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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!
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Kuh Distinguished Lecture: Andy Grove, Intel

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