Please enjoy this transcript of my conversation with Jake Becraft, the CEO and co-founder of Strand Therapeutics, a company building one of the most advanced programmable genetic medicine platforms in biotechnology. Under his leadership, Strand is redefining what RNA medicines can do by enabling cell-selective targeting and therapeutic payload delivery inside the body, unlocking a […] The post The Tim Ferriss Show Transcripts: Tim’s Founder Kitchen — From Brainstorm to the President’s Office in Two Months (Featuring Jake Becraft, Strand Therapeutics) (#868) appeared first on The Blog of Author Tim Ferriss.
Please enjoy this transcript of my conversation with Jake Becraft, the CEO and co-founder of Strand Therapeutics, a company building one of the most advanced programmable genetic medicine platforms in biotechnology. Under his leadership, Strand is redefining what RNA medicines can do by enabling cell-selective targeting and therapeutic payload delivery inside the body, unlocking a new class of precision genetic therapies.
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Tim Ferriss: What does Strand do?
Jacob Becraft: So Strand designs what we call next-generation genetic medicines. You have DNA inside of your cells, the DNA makes RNA copies of itself, and then that RNA makes proteins. And actually life is all proteins. Your skin, your hair, your organs, every cell is basically just proteins stacked together. That is everything that we are. You don’t really see the DNA and the RNA. It’s very small. The protein is what we think of as our being, right? And so the way to actually intervene in disease, the way to get to its core is to create the correct proteins.
If you have a deficiency, everything from an enzyme problem, to a rare disease, to cystic fibrosis, it’s usually a problem with a protein that is being incorrectly made by a cell. And so what we have figured out over decades and decades is what’s gone wrong with that protein, and what would need to go right to fix that protein or how you would replace that protein correctly. What we have not figured out is how to make the cells do that, right? And that’s because it’s a very complicated problem to tell certain cells in the body to do various different things. And so what we are really focused on building, we know what proteins need to be made. We know where they need to be made. What we need to do is get the message of what type of protein to the place in your body where they need to be made, and we need to do that effectively and safely.
And so what we have essentially figured out a way to do is take that message, which is in the form of a molecule called RNA. A lot of people are familiar with it from the COVID vaccines, but those are very small examples of what RNA could actually be utilized to do. And then we have found a way to send those messages into the body, into diseased areas where they can access the cells and essentially return the cells to a state of homeostasis, which either corrects the problem or in the case of cancer, removes the problem, any of those pieces. And so that’s the base case of what we’re trying to accomplish.
Tim Ferriss: Mm-hmm. So let me back up and give people a little bit of context. So the first time we met was in Boston at a dinner. Do you want to describe, I don’t think they’ll mind, who else was there? Who else was at the dinner?
Jacob Becraft: Another biotech CEO, Phil Strandwitz, and a — I don’t know how to classify Jamie’s job.
Tim Ferriss: Bit of a polymath.
Jacob Becraft: — professor at the MIT. Yeah, polymath, MIT Media Lab, professor, healthcare entrepreneur, advisor to anyone who wants to know fancy things.
Tim Ferriss: Mm-hmm. Great guy. Yeah, so I’m already an investor in Holobiome, Phil’s company, love what Jamie’s up to and very interested in what he’s building as well. We can put that in the show notes. We’ll put all that in the show notes. And then we met and part of the reason I became very interested in Strand, there were a lot of reasons. So one is the technology, the results, the photograph, or I should say, images that you showed me, which we’ll get to in a second. The second is founder, builder who is technical, but for whom also this company, this is going to be a strongly worded statement, but is existential, right? You’re not a hired gun CEO who has been brought in, right?
This is very much entwined with your identity and personal mission, which I find very attractive. And quite interrelated with that is the fact that I found you to be a very good communicator over that dinner, right? I learned a lot. You recommended a number of books to me at the dinner and then afterwards. I’d say chief among which was the Genentech —
Jacob Becraft: Fantastic book.
Tim Ferriss: — origin story, which is one of the best, I would say, business books I’ve ever read. Just unbelievably good because it also, and I can’t believe it made it past all the Genentech censors, but it’s actual contracts, screenshots of contracts, negotiations, mistakes, all of the serendipitous, lucky moments and unforced errors by universities and so on, that had to coalesce for Genentech to even survive. It’s just an incredible story. And I also, just again, this is more for people listening than for you, but I’ll continue to fluff a little longer, which is also that you seem to me to be very aggressive without being haphazard, right?
So you were just furious at this dinner when I started to try to get an idea of the general biotech scene in Boston, and asking questions about various startups, and figures, and companies, at how conservative and dogmatic, maybe would be a very generous way to put it, you view a lot of folks, not all, but the default, right? The status quo. And in contrast how you’re going, you’re taking big swings, right? You are taking big swings. So all of those things were attractive.
When it comes to Strand, let’s talk about the image for a second. What was the image that you showed me, or images?
Jacob Becraft: Yeah, so I happened to show you a photo of one of our patients, one of the very first patients that entered our trial, the way that these early-stage trials work in oncology, so then a patient with stage 4 melanoma, in early-stage trials, you end up with patients who have been through every, exhausted every option by the time they end up in your trial. And they often have pretty progressed disease, right? And so you hope you can offer something to these patients.
They had melanoma, so that’s a skin cancer, but they had not only aggressive, what we call cutaneous metastasis, which is across their surface of their body in the skin, but they had what’s called visceral metastasis. That’s actually what kills you in melanoma is the metastasis to the organs of your body and it was in their lungs. It was in other sorts of areas, so I think muscle deposits and bone deposits. And in addition to that, this patient had had multiple other therapies that historically actually respond very well to, melanoma responds very well to.
What’s unfortunate about the current state of affairs in melanoma and in some cancers is we have these immunotherapy drugs. What the biggest blockbuster of the last few years is a drug called KEYTRUDA from Merck. Incredible miracle drug, won a Nobel Prize a few years ago. In melanoma, if you respond to that drug, a lot of patients do. That’s great. If you don’t, the likelihood of survival begins to diminish very quickly. And this patient had had KEYTRUDA. They had had a whole number of other drugs through many, what they call, lines of therapy. You’d get a drug, your cancer responds or it doesn’t. If it doesn’t respond, you go to the next and the doctor, the oncologist cycles you through a number of drugs. And this patient was at a fairly advanced hospital that not only had given them the, what they call the standard of care and then the second line standard of care, they had given them actually a number of other, just like, maybe this will work, maybe this will work.
You’re trying to help the patient stay alive. And the picture that we have, and this is in, if someone, if you Google our ASCO poster, which is a big clinical oncology conference.
Tim Ferriss: Can you spell ASCO?
Jacob Becraft: A-S-C-O.
Tim Ferriss: Mm-hmm.
Jacob Becraft: It’s an abbreviation for the American Society of Clinical Oncology. It’s a meeting every summer in Chicago that is the big breakthroughs in clinical medicine for oncology, right? It’s the top of the top in a lot of ways for people. Big results, small results. We had presented this photo there, and I had met you a little bit afterwards to show — the photo itself is quite striking, and it’s in that poster, right? Which is this —
Tim Ferriss: Yeah, it’s basically a body riddled with cancers, right? They’re everywhere.
Jacob Becraft: You don’t have to be an oncologist to look at that scan and understand the extent of which this patient responded, just riddled and then no more. And one of the things, as a scientist, right, Tim, you mentioned something earlier, which was that this is more than a company for me, and actually a company is only about one third to one half of the time that I’ve spent on this mission to make genetic medicine work correctly for patients. One of the greatest accomplishments in that career that I’ve had thus far is being able to say that you did help a person. If that was just one person, one patient, I’d say, “Wow, what a career.”
We dream of more. We have big ambitions here at Strand. I have ambitions for what we’re going to, how many people in the scale at which we’re going to be able to help people. However, that was the first time that I really felt like our science went out into the world, and it took someone’s grandmother and not only kept them alive, but we’re a year and a half in, and they still have no detectable lesions.
Tim Ferriss: Yeah. Yeah, it’s wild. So in the investor deck, right, the pitch deck that I initially read and had, I apologize for that, but 1,500,000 questions about, what, for the non-technical folks, right, the muggles. They can look things up and are curious, what are things that stuck for them? Particular slides or phrases, certainly the images, but is there anything else that comes to mind that really resonated with people from that deck?
Jacob Becraft:I think there’s one other bigger generalist investor who had come into the round personally, and I had been having a conversation with them about something in oncology that we call the Kaplan-Meier curve. Kaplan-Meier curve, if you’re looking at oncology results, is a survival graph. So you maybe look at two years, and you look at, from 100 percent where you start the study, and then it looks like a step ladder going down. The standard of care line has some amount of people, steps down, and you want to have your drug be significantly above that, right? Either having more people alive longer or you have, what they call, the long tail where you, everything goes to zero in standard of care at a certain time point, but you have an amount of patients that just look cured. They continue on for many years.
In drug development, we get very used to looking at those graphs, and making very statistical calls, and saying, “Oh, this doesn’t look like it’s active,” or, “This drug’s there or isn’t that great.” But I think one of the things that I’ve spoken to some generalists, some of our larger investors who maybe aren’t from the biotech world, and I’ve tried to zero in on some of those survival graphs with, is to say, “When we look at these steps, these are lives, right?” The lines that go down on this, that the vertical part of the step is someone’s loved one dying. But the ones that go horizontal, and every time you see something go further along, right, that is someone who got to, even if it’s just three months, right, you have no idea what that means within that person’s life.
When we take that Kaplan-Meier curve, and those steps, and we zero in on each patient, we start to look at them and we start to say, “This is a patient that didn’t think they would see Christmas in 2024 and they just celebrated the new year of 2026,” that I think is meaningful in what we’re doing. Now, whether or not that will be a good product, right, there’s a difference between a good drug and a good product, right?
Jacob Becraft: I’d say the good drug is, can someone take this and it does something. Injecting a therapy into someone in a way that is very hard to replicate but did a great thing for that individual person is a good drug fundamentally. It is a good drug. It helped that person. And a good product is much more — this is where the idea of how we get medicines to people come into play. I’ll give you a different example. There’s something else that we’re working on called in vivo cell therapy. Essentially, there’s an entire type of science that we have discovered how to take the immune cells out of a patient, take their immune cells out, reprogram them so that they learn how to attack cancerous blood cells, and then put them back into a patient.
They are phenomenal drugs. There are people who are about to die of myeloma and then they get this drug. But the drug costs, not making money, the drug costs $750,000 to make, just to manufacture. It costs three months of time to manufacture. It’s very hard to see a world in which that drug has a large impact on the patient population because of the fundamental cost, the COGS, the cost of goods sold. Not biotech, just straight business. The cost of doing it and the time it takes to get it to people, that’s a bad product.
And so if you could, say, instead of taking the cells out of the body, if you could reprogram them while they’re still in the patient, now you have a good product. If you can make the cells recognize the cancer, the immune cells programmed to activate against the cancer in the same way, but make it an outpatient procedure where a patient just gets hooked up to an IV bag for two hours and then goes home, that is a phenomenal product.
Tim Ferriss: I have to look at this from the perspective of a non-specialist because that’s what I am.
Jacob Becraft: Yes.
Tim Ferriss: But if you were giving a TED Talk on this and had to get across at least part of what you’re doing, I feel like what you just said hits the nail on the head within the first few minutes.
You’d have to talk about the central dogma, so to speak, of DNA as master copy, so to speak, mRNA, and then protein. But just in brief, could you describe the treatment? What the treatment actually looked like for the patient in those photographs, the before and after? Like dots everywhere representing tumors, and then holy shit. I think everyone, whether they’re technical or not, that looks at that deck, probably had the same response to those images.
Jacob Becraft: So in cancer, you have chemotherapy. I think people are fairly familiar with. You also have immunotherapy, which is the ability to activate the immune system to attack the cancer directly. And that’s what some of the biggest blockbuster drugs of all time are currently Merck’s Keytruda, Bristol Myers Squibb’s Opdivo. And then there’s a number of other types of immunotherapies which are classified as checkpoint blockades. So what that is, is your cells essentially have a way to tell the immune system that they are your cells. So you don’t want your immune system to attack your own body, obviously.
And so one of the mechanisms that you have is this “I am you” signal that you can send to the immune system, your cells can send to the immune system. Cancers hijack that mechanism to protect themselves from being attacked by the immune system. And what we figured out was a way to block those signals. And that’s the entire field of immunotherapy. Not the entire field, but I would say a vast majority of the field of immunotherapy. And the successes of the last decade of treating cancer and also commercial success for a lot of these companies has been based on further refining better checkpoints.
The problem with that is that they’re all very similar mechanistically. And so if one doesn’t work, if you have cancer and I give you Keytruda and it doesn’t work, the chances that the next types of therapies will work, since all of them are very similar mechanistically, the chances diminish quite drastically. And there’s some nuance here. And I’m sure if there’s oncologists listening to me, they’re like, “No, but you don’t know. And double negative this cancer if you combine with these.” It doesn’t matter. In general, these mechanisms become degenerative and we don’t have good additional options to excite the immune system.
A second theory for going back to the ’90s was, if instead of just blocking the cancer’s ability to hide from the immune system, if that’s not enough, what we actually need to do is we need to activate the immune system directly. And it would be best if you could send that activation signal from the tumor itself. So now you have a tumor. Instead of just blocking the tumor’s ability to hide, you actually have a tumor that’s screaming like, “I am a foreign object, please come and eat me.” That’s how immune systems kill things. They eat the other cells.
And so the issue. This is not new. This is basic science from immunology from the ’90s. The problem is, we haven’t had a good way to get the tumors to send those signals. We’ve tried to make the signals in the lab and then inject them into the tumors. And the problem is the signal just goes away immediately and then it’s circulating in the body and the immune system doesn’t know what’s sending the signal. We’ve tried everything we can to make this signal artificial and get it into the tumors. And every single time we do it, it’s either not enough in terms of no efficacy, or it activates the immune system in all sorts of places we don’t want it and it causes all sorts of toxicities.
And so what we are doing with our medicine is delivering the instructions into the cancer cells in a way that causes the cancer to basically send its own signal out. So it’s artificial in that we have made it in a lab. But instead of making the signal, we’re making a message that tricks the cancer into sending the signal. And so that is drastically different. It makes a huge difference in both safety and efficacy. Because now you are recapitulating how the signal works naturally. If the cancers weren’t cancerous, if they were just deregulated and cells were starting to grow out of control, your cell would naturally send the signal and be like, “Oh no, something’s wrong.” And your body would take care of it.
You actually generate cancer all the time in your body in terms of dysregulated cells. Your immune system just comes in and takes care of it before it becomes like a — when it becomes a real problem, that’s when you get tumors, that’s when you get the disease we call cancer.
And so what we’re doing is we’re resetting that system. We’re having the tumors resend the signal out. And so what we created in that first drug was a very simple administration procedure. You take our genetic medicine and you inject it into the tumor directly. And what that does is the immune system comes into the tumor and it kills it. But then it gets activated by that killing process and it learns what the tumors look like and it can better identify the other tumors that have been hiding throughout the body.
Tim Ferriss: That’s the point that I was hoping to get to. It’s basically like, in the case of this patient, not to belabor this point, but it’s like you injected, if I’m remembering correctly, into cutaneous, meaning just under the skin, I’m not sure what the right term is, nodules, like instances of cancer. So my follow-up question is going to be like, well then how do you suddenly get to the visceral instances, right?
Jacob Becraft: Yeah.
Tim Ferriss: And I think that’s what you’re describing, right? And within the world of oncology, is that a novel observation? Is that something that is new in terms of being able to do that?
Jacob Becraft: So it’s something called the abscopal response or the abscopal effect, which means that one tumor is what you’ve put the activating drug into, and that’s where the immune system will attack first. But now the immune system is activated and educated to go and kill the other tumors. It’s not new in the fact that I didn’t come up with that name. It has been observed in limited other settings of a few other drugs that people have gone out with. I guess the problem has been that it’s been very, very limited in terms of the abscopal response that other people have seen.
So for instance, you would have a patient with a tumor, maybe melanoma patient, so they’d have a cutaneous lesion, a skin lesion on their chest. And then they’d have another one on their shoulder. And you would inject the one on the chest and the shoulder one would also shrink. And they’re in the same region, right? The immune system is fighting the cancer in the same region. But you wouldn’t necessarily see that happen in the lungs. And so, one of the big pushbacks on a drug, like the one that we took to the clinic two years ago was, you don’t die from having tumors all over your skin. You die from when they metastasize into your lungs and into your liver and impact the organ functioning, right? That’s how patients die of melanoma.
So if you are only able to address the tumors that you can either inject or that are near the injected tumors, you won’t have an effective drug if a patient already is further along. We are, to my knowledge, one of the first companies, if not the first company, to demonstrate that a direct injectable drug into the tumor in a large number of patients — this isn’t a one-off. It wasn’t one miracle patient that had… That is a beautiful photo of that patient. And I’m so happy that they’re still on the trial and still doing great and it’s amazing. But this is about being broadly applicable because that’s how you actually impact population level lives.
And so we are the first company that I’m aware of to show this extent of abscopal response in visceral, deep organ metastases in a multitude of patients. And really right off the bat. I mean, this is from the very first patients we put on this trial, at the very beginning of it, began responding. That is very uncommon. It’s very uncommon to have patients on a phase one trial on the drug six months later. And of our first three patients that ever entered this trial in the summer of 2024, two of those three are still on the trial 18 months later. That is something that, I think, is fairly shocking.
Tim Ferriss: Yeah.
Jacob Becraft: And if we were a traditional biotech company, we’d be really happy with all of this data and we’d say, “Wow, let’s take this forward.” However,I think the real message of Strand and what we can accomplish in genetic medicine is, we don’t have to stop it just injecting into the tumors. There are a number of concerns with injecting tumors from a product perspective. Not a drug perspective, but a product perspective. The difference between, a drug is all about does this work, and a product is about how will these patients get these drugs? And injecting directly into a tumor is doable and most oncologists can handle it, especially for skin cancer patients. But as you go to rural health communities, it gets harder and harder to have doctors that have that training. And as you get to other sorts of tumors beyond skin cancer patients, some of their skin lesions have been removed by a surgeon. And then you go beyond skin cancer. How are you going to inject a patient with non-small cell lung cancer?
Like you start to get this idea of there’s a limited amount of patients you can access, right? And so you have a product, maybe limitation. In cancer, the way that we actually treat cancer patients is that there’s an infusion clinic. You go to the infusion clinic. The oncologists and the nurse practitioners and everyone, technicians hook you up to some sort of an infusion, and then the oncologist can monitor multiple patients at a time. And that’s what our infrastructure looks like right now of how we treat patients. And if you want to have the largest impact in medicine, you need to make medicines that plug into existing infrastructure.
As much as you want to tell everyone, “Hey, change everything about how you think about treating patients,” the way to have a near term impact is to build drug solutions that can plug into existing infrastructures. If we become a giant biotechnology company that has all sorts of resources, maybe we can talk about changing how everyone gives drugs. But for right now, if we want to be able to help the most amount of patients in the near term, we need to plug into that infrastructure. We need to find ways that we can access organs.
I’d say, in addition, the bloodstream is also a really good way to get around the body, believe it or not. I mean, the bloodstream carries oxygen to everywhere in your body. And so if your drugs can travel through the bloodstream and get where they’re going, very effective. In genetic medicine, I would call it the holy grail. For the last 30 years has been thinking about how do we IV administer intravenous, which means into the bloodstream, administer genetic medicines that can get to places throughout the body. We’ve been trapped in one organ for the past 30 years, and that’s the liver. The liver naturally filters your blood and thus it picks up a lot of these genetic medicines that we put into the bloodstream.
And so what we’ve done for the last 30 years is figure out how we can treat diseases in the liver with this old internet meme, which is like, step one, blank. Step two, question mark. Step three, profit. I remember the old days of FRedit. People used to use that structure. Step one, do this. Step two, question mark. Step three, profit. In biotech, in genetic medicine, the joke is like, step one, prove it works in the liver. Step two, question mark. Step three, we’ll treat all these diseases. And after 30 years, we’ve really nailed step one. And step two has remained this big question mark.
And so when we started Strand, our number one goal actually was not even to get to this first drug, as amazing as it’s been for these patients and as happy as I am that we have been able to help those people in their lives and as impressive as it is. Our main goal was to solve this step two question mark that’s been sitting there in plain sight. And I guess the big piece here is that everyone who thinks they know what they’re talking about in genetic medicine will say, “Well, the issue is delivery.” And it’s like, you need to be able to deliver. And I’m like, “That’s a very hand wavy.” Again, it’s just a cheap answer, which is not wrong, but it is incomplete. And I believe that it’s actually three problems at once. It’s three children in their father’s trench coat pretending to be an adult.
It’s like, “We’re delivery.” And then you open it up and it’s like potency, specificity, and delivery are all here inside. And no one wants to hear that because people want simple solutions, right? They want like, “Oh, it’s delivery, so we’ll just fix delivery.” I mean, just 30 years in, no one has a good idea about this piece, right? And I’d say that the thing at Strand that when I started the company that I just could not understand why everyone didn’t see what I was trying to tell them. And I was very bad at pitching. You think I’m too much of a scientist. Now perhaps. Or maybe your audience does, if they’re listening. But like, man, you should have seen my very technical zero market insight pitch deck of 2018 that is complete dog shit. It is an awful — I can’t believe someone funded us.
I’m a huge fan of Elon Musk’s first principles-based thinking. I don’t know if Elon is the one who invented first principles-based thinking, but I think he’s probably the main evangelist and popularizer of this thinking modality, where if you take SpaceX, for example, his idea was, what is the thing preventing commercial space flight? And it’s dollars per kilogram of launch. It’s just like, dollars per kilogram. That’s it. How do you get it down?
And you start to like, “Well, where’s the cost centers in a launch?” And you go, “Okay. Well, the cost center in a launch is in these rockets, these fuselages —
Tim Ferriss: Trashing rockets.
Jacob Becraft: They were trashing — we’re trashing 80 percent of it. And you go, “Well, why don’t we just reuse them?” And people are like, “Well, they do this, they do that. They’re hard to retrieve. They’re in the ocean. They’re floating. They can’t…” And he goes, “What if they land themselves?” And it’s like, that’s an insane person thing to say.
What I want the world to understand is that we are standing right now on the precipice of a revolution in genetic medicine. And that’s important for a number of reasons. One, it’s important because there are near-term diseases that we’re going to be able to solve. We’re going to be able to get to a point in the not-too-distant future where I think a lot of types of cancers are, at the very least, chronic diseases instead of death sentences. We all want to get to cures. I want to get to cures. But we are getting at least to a point where it’s a manageable disease, right? That’s, I think, a near-term piece.
There’s multiple lines of technology that are coming together that I think people are not fully appreciating what they’re going to mean for the future of medicine. And so, there’s a lot of focus right now on AI-based drug discovery. And people, they’re building proteins and antibodies and all sorts of stuff with AI models that are doing incredible things. We have decades of work on designing exquisite proteins that do all sorts of stuff, from edit genomes, to cure whatever in some sort of mouse model.
What we don’t have is the infrastructure, the biomedicine infrastructure that gets any of these things, these discoveries, whether they’re made by a human with Microsoft Word stitching amino acids together, whether they’re made by an LLM that knows exactly all the pieces that are going to make this, whether it’s made by high-throughput screen of 14 different robots in concert. It doesn’t matter. What matters is how we’re going to get those into patients, how we’re going to get them into the places they need. And I think about this as this infrastructure of medicine comes forward and what this will actually mean for the future of healthcare.
Anyone in any sort of a place of power throughout the world, I think, needs to understand where, in the next 10 to 20 years, we very well may be headed with medicine. Which is smaller indications, niche indications.
So what’s important for folks to understand, and what I want people to see is, we are moving in a way where, I think, medicine becomes, maybe not completely bespoke, but much more refined. And the way that we get there, we’re going to get there technologically and we’re going to get there from a design perspective much quicker than we’re going to have the infrastructure to actually deliver those medicines to people safely, effectively, at scale.
And so our goal at Strand, and our challenge, is building drugs today that impact patients’ lives. We’re not a research institute. Our goal is not to do really cool research on mice and join the ranks of people who have cured mice of cancer. There’s millions of them. There could be a Nobel Prize every five minutes for someone who’s cured a mouse of cancer. Our goal is to cure human beings of human-being cancer. Our goal is to cure human beings of human-being diseases, and do so in a safe, effective, scalable way that impacts a person’s life as little as possible. And that is what we’re building. We’re building as a commercial organization. We’re building drugs today, but what we’re doing is we’re laying the groundwork for this infrastructure to where when we’re successful in tumors with the new trial that we’re running this year, when we’re successful with being able to IV deliver, infuse a genetic medicine that goes to the tumors, we have an instruction manual, what we call a payload, the protein that we’re tricking the cancer into making. We have one that we’ve chosen. But success there actually means that I could now, in six weeks, design a completely new protein to be delivered to the tumors. And I could just go over and over and over again. I’m only going to be gated by the infrastructure I have to build, like new ones of those, and the FDA’s ability to move quickly with us as we try to test new and newer things, but we know the general high level safety of this.
That’s coming, right? That’s coming in a lot of other areas of the body where we’re designing things to get into T-cells, so we can help temporarily influence the immune system so you could take out things like autoimmune disease and allow patients to revert back to their pretreated state without doing any sort of genetic modification. We’re trying to get all sorts of these therapies forward. And every time we have a success, we lay the groundwork for this infrastructure going forward.
I want people to understand it, one, because we have large ambitions. A lot of people have thought, first, they thought that the first principle-based approach we were taking was incorrect. They’re like, “It’s a delivery problem. You need to build a better delivery vehicle. Why don’t you focus on that?” And I’m like, “Okay, everyone’s done that.” Right?
Now, we’ve shown this complex solution actually fixes this age-old problem and we’re going to be continuing to move that forward. I’d say the biotechnology industry will be dragged kicking and screaming into the future, or it will be built up in a new way from new players. For us, I want to find the people throughout the globe who want to partner on these things, the innovators in America, right? And those are all sorts of different sorts of folks.
Tim Ferriss: Yeah. Let’s dig into that just for a second. For instance, with this podcast, let’s say I was like, “Well, I’ve got good news and I’ve got bad news. The bad news is, I can’t put this out to my whole audience. The good news is you get to tell me which thousand people I send it to, and that gets hand-delivered to a thousand people.” And I mean, a similar way to look at it would be like, “All right, you’re giving a TED Talk, but it never gets shared online. It is only for the thousand people in that room, but you get to handpick them. Who are those people?” And it could be categories of person, but how would you think about that?
Jacob Becraft: I think there are people, policy leaders not just in the United States, but across the globe that need to think critically around how we are going to both handle, enable, and empower the future of medicine because things, incentives, things are going to look quite differently 10 years from now than they do today, in terms of the scope and the style in which we can build medicines.
Tim Ferriss: And the policy leaders are important. Sorry to hop in, but because ultimately, they’re going to determine the rules by which healthcare is played. Is that one way to put it?
Jacob Becraft: Yeah. Healthcare is very similar to the space industry and that policy leaders essentially have two major pieces, is that they are both the arbiters of what is allowed to be done. And they are a major payer, not the only payer, but they are a major payer of the purchasing of that. And so as the fundamentals of medical development change. Now, I’m not making a drug that I hope to give to two million people worldwide. I’m making 100,000 variants of a drug that I’m hoping to give to 10,000 people worldwide, or 10,000 variants of a drug that I hope to give to 100,000 people worldwide. And I get to more people, but there’s more variants. Both the regulatory and the payment systems, I think need to adapt themselves to allow for that.
It’s on us, the medical innovators and the engineers and the entrepreneurs, to build systems that are still good products. You have to think about where you’re going, and then build a system that can still be a good product. If it costs 10,000 times as much, it’s not going to work, right? It just won’t work at scale and you won’t access these patients. But if you can see a path forward and think creatively — I’m not a politics guy, but I am fascinated by policy and how incentives shape the future of highly regulated industries like biomedicine, like space, like all these things, and that is regulation, plus payment. I think that there’s incredible work to be done.
And the last big time of, I think productive collaboration between worldwide policymakers and the United States as a leader, but the last big collaboration of that came in the ’80s when biotech started to take off. In the ’90s when it really ripped, right? When we started to harness the power of recombinant proteins, the Genzyme book, you plugged it earlier, that’s phenomenal.
Tim Ferriss: Oh, the Genentech. Yeah.
Jacob Becraft: Genzyme is the Genentech of Boston. I get the two of them were like — the Genentech book really, studying the history of Genzyme, Genzyme actually had the leader, Henri Termeer, who was the actual quarterback, I’d say, of the policy innovation, worked with government officials to figure out what will this new class of medicines look like that aren’t just small molecules that you can take home. Right? Now, we have antibodies. We have all of these drugs that are amazing because of it. We have the Orphan and Rare Disease Act [Orphan Drug Act], which led to people building these rare disease drugs. I’d say we need to have more productive, collaborative conversations around what the future will look like because things are going to change very fast.
I read the AI report from the White House, for instance, and how the state of AI is. And I looked at, I read through it and I was like, “They actually need one of these for biotechnology as well, because things are changing as rapidly and it’s going to be further accelerated by AI.” And if we don’t have some productive conversations, we’re going to be stuck in one of two places. One is where only the ultra rich can get the really disruptive drugs because they’re the ones who can pay for it, because we don’t have a system set up to have these new radical changes commercial quick enough or dispersed quick enough. Or the second is the inability to pay, the inability to find ways that support an ecosystem makes an uninvestable thesis for investors. And so all of these great innovations that we have coming out of the lab right now —
Tim Ferriss: Just die on the vine.
Jacob Becraft: — get cut off at their knees because, just like space, space industry, it’s a long time cycle to read these things out and you need capital to get there.
Tim Ferriss: So a lot of what I try to do in my own meandering way is kind of answer the thousand people in a room question, right? And then to figure out, it’s like, okay, let’s just say you’re spending time in DC. You sit down, their staffer convinced them to sit down for 30 minutes, right? What do you lead with? And then that can inform potentially the website or appearances on podcasts and stuff. So just in case it’s helpful, I can obviously share this afterwards too, but it’s like, a couple of things come to mind, right? And I think in terms of like, okay, once you identify the people in the room, then it’s like, what does the TED Talk look like if you got 20 minutes on stage? And you’re good at this stuff, but sometimes you’re so close to it that it’s helpful to have a muggle who’s coming at it.
Jacob Becraft: No. I want to hear this, Tim, by the way. This is a free communication lesson from someone much more versed in the area.
Tim Ferriss: Well, yeah, thank God because I can’t do science. So the allocate responsibility as well, I don’t want me in charge of developing immunotherapy. So the Christmas story and the photos, right? So if you started with that, I’m just like, walking through my made up TED Talk, right?
Jacob Becraft: Yeah.
Tim Ferriss: And then you talked about, let’s just say you went from there like, “Okay, let me take a sidebar for a minute.” And you talked about SpaceX and the reusable rockets, right? And the analogy also of like, once you have this engineering platform developed from first principles, now you have something that is payload agnostic, right?
Once you’ve made it economically feasible and you have this platform, whether you’re launching superconductors into space as an alternative to propellants for a satellite reorientation — you should check out this company called Zenno. I might have to redact this, but they’re in New Zealand, Z-E-N-N-O. They’re pretty fucking amazing. But whether it’s that, whether it’s something else, is entirely up to you in terms of deliverables because you’ve done the hard work of developing this engineering platform, right?
Then talking about like, “Okay, well, what does that actually mean for biotech?” And you’ve got the holy grail, right? How do you IV administer genetic medicine? And then you could segue and tell people. Because there’s a good drug and there are lots of good drugs that die. Why do they die? Because they’re never going to actually make it into production, so to speak, at scale in healthcare.
And I’ve seen a lot of analogies with this, and I won’t digress too far, but with psychedelic medicine.
Jacob Becraft: Yeah.
Tim Ferriss: And it’s just like, okay, you need, like, an overnight nurse. This is going to be an eight-hour experience or six-hour experience. And sure, you could argue that you might have the rich people pay $10,000 out of pocket and that subsidizes the — it’s sort of like Uber Black subsidizing UberX. There is an application there, but if it’s fundamentally incompatible with current healthcare, you’re trying to win a race with your ankles tied together, right? It’s probably not going to happen.
And then you have people looking at like, 5-MeO-DMT instead of psilocybin and stuff, and I have my own thoughts on that. But sure, it’s like you look at the failure just real quick, of like, MDMA-assisted psychotherapy when it got in front of the FDA advisory committee, a lot of reasons for that. But then you have people coming out of the gate and they’re like, “Oh, we tried to couple…” They tried to couple psychotherapy with it. The FDA does not regulate psychotherapy.
It became a huge quagmire of just confusion and therefore, these other people are like, “Well, let’s do methylone and has a much shorter half life, you can actually fit it into like an hour hypothetically.” Right? You can decouple the therapy or just looking at drug effects and lo and behold, it’s making a ton more progress, right? But the point of saying all that is that you’ve got the SpaceX, you segue to the holy grail, and then like, what if you could reprogram cells in the body? What happens? So I do love the fired up, like hand wavy delivery thing, right? Because you’re like, what they’ve missed is — and again, I’m ad libbing here, so it might be questions like, “They’re right and they’re wrong. They’re wrong because of reasons X, Y, and Z.”
Right? And this is a lot of hand-wavy stuff and we’re still at a point where we’re defining triple negative breast cancer by what it isn’t.
It’s like, if you have trouble with your shoulder and you’re like, “Well, good news, it’s not like elephantiasis and it’s not Parkinson’s disease.” And you’re like, “How does that help me?” It doesn’t really, right?
But then you say, they are right about delivery, in the sense that if you cannot plug this into healthcare and deliver it to end patients, game over. It doesn’t matter how effective it is in an N-of-1 or an N-of-5, or whatever your small clinical is, right? So in the idea, these are not necessarily in the order, but talking about like even though it’s not the end goal, what if we could turn cancer into a chronic disease that can be managed, right? And it’s like back in fill-in-the-blank, 1980x, right? HIV was a death sentence and no longer the case. Now, you look on television and it’s like, you see ad after ad related to some preventative, but also like maintenance drugs that allow people to live with the chronic condition.
So anyway, those are a few things that kind of hop to mind.
I would be curious, for policymakers, what are the things that most catch their attention, whether from experience or hypothetically, right? What is it that actually gets their attention?
Jacob Becraft: I was in DC yesterday, and my overarching message is sort of like, there are two things we need to do better. We have to build regulations that I think are common sense that still allow us to more cheaply test drugs right now for a lot of reasons. We have sort of vestigial over many years, reasons as to why it takes us a lot of money and a lot of time to just get to a simple answer on a medicine, right? And that is creating a world in which the biotechnology industry is incentivized to do very small steps forward because the cost of failure is so high that you’re trying to reduce your risk in a way that is, let’s make a drug that’s 10 percent better, right? Because taking a truly innovative risk would be very difficult, would be very difficult to underwrite for certain investors.
I’d say at the other side, the thing that catches folks’ attention is to talk about how medicine is fundamentally changing. And we all can see that AI is changing how business is done, how people build things, how people read things, how people parse through information. It’s making highly motivated people 10X better, if not more. And it’s not just AI and biomedicine, it’s sort of multiple threads coming together of novel technologies of how we build medicines, genetic medicines, and their sort of advancements, things like what we’re bringing forward. Our ability to diagnose diseases and subcategorize diseases and change the way in which we interpret how this disease is, the sequencing technologies which allow us to do that and other sorts of computation and AI that plugs into those pieces, all of that’s going to fundamentally change medicine, right?
Tim Ferriss: Yeah.
Jacob Becraft: Because if I can’t just make a decision around the drug that every breast cancer patient gets, and then I agree on the cost that that drug is, and I pay for it a number of years, and then the drug goes to generic and someone brings the next drug forward that’s 25 percent better and blah, blah, blah, and we just continue along that, that’s the non-innovative way in which we’ve been developing medicines for the past number of years. And every once in a while, we have a breakthrough. I’d say, policymakers tend to like that because it comes down to like, numbers, right? And medicine is a very interesting piece in policy.
Tim Ferriss: What do they like? Could you just say that again? They like the idea of breakthrough versus incremental.
Jacob Becraft: They like trying to learn about it. When you start to talk about medicine, it’s very interesting, because medicine, like, you think about paying for medicine, like the government or health insurer, but the government, paying for medicine is a near term cost center that should long-term reduce a larger cost center, right? Brand name medicines are eight percent of US healthcare spending, but hospitals are 26 percent, something like that, in the high 20s, I believe. And so you imagine that for eight percent of your dollar in healthcare spending, you are pulling down the amount of people that are now hospitalized. You are increasing people’s life. You’re keeping people in the workforce, you’re keeping people in their homes. You’re keeping people out of a system that both no one wants to go to the hospital and the government that pays for a lot of people’s hospitalization in the form of Medicare and Medicaid, doesn’t want to pay for people to go to the hospital.
And so you begin to talk about that system and you say, preventative healthcare, but all medicine to a certain extent, it can be thought of as preventative if it’s able to stave off hospitalization. It’s at least, at the very least hopefully, preventing you from being in the hospital. And so policymakers like those conversations.
Tim Ferriss: I’m going to try to keep this from sounding too conspiracy theory, but what I’d love to know is what’s in it for policymakers to help you? And that might sound strange, right? Because I’m not saying these are bad people and we could talk about the kind of industrial regulatory exchange programs another time, but like, that’s a thing, right? So I guess what I’m wondering is, how do you align incentives with policymakers so that they feel compelled and interested in being helpful? That’s the big question that comes to mind.
So let’s just say there are a thousand policy makers listening right now or if you’re in the room, but like what is your ask? If they’re like, “Hey, look.” Again, good news, bad news. “Bad news is I can’t meet again. I’m just too busy. Good news is, if you have a reasonable ask, I can greenlight it right now,” right?
Jacob Becraft: Yeah.
Tim Ferriss: But you need to do it. What is the ask?
Jacob Becraft: My first ask right now is we need to streamline how we test new medicines in humans, in clinical trials. In fact, maybe if this ever sees the light of day, hopefully the op-ed that I wrote on accelerating first-in-human trials and becoming a more innovative powerhouse as a country comes.
Tim Ferriss: Oh, where’s that?
Jacob Becraft: I just wrote it a couple of weeks ago and submitted it to a handful of places in the last couple of days. I think that it’s the single greatest advancement in biomedicine that we’re going to be able to make. And then of course, it opens a lot of doors for us at Strand, because we have way more ideas than we have the resources, time, and money to take forward at $50 million a try. But if you start to make it more simple, and a lot of these things are common sense regulations, we’re spending way too much time and way too much money doing things that I think are quite antiquated and vestigial in our regulatory process. And so if you can reduce that time and reduce the amount of money, then you can change the economics and the incentives around building new drugs. And you can begin to generate more diverse data that allows you to train things like AI models on what actually makes a difference in a drug and a human.
We just don’t have enough data and we don’t have enough diversity of data to be able to train them nearly to the level that we want right now. And a lot of it, just at the end of the day, it comes down to like, does this do something in a human? You could do all you want in the lab, you can do all you want in mice, you can do all you want in primate studies. Whatever it is that you do, it just doesn’t matter to nearly the same level until you do it with a human. And when Genentech and Genzyme were coming up in the ’80s and ’90s, it was a comically fraction of the cost and time that it takes to bring new medicines forward today. This isn’t an impossible thing. We’ve just created a lot of weird barriers and we need to get back to a first principles way of thinking within government as well.
I’m not the only person preaching that, and I’m certainly not the only one in policy that thinks about it. I’d say in America, we want to be the headquarters of innovation, but a lot of other countries want to be innovative too, right? In Asia and in the Middle East, there are countries that are like, “We can do this. We have the technology. We can make investments into the space. We can make investments into companies earlier that we think have a high leverage point in the future health and we want to go in those directions.” The United States is able to do it too, but that’s it, right?
Tim Ferriss: If you did an 80/20 analysis on the impediments and someone is like, “Okay, we want to streamline, but if there are 10 items on your wishlist, let’s pick two or three,” what are those two or three?
Jacob Becraft: One, I think is that we should remove the FDA from a direct permission-based oversight organization on the beginning of first-in-human trials. So let me just explain this for a different sort of audience, right? Right now, in order to do a clinical trial of what we call a first-in-human, the first time you give a drug to a human, a new drug, so a phase one, in order to do that in the United States right now, you need to write an IND, which is called an initial new drug application to the FDA. It’s very long. I think ours for our first trial was 22,000 pages long. You have to have professional writers, profession
