Good afternoon! It's a very special afternoon, so I want to
welcome distinguished guests, students, faculty, and friends to this really special event. The inaugural Ernest S. Kuh distinguished
lecture. Each year, the Kuh lecture will bring to campus
an outstanding leader in the field of engineering. We are delighted that Dr. Andy Grove will
launch this wonderful event today. I'd like to thank our student co-sponsors
for helping with today's event. The Berkeley chapter of the bioengineering
society, and a new group on campus that was chartered just this year - we are proud to
welcome them, they are called "O Stem", Out in Science, Technology, Mathematics to the
college community. And those are the guys in the engineering
shirts - Here, and they should be all around. I want to pay special tribute today to Ernie
Kuh, the former dean of the college of engineering, professor emeritus, and a trailblazer in the
design of integrated circuit systems. Kuh Lecture was endowed through the generosity
of Ernie and his wife Patine, and they're both here with us today. Ernie's achievements are many. His pioneering work has had a huge impact
on electronics. Particularly the design of IC's. He was a cofounder of cadence design, transferring
his research achievements to industry. At Berkeley, he was teacher and mentor to
some 40 PHD students. As Dean of Engineering, from 1973-1980, he
contributed nationally to the advancement of engineering education. His tenure was marked by great growth in the
college - in fact, the Bechdel Engineering Center where we sit today is a part of Ernie's
efforts as dean. Ernie is a member of the national academy
of engineering, the Chinese academy of sciences, and the recipient of a host of top ons. In 2008, he was inducted into the silicon
valley hall of fame. It's an honor to be his Berkeley colleague. And I might say he was dean when I was a student
at Berkeley, as well. Ernie, I'd like to present you with a memento
to commemorate this inaugural event. [applause] This would normally have been my cue to say,
"I'd like to join you in this case to say a few words", but professor Kuh has a very,
very sore throat. And as a result, he has lost his voice. So, I will welcome his son to the stage, and
please Tim come to the stage to But before I hand it off to you, come up to
the stage! Come on! [laughter] Come on! Come on! [laughter] Before I do that, I'd like to aknowledge and
thank Patine, for her many years of support to the college. And we are all most grateful. Thank you very much Patine! [applause] Ernie and Patine's two sons are both alumni
of Cal, and Tony is on the faculty as the chair of electrical engineering and science
at the University of Hawaii. He can't be here, but his wife and family
are here. And Ted is also an alumnus from the Haas school
of business, and he's here, and I think he's now going to pitch in for Ernie and talk a
few words. Please. [applause] Good afternoon. Well, today started with a 7am call from my
mother, who unfortunately told me that my father was under the weather and had totally
lost his voice, so I'm a pinch hitter for my father's speech. I asked my mom actually to give the speech
because she was, is, significantly responsible for my dad's success and I have nothing to
do with his success. [laughter] So I've made a few editorial changes - dad,
I hope you don't mind. [laughter] Here goes. Thank you Dean Shastry for your generous remarks. I am truly grateful. Thank you Chancellor Bourgenoe for attending. Patine and I are so very happy to endow this
wonderful lecture series. I came to UC Berkeley in 1956 from Bel Labs. I supervised many excellent PHD students. Some of them are here today. And I enjoyed working with faculty, staff,
and campus leaders, including chancellor Elbert Boucher, chancellor Michael Hayman, and chancellor
Tian. Meeting my wife Patine some 55 years ago has
been the highlight of my life. I want to also mention our two sons, Tony
and Ted. Tony is a professor and chair of electrical
engineering at the university of Hawaii. Ted is an investment banker, most recently
with Citigroup, and next term he will teach a finance course at Cal at the Haas school
of business. I owe a great debt in my career to many faculty
colleges whose friendship I have greatly valued. I want to mention just a few. My good friend and schoolmate from Stanford,
Don Peterson, brought me here from New Jersey, and I have been here ever since. With Charlie Dissor, my classmate from MIT,
I wrote two well-received textbooks. The best teacher I ever had was Ernie Gilleman
of MIT, who taught me how to teach. And finally, Lot Fizade, a Berkeley computer
science professor whom I succeeded as chairman of EECS and gave me invaluable support and
advice when I served as dean. I also want to say a few words about our distinguished
speaker. I have read Andy Grove's books, and have always
been enormously impressed by his achievement in science and technology. His role in the invention of the microprocessor
changed the world. When I visited him at Intel when he was CEO,
he sat in a cubicle in the middle of a huge room, working side-by-side with his fellow
employees. Indeed, he was a pioneer in both technology
and modern management. I thank Andy and all of you for being here. Thank you. [applause] Well, thank you so much everyone for coming
to this lecture, and thank you Ernie for making the lecture possible in the first place. This new Kuh lecture expands the wonderful
legacy that you've given Berkeley as dean and professor, and we're deeply grateful. One of the special privileges of being chancellor
is that one gets to meet many remarkable people. Great leaders, great spirits, big thinkers,
captains of industry. But it's very unusual to find all of the attributes
that I just described in one single person. But this case, in today's speaker, Andy Grove,
we indeed have such a rare individual. As everyone here knows, Andy is a true legend
in the electronics industry and in the growth of silicon valley. Not only because of his achievements and leadership
in technology and business, but because of his personal dynamism and his commitment to
reaching for big, new, game changing ideas. I guess, Shankar, that means he was the inventor
of big ideas. Andy earned his PHD at Berkeley in chemical
engineering in 1963. Five years later, he founded INTEL corporation,
with fellow Berkeley alumni Robert Noice and Gordon Moore. He's lead the company as it's former chairman,
CEO, and president. And today, he remains as senior advisor at
Intel. He's done pioneering work for technology,
is the author of six books, and nearly single-handedly shaped what today are the best practices for
managing high tech enterprises. He's won nearly every honor around, from election
to the national academy of engineering, and I have to say Andy, the following I like especially
- he was selected one year as Time Magazine's "Man of the Year". Recently, some of you may have seen that the
Wall Street Journal published an article about Silicon Valley Leaders who are involved in
helping undocumented young people gain access to higher education and jobs. Andy Grove, together with his spouse Eva,
are among those admirable leaders who have courageously supported educational access
for undocumented youth. Understanding that it is an issue important
not only to sustaining equal opportunity but also to the economic health competitiveness
of California and US more broadly. In fact, I wish we'd had you here yesterday
because at the end of the day yesterday we had a reception to celebrate the first scholarships
that we've been able to give to our undocumented students because of the path they chose, AB130,
and next year, as of AB131 we'll be able to provide them conventional financial aid, including
cal grants, and it was probably one of the most inspiring events I've been at since I
became chancellor of Berkeley. We though there were about 50 undocumented
students, and 140 have turned up and gotten financial aid. These are courageous, wonderful young people. At Berkeley, we are proud to call Andy a very
good friend. He's been a benefactor and a sound advisory
to a succession of chancellors, including myself and deans of engineering, including
the two of them sitting there and several others in the audience. In recent years, he has turned his efforts
to advancing medicine and patient care. He's been patient advocate at UCSF and has
worked to further research on prostate cancer and Parkinson's disease. He does great work in many areas, through
the Grove Foundation, and we are proud to have with us today his partners in that effort,
his wife Eva, but also his daughter Karen, who's a Berkeley engineering alumni. [applause] As you will learn today, he is passionate
about shortening the time it takes to translate new technology to better, affordable patient
care. Central to that effort, he has been a driving
force in the creation of a master of transnational medicine degree program, which is awarded
jointly by UC Berkeley and by UC San Francisco. It is my great pleasure to welcome Dr. Andy
Grove. [applause] One more remark. [applause] Andy, before you begin your talk, I'd like
to mark this occasion in a special way. The Chancellor's Citation is given to distinguished
visitors whose presence honors our campus and achievements the university salutes. And to celebrate your remarkable career and
your long partnership with your alma mater, we are delighted to award you the chancellor's
citation. [applause] As I was listening, I wondered if you were
counted among the immigrants? Congratulations! [applause] Before I start my talk, I would like to explain
the title. The title is a little bit of history. As the chancellor said, I have been concerned
about the speed with which medical developments take place and compared several occasion how
we do similar things, how we increase the learning process to get results faster. I discovered that whenever I made these comparisons,
fairly aggressive blog writers crapped on my head. Berkeley. Mario Savio would agree. The only good news about this - he was consistently
complaining about microchips are not men, and men are not microchips. But as he kept doing this, he decided to call
the possibility of comparing these two things as the andigrove fallacy. If you knew me well, you would know that I
am green with envy every time I hear about Moore's law. [laughter] Well, Gordon, you don't have a fallacy. [laughter] The
problem with the speed of discovery is that a small part of - it's a very serious problem. Economically, it is single-handedly capable
of doing major harm to the US economy, comparable to a handful of wars, financially. The more we drive the engine, the less it
wants to move. This is one of an infinite number of statistics
showing that when you compare the United States to advanced countries, life expectancy - there
is an advantage to being in the US. US medicine did do something with all the
money that we spent on it, but it seemed like we are driving the whole thing into separation. So how do we break out of that situation where
the more we spend, the best we can hope for is to not make things worse. Before even thinking about that question,
I want to tell you about the US government's part and participation in this problem is. It takes the shape of two very major organizations. Lots of PHD employees of longterm standing,
dedicated and hardworking people - not alltogether different from an academic campus. The NIH is responsible for developing science
for medical use, the FDA is supposed to make sure that when the science becomes a drug
it is safe and effective. And CMS is - how many of you know what CMS
is? Two? Four? CMS is your building agency and healthcare
matters. Every time you get a statement Your treatment
- which I will not remind you what it is - would have cost you two million dollars. But since we give a major discount, it only
costs 20,000 dollars. That is the work product of this CMS driven
financial system. I want to talk a little bit about each of
these blocks. By the way, I should say the person who writes
the blogs might as well say that these are my personal opinions. Occasionally supported by data. [laughter] My data is no worse than his data. My opinion is better than his. [laughter] The NIH is responsible for the scientific
work. And there's a phrase using the principle of
the phrase to prioritize what gets funded and what doesn't. And that phrase is, "When everybody has left
these medical science business, we want the best science." Best is hard to quantify, but at least it
ought to be directionally definable. It isn't. It is the instruction given to groups of people
to judge the merits of different proposals. Best wins. And if the people disagree, there's no metric. Relatively few facts that set the value. Consequently, there seems to be an arbitrary
referendum to make decisions of the NIH which over a long period of time average out. But in facing any given problem, this vague
instruction does not help focus. The second building block I want to talk about
is the FDA. The food and drug administration. That doesn't have anything to do with food,
it has a great deal to do with drugs, and it is probably one of the strengths of the
US medical system we have a strong organization dedicated to make sure that drugs are safe. This responsibility was given to the FDA many
years ago back in the 1930s. And it is a fairly simple one. Actually, when you start arguing any safe
turning into a carcinogen, you have to go to congress to get a definition. What is worse, the FDA has shown, or was urged
to evolve admission in a creeping fashion where in the 1960s, due to a variety of things
that took place, the senate passed an addendum to the law that gave it a responsibility for
effectiveness. So thereafter, a drug could only be taken
by you if it was safe and if it was effective. Effectiveness is even harder to define than
safe. I can illustrate that. This is a mortality curve. Percentage of people surviving at any given
time. It happens to be the victorious result of
20 years of work and prostate cancer immunotherapy, and I dare say that if you wanted to bet with
me that if we did the same trial over with another cohort, there would be as much difference
between the two cohorts as between the drug and the control. Nevertheless, this has become an accepted
medication. The FDA said that it was safe and effective. The treatment cost about 100,000 dollars a
year. The effectiveness, if what you see is real,
is pretty minimal. What are we not spending money on, when you
spend 100,000 on someone like me - I could very well be a candidate for that - and get
a few more months of life? It's a very hard question. What is not hard is to face the fact that
a dollar is a dollar. If you spend it on one project, it did not
get to be spent on another one. So with your judgment - as much as it is odius,
as much as it is a lot more controversial than going after the best science - is mandatory,
because dollars are finite. So what happens when you have severe conditions
imposed by a drug that you barely understand? You reject a lot of them. And every time you reject a drug, the surviving
drug is a lot more expensive, because the cost of the failed drug has to be lumped on
something, and it lumped on the survivors. How much more expensive - this is a chart
showing the cost of the surviving drugs as a function of time, in billions of dollars. A few thousand years ago, the only thing that
civilization was able to do, to build, to spend on, that was of that kind of magnitude,
was the great pyramids. You can actually go back and calculate the
workflow, the hours spent, the cost per hour (because even slaves cost money) and come
up, you think of when you think of an FDA approved drug, think of the great pyramids
of Giza. And it takes a long time. And it is getting longer and longer. People are not chips and chips are not people. 14 years is the last number that I could find. It is eight years old itself. But it's a very, very troublesome time. It is very troublesome because it causes people
who live out of the success of their investment, where the success is measured by the money
you make and how fast you make that money. An undesirable activity in the field of medicine. This year, particularly, DC firms withdrew
fairly rapidly from the healthcare department, and the cash in the seed start ups looks like
a rock dropping. I am not bleeding for venture capitalist's
personal wellfare. I am bleeding because venture capitalists
so happen - can be shown to be the most effective way to move the results from the lab to the
market. You can wave your arms - I can wave my arms. Why? It has been true that both because the regular
systematic mechanisms are slow and because the entrepreneurial problem solving mentality
present in the venture system is good. And it is exactly that - this effective capital
use - effective in the terms of speed, that is withdrawn from the market. The second problem, which I can't prove with
other people's data because they don't even look for it, when you invest in a new drug
or a new procedure, you are motivated by finding a solution to a life-science problem for a
good result. You come up with a drug, you sell the drug,
everybody is happy. Well, almost everybody. But, if you come up a manual method, that
does the same thing as the other one, at a fraction of the cost, I call that cost motivation,
it is also good, if we took that prostate cancer drug and came up with a way to deliver
that effect for a fraction of what it cost, I would be less critical of it. Very few investments appear to be clearly
motivated by cost analytics. In fact I was prepared to say that in an effort
to be prepared for this talk, I couldn't find even one. I was at a meeting on Monday, where this new
class of this Mathis program that you heard about a minute ago, we participated in that
and picked a project. I had to pinch myself. Half of the projects were cost motivated. That is an exceedingly good development even
if it happened by mistake. Now there is one more problem that cannot with the FDA, MIH. These results
that you develop to justify that your product is safe and cost effective are literally loaded
on a crock in a typical case. They are not digits. They are paper. They are driven to Bethesda, the decision
is random, put into long term storage that looks something like what you have here - just
a lot bigger. I hesitate to ask, how many of you are comfortable
with the phrase "big data"? Not as much of a difference as I thought. In an age where digital processing is practically
free, where digital storage is practically free, you can build deposits of data in incredible
amounts and process them as fast as you can dial a phone number. What is possible in this world, called "big
data", at the moment, in the hands of futurists. But there's going to be a huge deal and one
of the huge, hugeist of the huge deals would be the ability to see through all the data
that was collected from hundreds and hundreds of thousands and hundreds of thousands of
patients and find answers to questions of people who are not in that data bank yet. It's very complicated, it will be very expensive,
and I would love the federal government to spearhead that kind of work, such that because
of the scholarships available I would get a full raise of hands. Somebody I know made an observation that I
invite you to jot down. The observation is that life itself is one
big clinical trial, but the data are under lock and key. The data has to be open, available to other
researchers, the lock and key has to be replaced by only protecting the identity, and it is
like the king's riches that has come out of this data depository. With that, we can discuss money. The agency that the government gave the task
of deciding how much a treatment is worth is the CMS. The abbreviation, if I remember right, stands
for Center for Medicare, Medicaid Systems. It is the price determination, determiner,
or rather the reimbursement determiner for anything the federal government has a stake
in. It is not very clear how it works. I can tell you how it starts to work. To apply to the American Medical Association,
a brand new revolutionary agency, they determine a new code - in engineering terms, product
part number, product number is needed for this. Then they invite opinions, should it be approved,
these have already of course paid at the altars of the FDA already. In their backpack they already carry this
cost. And at this point, they start arguing - if
that radiation treatment moves in, what happens to to the surgeons? On and on. Ultimately, they don't get turned down as
much as they get priced out of the market. And the price negotiation that plays between
are not required to have all the stakeholders present, and take place with very minimal
process of what it takes to approve. It is as un-transparent a process as anything
you can find in the workings of federal government. I actually wonder if the freedom of information
act applies to this kind of thing, but I've never heard of it. A participant who actually has business with
the CNS, so I should be careful, has said that determining how drugs are priced is a
complicated exercise, involving methods that are not readily apparent. Let me show you what he was talking about. Here's a quote from the CNS procedure book
- I will not read the whole thing. "Intermediaries - pharmacy-benefit managers
and group-purchasing organizations - negotiate prices with drug manufacturers on the basis
of a variety of considerations, blah blah blah." About a month ago, one of these cases ended
up in federal court, and the federal judge vacated to a previous decision and his opinion,
I kid you not, said [laughter] Who says engineers are not literary? So, we have a health organization, health
world, 2 billion dollars, by various estimates, 30% more than it needs to be and we have NIH
which has, in my opinions, problems with priorities, FDA, whose creeping complexity, creeping charter,
and the CMS with what I call obscure pricing. It always bothers me when somebody from outside
the United States criticizes some US institution. It really hurt in the gut when a few weeks
ago I saw this as a headline of the economist. They were using the healthcare problem as
a more general. Actually, it is worse than that. This over regulation costs a lot of money,
in spending and in opportunity lost. But it is really bad that it costs a lot of
money in all these ways, and without a strategy of what are we trying to do with the system. What is the first, second, and third priority
of what we are trying to do as a society? At this point, I remember my blogger. Just for a minute, let me compare the medical
flow with technology as we know it. Free technology, minimal regulations. The first thing you will all know, volume
is king. When before Intel was formed, I was a freshly
minted PHD and I didn't know what the standard things, but I did have an office which later,
as I gained experience, I lost. And the office for some reason was the meeting
place of two manufacturing managers who were ostensibly coming there to beat me up for
something but ended up arguing because half an hour before they came to meet with me the
then manager of the fairchild semi-conductor, Robert Noice, that you heard about, went down
to Los Angeles and at a meeting of the fleece balls of industry, which are most of them,
and asked that integrated circuits, parenthetically developed by and for the US government, to
shoot missiles at the Russians, very expensive, very quality conscious, $40 - $50 a piece,
Fairchild did quite well with them. Integrated circuit told the people in Los
Angeles would cost one dollar a piece. These two guys - "One dollar?!" It was maybe 10 years later when the people
who were struggling to sell integrated circuits for 20 cents would have killed for the dollar. But it was a different world. That's when professor Kuh came, that's where
all the fleeceballs got their act together, and integrated circuits became electronics. I don't have such a story about microprocessors. I was a little more conscious and I appreciated
the order enough of the process - the order went like this. I say to them, "I just sold four chip microprocessors
in calculators." "How many calculators are there?" "At least a thousand." "I sold them into traffic lights!" "And how many traffic lights are there?" Microprocessors became inexpensive, well understood,
and tens of thousands of engineers knew how to program them. Because they took the application that they
served and took another step, and another step, until we have today's chips. With 20.2 nanometer critical characteristics
having billions of transistors in them, costing dare I say just a few dollars. To see how these differ, microprocessors and
people, I have a special illustration of that. First, let me call attention to the vertical
axes, so we are seeing some certain orders of magnitude drop on the characteristic of
how long it takes for an MRI machine to be deciphered as time went on, every strategy
light became digital MRI prices, MRI performance, it went on. By comparison, that horizontal line is the
average test result in a blood panel. Lipid panel. Just bad chemistry. That is the difference, and I think we should
consciously look for dedication where Moore's law works. Because God didn't give us Moore's law, he
would do more than give us Moore's law. Your predecessors in the labs worked for them. And they paid incredible benefits. In people, too. And now for a bit of levity, what is going
to happen - we're going to do these things. What is happening to other kinds of industrial
goods if you don't do a good job with them? Some other country does. And we'll label it with a kind of a hang dog
lock designed in Gilroy. Manufactured in China. Because you can't develop an industry without
doing at least a sufficient amount of each of the functions involved in the production
of process. And we've lost a lot of industries. All manufacturing put together, the percentage
of the world. Blue line is the US, red line is China, they
crossed over a couple of years ago. People can't understand why we have such a
obstinate job situation. Recession is over. Demand is up. Jobs - maybe a little. I think this is where we need to look. And the points I'm making is that there's
going to be another place where you can look for it. Clinical trials is a labor intensive, not
terribly - a bold of lightning is going to hit me - a very difficult undertaking, but
it is sufficiently easier and cheaper in many advanced countries like the UK, as well as
many developing countries. They are moving, like electronics did, like
TVs did, like machines did, and we're going to be there wondering what happened to employment. Something has to be done. And it's big. This industry has to be changed. Not by one law by congress when it's in a
good mood. But with hard work, step after step. And it's not I am saying it. There's a quote here from every one of the
three building blocks that represents the federal government's part. Reengineering Translational Science, Francis
Collins, NIH. The opportunity to remake the agency, she's
about the FDA, Andy von Eschenbach, the director of the FDA at the time, Healthcare is headed
for a cliff - Donald Berwick, then - head of CMS in fact in his goodbye speech. So what would we do if we were really serious
about healthcare? Your life may depend on it. Your parents' lives are going to depend on
it. Your child's life, your childrens' lives are
going to depend on it. If you're not going to be serious about that,
what are you? So I did what I do, excuse me, did what I
used to do when I was young and employed - I dusted off the manage and buy objective system,
and level by level, working with my colleagues, set out things that need to change. I will close this speech by giving some examples
of what this might look like. The first, the larger letters, are the statement
that the result we want to achieve, it is supported by things we do to achieve that
result. That's all. You can save thousands of dollars that you
can offer as an entrepreneur. First thing is you need to facilitate the
reallocation of healthcare resources so it bears some dynamic act to the need. And there is a number of things I would do,
and I won't get into justifying each of them. But I do want to call your attention to the
last one. Transparency, discussion, analysis, the clash
of opinions supported by data, that is where people win. We can improve on those. The second one, I would look at a separate
group, becoming an international business, I gave you a teeny bit of illustration of
trials, but unless we manage this a little bit more carefully there won't be anything
left to develop or protect any more than you would buy an american TV set. So I would put a cabinet level office in charge
of that, using transparency and debate data experiments, find a better balance. And last, I would teach, as a compulsory subject,
health care economics that every engineer that goes to work in a smelt, or in a silicon
mine, is taught, the economics, the tools with which you compare one business with the
other, the way you run experiments to measure the rate of change, and you can teach that
at a level appropriate for graduate students, which is usually a little more detailed than
the one we throw at upper sophomores, but they all need to learn it because they need
that language. Otherwise, we are going to be throwing opinions
at each other, and if we don't like somebody's opinion we call it a fallacy. We badly need that. We need to understand economics, we need to
be transparent, and I'm just going to drop the last thing. No field of study is as sensitive, as reluctant
to undertake evaluation because they may be controversial, where they can have contracts
creating comparative effectiveness studies and fund it, with the role that they may not
mention cost. We are so afraid of the truth. We are so afraid of the hard decisions in
this society, that that alone is going to sink us. Thank you. [applause] Thank you very much Andy. That was a fantastic talk and provocative
as usual. I'm tempted to take a look at what the blogger
had to say about you. I'd like to invite members of the audience
to ask some questions, and I'd like to make sure that we get our students out here. We have microphones - Karen is holding microphones
out there. When you use the microphones, please tell
us your name, major, and year in school. So please. One right behind you, Karen. Hello Dr. Grove, my name is Christopher Anderson,
I'm a senior here studying mathematics and economics. So earlier, you talked a lot about the need
to combine government organizations so they can effectively respond to changing priorities. I remembered that in the context of longer
and longer approval times for the FDA, for instance. What are your thoughts about how we should
change our priorities? For instance, do you think we should shorten
the time for approval, through the cost of a less thorough process? I think I would approach this by having a
degree of harm, not treat all harm or all effectiveness as the same. And by some working definition of that, introduce
judgement that is shaped to be more systematic. The penal system has such a judgement. You're guilty or you're not, but then they
don't give you the same sentence. Thank you doctor. Hi, my name is Jeff Unis, and I'm a third
year bioengineering PHD, excuse me I'm a little nervous. You mentioned at the beginning of the talk
two of the building blocks. One of them was the FDA, which is a regulatory
arm of the government, and the other one is the NIH, which is a funding arm of the government. And for both of them, you mentioned that they
have some serious drawbacks for when it comes to health. For example with the NIH, you said that some
of their funding is somewhat arbitrary, and I can understand that - being a researcher,
I sometimes see labs get a 50 million dollar grant, and sometimes I see them get a 10 thousand
dollar grant. I'm not really sure if those are tied to the
value that those labs bring. In terms of regulation, you mentioned that
they've had increasingly more responsibilities of what they have to prove in order to bring
a product to market, for example they only used to have to prove that a drug was not
harmful, but now they have to prove that it's effective, or more effective than other products. I also heard that when Intel was founded,
the national priority was to build large mainframes and to fund large mainframes. To build small monitors was pretty much considered
a crazy idea and you couldn't get funding. But then I'm surprised that an appropriate
approach would be, in terms of electronic medical records, was to have the federal government
spearhead new initiatives. Also have offices that try to evaluate the
costs and the values of these programs. So I'm wondering how you reconcile those two
approaches. On one hand it sounds like funding as well
as regulation through the government is harmful, Can I help focus the question? Yes! [laughter] You're asking why I did not mention electronic
medical records? Well you mentioned the big data, and you said
that the federal government should be the one to spearhead that. And I think that, it seems like that you want
them to spearhead that, but you're not sure how, because you have the concern of both
having them spearhead the regulation as well as the funding of those initiatives. Neither has anything to do with electronic
medical records. I think electronic medical records were a
market development effort by industry that I have not encountered anyone who is an enthusiastic
user of. The warehouse in Bethesda does not have a
constituency. He just sits there, writing away. Has the world's information in it. So why do I want to take, and introduce a
tool of questionable productivity, in place of mining the secrets of the pharaohs, it's
my opinion. Andy, I thought one of the other questions
was that when you talked about Intel, DOD paid for the NRE, for the chips, but then
it actually needed somebody with insight into this mass market and volume as king, and that
was the commercial driver. I think part of his question was what was
the interplay between the federal government and paying for sort of the basic research
of the NRE, but then later the volume drivers and the commercial drivers really lowering
the cost. Maybe I'm just making up this question, listening
to you. I didn't hear it, but I'm glad to go where
ever you take me. How would you like to fly in a commercial
airline system? That was treated with the technological sophistication
of the FDA warehouse? Hi, my name is Jeffery Zhou and I'm an undergraduate
molecular cell biology major, and if we have regulators whose job are measured by the number
of bad drugs on the market, or minimizing that number, that's solely what their jobs
are measured by it seems, how would we change that in order to have a more balanced regulatory
system? There are one hundered and ten million people
in the United States who have a job. They are all evaluated in systematic or not-so-systematic
fashions. How many did screw up? How many did they let get away? How many did they do too long? This is, this kind of evaluation is what is
used by most modern businesses, small or large, to move on and evaluate their employees in
the system. Why is it different for the federal employees? And actually, if they had a system like this,
I don't think they would come up with a particularly bad or undesirable outcome. That's only my opinion. Doesn't the public demand, when they hear
a story about, people get mad. People don't get mad if a good drug is not
released. They use the prevention, too. You don't let the public's demand through. One more question back there. Hi, I'm Tony Keevney, and I'm a professor
of mechanical engineering and bioengineering, and thank you very much for your presentation. I think one of the challenges with a health
economics approach is people are afraid that a government body will make a decision about
what kind of implant or procedure they will pay for. So in England, for example, you either use
the generic cheap hip implant that the government decide everybody should have, or you're on
your own. And I think that's something that people in
this country don't get excited about. So I just get a sense of your reaction to
that? I'm not sure. You're asking me to express my leanings on
this subject? You know, two people reasonable people can
disagree on where the government should be the dominant force and where private enterprise
should be. But I don't think we would have too much disagreement
if we were to require a good performance from each of them. And defined what that is. Ok, so I'm being asked that - so we can continue
this conversation. It's been a fascinating afternoon with you,
Andy, and we knew it would be. So thank you very much to Ernie and Patine
for providing this wonderful forum. Thanks to you, Andy. [applause] Such a memorable inaugural lecture! [applause] I want to thank our student co-sponsors, the
bioengineering honors society, and Out in Science, Technology, Engineering and Mathematics,
Out in STEM, OSTEM, for helping us host this event, and I hope all of you will join us
for a reception right outside in the Garborini Lounge. Thank you all very much for being with us! And Go Bears!