jesse Gelsinger, who volunteered for one of the early gene therapies and unfortunately died of a reaction to it. You know, you’re highlighting one of the less happy aspects of all this, which is when we’re dealing at the level of the genome… with any drug, but especially if you’re going down to the level of the cell of the genome, where all of our functions that allow us to live are… one mistake because of ignorance, because it’s early and we haven’t learned yet, can cause someone real damage or even death. And that’s always been true in drug development. Fortunately rare, but it is part of the picture. And I don’t think we’ll ever be completely away from that, because by definition, the more effective the technology, the more intrusive, if you will, into the very substance, the code of life, the more there is to know about how do you do it safely? How do you do it properly? You know, there are hidden side effects, and you can only learn when you see the side effect. So that’s an issue.

 

But in the case that you’re talking about, like cherubism or like dwarfism, for example.

Yeah.

Those are things that once… I don’t know the extent to which we will be able to intervene once someone is born with the defect. It depends on the defect. For example, in muscular dystrophy, we’re making great progress with gene therapy, it’s not perfect. But in muscular dystrophy, it’s really a mutation that causes the body to make a protein for the muscles and muscle function that doesn’t work properly. In that case, you can go in and put in a gene for the right protein and then hope that you got there early enough. And it’s been shown that you can do that. Kids who have growth issues because they don’t make growth hormone or they make the wrong growth hormone, you can put a gene in potentially that gives them the growth hormone and then they can grow normally. So you have that.

On the other hand, if it’s a major structural issue, if it’s due to a single gene and you catch it early enough, maybe. Maybe you can make a difference as the child develops. If it’s several genes, and I don’t know the condition well enough to know whether it’s several genes or not, then maybe not. But ultimately, the way to address that is to have more and more effective tools for detecting genetic malformations in the uterus, in the fetus, and then applying the gene in the womb. And that’s already been done in very, very narrow cases for other conditions. It can be done and my guess is that over the next 10, 20, 25 years, we’re going to see more of that.

It needs two things. One is knowing which gene to look for. Because there are 30,000 – 40,000 genes. You have to know which gene to look for, or genes. You have to have tests that detect them all. So you have to get a sample from the placenta or the uterus and diagnose it in advance, and then you can intervene.
Ideally, we’ll have tests that are so inexpensive and so broad in terms of detecting… because now we already have certain genetic tests that you can go give a blood sample, you’ll get your 23andMe and so on… Ultimately, if you could get a panel that would detect most… the father and the mother both get tested, and then you have a sense of which genes the baby would be at risk for, and then you can intervene in a more precise way.

The more effective the technology, the more intrusive into the very code of life, the more there is to know about, How do you do it safely? How do you do it properly?

So I think all of that is coming. Some of it’s here already in a limited way. And to your point about cherubism and the sorts of terrible malformations that you have to encounter and try to deal with surgically, those will give way eventually. I don’t know how long eventually is.

Guiding Growth

Has there been any research done in guiding growth? Because I feel like tissue engineering, genetics, if you were to merge those two, the ability to guide growth similar to how we guide a plant’s growth, right? I have a money tree in my office, and they’ve guided it so that the stems and the trunks are actually intertwined with each other. So we can do that with very rudimentary things like plants and stuff like that. But is there any research happening in the biotech industry to guide growth of bones and tissues similar to how we manipulate other substances?

Yes. Yeah, I mean, there are companies looking at that, the ability to guide growth. A number of stem cell companies are looking at that because a stem cell is a cell that can multiply and become any type of cell or various types of cells. So if you have what’s called a hematopoietic stem cell or a blood, bone marrow stem cell, in the beginning, it can become any of your blood cells. It can become the white blood cells, the T cells, the B cells, the red blood cells, the cells that make your platelets that help clotting and so on. And there are various chemical signals in the bone marrow that make it do that.

Well, scientists have become very, very good at doing this outside the body. At getting stem cells and then getting them to become nerve cells, liver cells, kidney cells, bone cells, anything you really want. We’re still at, I think, relatively early stages of all that, because it’s not enough to make the cell. You need to know where to inject it, how much to inject it, how often to inject it, what else to do around that that will allow those cells to take and then form tissues. So people are looking at stroke, for example, and taking certain nerve stem cells, putting them in the brain and in animals, you can see that they grow and they form new connections and so on. Is that going to cure stroke or improve function in stroke? I think the odds are it probably will, but it’s going to take a lot of experiments and blind alleys, and then eventually people will figure it out.

There’s a great scientist named Leroy Hood, who invented a DNA sequencer decades ago. He has a wonderful quote that is one of my favorites in all of biotech and biopharma. He said, “In the short term, people overestimate what they can do,” meaning with a new breakthrough technology, like I said, “Oh, my God, we sequenced the genome. Next year, we’re going to have all these therapies.”, he said, “But in the longer term, I’d say about 25 years, people underestimate what we will be able to do.”

Yeah, Bill Gates has a similar quote, they call it Gates’ law – We overestimate what’s possible in one year and then underestimate what’s possible in ten years.

Yeah, that’s right.

I think that the ideas that we’re presenting here, I really hope that they come to fruition, but let’s talk a little bit about stuff that’s actually happening that I think would be very interesting to our listeners.

Just a few streets from me at Harvard MGH, they did the first kidney transplant for a kidney that was completely washed of all genetic material coming from a pig. And then they put it into a patient and that patient died. Is that something that we’re on the cusp of, or is this a huge setback for the industry? Is this something that’s going to be tried again and be successful soon? What do you think about that?

Pioneers Pushing the Frontiers

So, I’m going to switch my background to a horizon because, you know, we want to look out over the horizon here.

Sure.

No, I don’t think it’s going to be a major setback. And again, go back to Jesse Gelsinger and some of the other folks who unfortunately had really bad effects from early gene therapies. The people who volunteer for those studies deserve our enormous gratitude and thanks, because they’re pioneers, no less than the physicians and scientists. You have to have people who are willing to go out on a limb. And by the way, I mean, sometimes it works great, sometimes the first people to try a therapy are delighted that they did and sometimes not. And so that’s part of the equation.

People have been trying to do what you just described, which is to alter a pig organ in such a way that it is not causing the immune system to attack it, so that it looks human to the body and then you can implant it. They’ve been trying to do that ever since the human genome was sequenced. I’ve been reading about this for over 20 years. People don’t remember this because maybe they never noticed. There have been companies 20 years ago that formed to try to do that. And they worked really hard, they had a lot of smart people, and the companies ultimately failed because they couldn’t do it. So again, to the Gate’s law or to Leroy Hood’s law, you fast forward now almost 25 years from when the genome was sequenced, and now you’ve got a genetically modified pig kidney that looks like it should work.

I’m not exactly sure and I’m not sure if the team that worked on this knows why that patient died. If it was because of a reaction to the kidney or something related, because they did have kidney failure and associated disease. But the point is that they’ve gotten to the stage where at least you can look at all the markers in the kidney and say, “Wow, this should work.” Which you couldn’t do five years ago, you couldn’t do ten years ago. That is progress. And they’ll keep learning, and they’ll get more volunteers to do it. And it will work at some point.

Could it work next time they do it? Sure, because that’s how close they are. Could it take another five years? Yeah, but that’s massive progress and I don’t see the episode with that patient as holding it back. When they did the first heart transplants… this is Christiaan Barnard going back 30-40 years… when they did the first heart transplants, some of the first patients died also. And even now. It’s a terrible disease, some people do die, but most people don’t, and their hearts survive. So it’s like everything else in medicine and the history of science and medicine. Some things you’re lucky it works pretty quickly. Some things you just have to keep tweaking and tweaking.

And the good news to me is, as we started this conversation, there are so many technologies now that allow such rapid understanding of what’s going on that I think we’re going to see that 25 year window that we’ve been talking about compressing. And not only for inventing a new drug or a new technique to cure a disease, but actually developing it. Because it takes, on average, 10-15 years to develop a drug once you’ve selected it, and that doesn’t count all the time it took to just get to the molecule. With AI and machine learning and other techniques, we should be able to compress that timeline. And of course, the less time it takes to develop a new technology, the faster people get access to it.

Longevity

So let me ask you a question. We’re talking a little bit about all these different technologies. The one thing that I feel like is on everybody’s mind right now, both in the general public as well as in the medical field, is longevity. And, you know, a lot of this is very much a biotech issue. And, you know, I’m really looking forward to the time where I can switch out my heart for a new one or take a drug that fixes my genetic predisposition to heart disease. What do you feel like is going to be the breakthrough that really gets us there? Do you think that it’s going to be some sort of drug, or do you feel like it’s just going to be an overall increase in quality of life? What is that going to look like, in your view?

There’s a huge shadow industry right now in longevity. And very wealthy people, in particular, and I know a fair number of them in the industry, who are using themselves as guinea pigs based on the available data. So there are certain drugs that in animals, or at least in one celled animals, have been shown to significantly increase longevity.

Actually, one of the things that’s been most effective is semi-starvation. And they’ve tried this in multiple species of animals, it pretty much always works. If you significantly reduce the daily caloric intake by call it 30-40%, you wind up with very, very skinny animals, but they also live 30%-40% longer. It’s pretty stunning.

So scientists have looked at that and then they’ve looked at, well, how does the protein expression in the body change when you do that to an animal? So they’ve looked at those changes versus normal, and then they’ve said, well, which of those changes is responsible? And so there’s been a bunch of experiments. And there are certain drugs that mimic some of those changes, just by taking the drug. And when you give those drugs to animals, guess what? They also live longer. So there are certain people, because these are drugs that you can get… they’re expensive but you can get them… who are taking those drugs right now. So it’s like a non-formal experiment. The problem is we’re not going to learn a whole lot from that because each person is at what we call an n of one. Right? So if they lived to be 100, how do you know they weren’t going to live to be 100 anyway? How do you know it wasn’t because of their diet or their exercise regimen, not because they took that drug. You’re not going to learn a lot from that. On the other hand, if they all die before 60…

Then you know it’s not working.

Well, maybe they would have died at 50, but not likely.

Right.

I just read an article recently, I forget where it was, but the title of the article was something like, “Your dog will live to be 100 before you do.” So I do think that that is coming. But honestly, today, I personally would not be taking the drugs that I know people are taking, because there are side effects, there are things we don’t understand, and it’s… Yeah, maybe it’ll work, but maybe, you know, maybe it’ll be negative or maybe have harmful effects.

What I would do is watch my diet. I do do these things. Watch my diet, keep my weight normal, make sure that my cholesterol and blood pressure are normalized (with available medications if they are not in a safe range). There are a whole slew of just lifestyle and basic medical interventions that people can do that could increase their lifespans by ten or 20 years if they did them regularly and started doing them on time. Stop smoking, don’t drink a lot of alcohol. They’re basic stuff. So there are a lot of people out there who are looking for that magic pill, right. Somewhere, maybe after we’re all gone, there will be some magic pills, I think so, that will increase longevity, clearly, and so on… but meanwhile, there’s an awful lot people can do to extend their lives by years.

Which one would you say is the most promising? They have the Yamanaka factors where they’re trying to reverse engineer all these cells to a more earlier state. You have, like, David Sinclair and talking about NAD and telomerase and all that stuff. You’ve got Aubrey de Grey talking about the mitochondrion.

I feel like there’s just so much information, it’s hard to tell what’s snake oil and what’s not. Do you have any one that you’re particularly looking at that’s more evidence-based?

No.

Okay, because?

Because the ones you’ve mentioned, like NAD… NAD actually has been attractive to me for a long time for various reasons, it reduces oxidation, it’s got a lot of things going for it. And, if I were going to take one of those drugs, it would probably be one of the NAD modifying drugs, because they exist, they’re used for other conditions, and they’re relatively safe. So we know that they’re safe, and so it’s kind of no harm, no foul. So that’s probably where I would look. I don’t know that they would be the most effective, but those are the ones that for many, many years, people have been looking at those as potential.

For the others, like Rapamycin… this is one of the hot ones that some people are taking and which, in animals, it works on particular factors that are associated with an aging response.

Yeah, the mTOR pathway, right?

Correct, correct. And they’re not benign. It’s not a benign drug. People look at Metformin, which is a diabetes drug, and there are reasons to believe that it also modifies aging factors. But again, it’s not free, there are potential side effects.

So, you know, everyone has to do what they do. But right now, I would say, there is not any single intervention of which I’m aware where there is nearly enough evidence in humans to justify a risk, if there is going to be a risk of taking those things.

Okay, well, listen, I really enjoyed talking with you. I always ask three questions of all of my guests that are more general science-based questions, to kind of see where people are coming from when they’re building the future, similar to what you are.

But before I do that, I would be remiss if I did not ask you one question, which is… you are in the biotech industry. I feel like you do have an insider view of how this industry works and the benefits that you can get from an overall health perspective. You’re a good-looking guy. We were talking a little bit about your weight and how to keep it down and stuff like that, just by lifestyle modifications… What are you doing in your own life? And, because you’re an insider, do you have any insight into stuff that you’re doing that might be atypical, that we might all get some benefit out of?

So in general, I do the things that I already mentioned, which is I take medication for blood pressure and cholesterol. I work out five times a week, five days a week. I have a routine so I don’t get bored. I mean, you know, Monday I do a certain thing. Tuesday, Wednesday, Thursday and so on. Actually, Tuesday and Friday are my days of rest and reconstitution. I watch my diet. I love cocktails and wine, but I drink on weekends and try to avoid it unless I have to go to a dinner with someone during the week. Because the old saw about red wine being good for you and so on… the data now has come in pretty clearly that there is no amount of any alcohol that is entirely safe. There is no level, and it is not beneficial. People used to think, well, it’s red wine and so on. It’s really not. In order to get enough of the resveratrol that doctor Sinclair talks about, you’d have to drink gallons a day of wine…. Don’t do that! So I drink moderately, but I don’t abstain. I’m not a monk. And sleep, getting enough sleep is really critical. Maybe the single most important thing you can do, because people who don’t sleep well also gain weight and have a lot of other things wrong. The one thing that’s a little bit off the beaten track… Oh, I’m sorry. I don’t eat red meat. I haven’t eaten red meat in 30 years. I eat poultry, I eat seafood, but I do not eat red meat except once a year. I have a tradition with a very good friend and my wife of having a New York pastrami sandwich on rye.

Oh, man, those are good.

So I do that once a year with mustard.

The one thing I have taken to doing more recently, in the last… I’d say less than a year… is partial fasting. And I really like what I’m seeing in terms of my metabolic markers, my blood sugar and so on, and just how I feel in my weight.

When we started this, as you know, I was finishing a banana, and you said, “Hey, what are you eating?” I said, “My breakfast.” And you said, “But it’s 1:30. How is it your breakfast?” Because generally speaking, I now don’t eat until after noon. So I’m essentially fasting. I have coffee, I have water, I have liquid, but I don’t eat calories until twelve, one, two in the afternoon. And that means that I’m fasting somewhere between 15 and 17 hours a day. And then the rest of it, I eat what I want. I eat a full dinner. I eat dessert. I do whatever I want. And what I’ve found is, for the first time in 30 years, I lost four to five pounds. Which I always wanted to lose and I’m now back to just above where I was when I graduated from college. I’ve been very impressed with the literature on that, with the overall experience on that.

There was recently a paper in the Journal of the American Medical association that did something else, along those lines, where people did a five-to-two fast or two-to-five fast. Two days a week, they ate one quarter of their daily calorie allotment. So they didn’t eat 75% of what they usually would eat in calories. The other five days, they ate normally. They ate what they want. This was actually a clinical study, and they compared those people who had diabetes to other people with diabetes who were taking particular drugs. And they found that the diabetic control of the five-two fasters was better than the ones who were taking medication.

Wow.

I don’t know if it matters how you do the fast, because this was five days normal, two days severe caloric restriction. Not total, but severe. In my case, I just don’t eat. And by the way, I work out in the mornings, so I don’t actually get hungry until after noon now. I don’t get hungry until after noon or 1:00 and so it’s easy. It’s effortless.

Good for you, man. That’s really interesting because I feel like it’s… I’ve talked to a lot of people in biotech. I’ve talked to a lot of people in the longevity space. Everybody says the same thing about alcohol. You know, that the mindset is shifting. I think a lot more people are less interested in alcohol. So that’s cool. And then the fasting thing is also a pretty similar commonality. So thanks so much for sharing your insight in the biotech industry, all the different exciting breakthroughs that are happening.

Motivation and Inspiration

I did want to talk with you a little bit about just generally, you know, where do you gain your inspiration from? It’s something that I ask all my guests. There’s also two other questions that I ask all my guests. But, you know, I saw you just hold the Superman mug up. I know that you’re interested in science and breakthroughs. So, as you can see from my background, science fiction has been a big interest of mine and a big promoter for a lot of the research that I do and a lot of the interests that I have. But what about for Ron Cohen? What is your big motivation for going into biotech as opposed to acting or practicing medicine?

You know, I still act every now and then. I got a part in a movie two years ago. It was a streaming movie. I really enjoyed it. So it’s not like an either or. It’s a matter of emphasis. What I discovered about myself… You know, my dad was a neurologist, he was a doctor. My mom was a concert violinist. So I have those influences. I love the arts. I love theater. And I actually get inspiration from my reading, from certain plays, from certain dramas that explore aspects of the human condition… But really what I discovered is somehow I came out of my upbringing with this impulse to heal, to make people feel better… I can’t explain it. It’s just there.

I totally get that. I’m the same way. I come from a family of physicians, and it’s just inherent in us.

The thing that crystallized it for me was when I was a medical student. Third year, they let us on the hospital floors. Until then it’s like college, you’re studying from books and so on. So you get your little white coat and your white pants, and you have your stethoscope around your neck, and you’re going out. And my first two years in medical school, I was still wrestling with this dichotomy of maybe I should leave and go to acting school after all, because this is just like college. It’s, you know, and I really want to get on stage.

What kept me sane was I went to Columbia Medical School, which was the only one in the country at that time, and I think still is, that actually admits students who can populate an orchestra because they’re musicians and are dancers and actors, because they believe that that will form a more humane environment. A more holistic environment to produce physicians who are not just great scientists and skilled at medicine, but also humanists and skilled at dealing with people. And I think that’s right. So I did two full scale musicals every year I was in medical school.

Wow.

That kept me sane. But when I got onto the floors one day, it was early on, I walk into a room, and there’s an elderly woman sitting up in her bed, and she looks frail, and she looked at me, and she said, “Good morning, doctor.” I know this sounds weird. When she said that, it was the way she said it, the way she was looking at me. I understood at my core that, number one, she thought I was a doctor… I’m a medical student. I know nothing… but she thought I was a doctor. But what was in that “Good morning, doctor.” and in that look was, “I hope you can help me, because I am sick, and I’m afraid.” And that washed over me, and in that moment, I gave myself over to it, and I no longer struggled with that dichotomy. I thought, this is the greatest privilege a person can have to be in a position to try to help someone with their illness, with their suffering. And I’ve never looked back.

That’s awesome, man. I have total respect for that mindset, because I think that it’s a calling and it’s not a career. And I really do feel like, you know, it takes a special person to recognize that. So thanks for sharing that with us.

The only other thing I’ll add is, what has kept me in biotech is realizing that now I can have that impact. If we’re lucky, if it comes through, if we can create one drug that affects hundreds of thousands or millions of people… even tens of thousands of people…I can do more that way than I could do in individual practice, and that’s what’s kept me going. And, of course, even being a CEO of a company, I get in front of patients all the time. I get in front of doctors and APPs, the physicians assistants and nurses all the time, because I still feel like I’m part of that healing community.

That’s awesome. So we talked a lot about biotech, where do you think it’s going to be in ten years? I mean, like, do you think that it’s going to be a situation where a lot of these diseases are a thing of the past? Or do you think we’re just going to continue to build on where we’re at right now? What do think about that?

Predictions for the Next 25 Years in Biotech

You said ten years, right?

Or 20 years. You know, give a time frame that you feel comfortable with.

I mean, I’d say 25 years, because I like that structure from Gates and Hood.

I can’t say specifically what will happen. I can say, in general, there will absolutely be certain cancers and other diseases that will be curable 10, 15, 25 years from now that are not curable now, that maybe you can help a little. There’s no question about it. There will be certain cancers where they’ll be a thing of the past for 90% of the people who have them.

Wow.

There will be autoimmune diseases like MS and various… Well, I mean, actually, MS is a good one. That may also effectively be cured by then. There will be other diseases where we can’t do anything now – certain cancers that are so virulent that you can barely do anything, like metastatic pancreatic cancer – that will, at a minimum, be much more controllable. People will live years and years longer with them. And there will be stem cell therapies that will reconstitute certain organs. Or repair heart muscle tissue, for example, in people who have had heart attacks. And actually, maybe not cure, but manage heart failure in a way that we can only dream of now. You can go on and on, and there will be, as we discussed, there will be therapies where routinely you go in and you put a gene or a gene therapy into the womb, and you wind up with a child who’s normal, who otherwise would have had a terrible genetic disease.

That’s awesome. I really hope that we live in that future. I think that’s something that everybody can really get excited about because I do think that there’s so much pessimism associated with the future. And when I look at biotech, I see all upside. And as opposed to other fields, I think that, like you, I see the logarithmic growth happening in the field. New breakthroughs are coming out every day, like we were talking about. Certain diseases are being fixed on a daily basis, like sickle cell. So I’m really excited to live in that future.

So, last question, the biotech industry aside… and even AI aside, because we talked about it… what other technological breakthroughs are you looking at as just a normal person that is not associated with the career that you’re in?

I can tell you mine, just to kind of give you an example. I cannot wait until we have personalised robots. I feel like when I have a robot that is able to clean my dishes, I’m going to be first in line for that robot. But what about you, Ron? Is there anything that you’re looking at when you read through the news that you’re really excited about that you can’t wait to happen?

The Importance of Fixing the Entire Healthcare System

So I’m going to answer that in a second. There’s one other thing I wanted to add to what I said before, which is the threat that I see to this amazing future in healthcare, in medical advancement and innovation. Which is no secret, especially in the US. Well everywhere, but in the US we have a very convoluted healthcare system. It’s very unequal. If you’re wealthy, you have the best care in the world. If you are not wealthy, good luck, because it’s unbelievably expensive and out of pocket costs and the insurance industry is screwed up and so on. And the part of that system that gets the most criticism is in fact the biotech, biopharma, pharmaceutical companies, because of the high prices of medicines.

What I would implore your viewers and listeners to think about is 95 plus percent of the people I know in my industry are like me. They are motivated, not by the money… you know, everyone wants to make money, everyone wants to make a good living and so on… they’re motivated by the calling, by the mission.

It’s expensive as can be, it’s billions of dollars to develop a single drug successfully. So you cannot avoid having high prices for drugs if you want these things to occur. Because if you want, 25 years from now, to be treating everything with the same drugs we’re using today, that will be cheap because they’ll all be generic, but you won’t have the drugs of tomorrow.

Everyone is guilty, and no one is guilty. Everyone’s trying to do what they’re supposed to do, but the system works against them.

So there’s a balance here. And I’m not saying that everything’s wonderful in the biopharmaceutical industry. What I am saying is, it’s the whole system. It’s the insurance. It’s the pharmacies. It’s the wholesalers. It’s the drug companies. Everyone is guilty, and no one is guilty. Everyone’s trying to do what they’re supposed to do, but the system works against them.

So when you’re debating it around the table and going to your Congress representatives and so on, ask them not to bash our companies and prevent us from innovating. Ask them to figure out a better overall system so that it’s more equal and that we can still invest in these miracles for the future.

Closing Thoughts and Final Questions

And to your other question, you know, I’m going to go back to one that we’ve already talked about for my industry. What turns me on is AI/machine learning in general.

I was just thinking about this the other day because our dishwasher broke, and we had to come in and have someone fix it. And so for a couple of days, we’re hand washing everything, right? And our daughters were doing it, my wife was doing it, I was pitching in. And I was thinking, “Wow, 75 years ago, before they had dishwashers… for all the history of humanity, this is what people had to do.” There is a point at which there are so many of our daily activities that are already taken care of by refrigerators and all of the household machinery we have, and washing machines for clothes, and so on, that what else do we need that will make a fundamental difference in how much time we’re spending? Well, a smart robot. Yeah, a smart robot would. So I think that’s reasonable.

But other than that, I find myself less turned on by things like that and more turned on by AI and what it can help us do and understand better. Not just in medicine, but in terms of going to Mars and in terms of understanding the universe and understanding where we came from. And that’s what turns me on. It’s the idea that intellectually, we will be learning and understanding things… Kind of like when Louis Pasteur came out and said all these things that you think are evil spirits, it’s actually these little things called bacteria. And then we found out about viruses and it opens up everyone’s eyes and you think about the entire world and the entire universe differently because of it.

When my wife, who is a communication specialist in biotech…She was pre-med, took all the pre-med courses. Before that, she’d been a sociology major. And I watched her as she learned the science, biology, chemistry, organic chemistry, physics, anatomy… And I watched her and I watched the way our conversations changed. And you know it, because you’ve been through it the way I have. When you get that education, you can’t look at the world differently. You can’t look at people… when I see a person, sometimes I idly am thinking about ( I know this sounds weird) but about the digestive tract and where the liver is and so on. And why do they have that flush on their face? Because you understand the world differently. I want to understand it 100 times differently. And I think AI is going to help us do that.

That’s cool. Yeah, I totally agree. I think it’s going to revolutionize every single industry. And I really appreciate you chiming in on that.

Thank you so much for joining us. I really feel like I learned a lot about where biotech is right now and where we are going, and I’m sure our listeners also would agree with that. So thanks so much, Ron.

And for all of our listeners who are listening on a regular basis, thank you guys for tuning in. Please like and subscribe as always. And for those of you guys who are tuning in on a regular basis, I will see you in the future. Thank you, everybody. Have a great day.

Thank you. This has been terrific. 

Important Links

• Dr. Ron Cohen – LinkedIn
• Dr. Ron Cohen – X
• Acorda Therapeutics
• Dermagraft®

About Dr. Ron Cohen