00:00:01
our guest today is Martine Rothblatt CEO and chair co-ceo and share of United therapeutics Martine you have an
00:00:11
extraordinary background and I thought I would give a quick summary of how your often described so we can get through a
00:00:18
lot of a lot of your accomplishments so Martine Rothblatt lawyer author satellite entrepreneur futurist pharma
00:00:27
tycoon philosopher helicopter pilot founder of sirius satellite radio chair and co-ceo of the biotechnology company
00:00:36
united therapeutics which you founded to save your daughter's life highest paid
00:00:41
female CEO in 2013 born a man now a transgender woman father of four spouse to the same woman being a flat for
00:00:51
thirty-three years I believe all correct Katherine that is an extraordinary life
00:00:56
to date so let's start with this question what accomplishment are you most proud of I think I'm most proud of
00:01:05
the family that Ben and I have created together my certainly my favorite part of every day is the part of the day that
00:01:13
I'm with bina my partner and the only thing that makes that even better is when we're with one of our kids or
00:01:20
grandkids I'd love to talk to you about your leadership you've led a number of
00:01:26
companies who founded a number of companies let's start with your life as a CEO what is a typical week in your
00:01:33
life if you if you're looking at the week ahead in your day when it's a typical week what's a typical week
00:01:37
typical week is interacting with different people that work in our company so if I'm someplace where I
00:01:45
could see them face-to-face I'd like to walk through the corridor I like to go
00:01:49
to people's offices I like to go into laboratories and I just like to say hi
00:01:54
what's going on whether you working on look people hi to I so that you can really engage with people and not make
00:02:02
them feel rushed like you're talking in an elevator you're on your way to
00:02:06
someplace if it's somebody that I mean they're scheduled to talk with or I know
00:02:12
they've requested talk with me or I need to talk them and we're not face-to-face then
00:02:16
I'll call them up so I spend you know a good chunk of each day I don't know
00:02:20
quarter of it maybe more on the telephone doing the same sort of thing talking through a particular challenge
00:02:28
or problem or different options and trying to reach a a kind of a mind meld with everybody I talk with in terms of
00:02:38
what should we do together next and you know you're leading a highly technical
00:02:44
company a company as I said United therapeutics which you founded to save your daughter's life when she was
00:02:50
diagnosed with pulmonary arterial hypertension you're not a you're not a
00:02:55
doctor an m.d. you're not a pharmacist as elite as leading this company how do
00:03:03
you navigate you know where you are pushing forward the scientific R&D agenda and where you are deferring to
00:03:10
others so it's on the sort of the larger scale issues Kathryn that I'm leading
00:03:16
and on the on the finer scale which which depending on how you look at it could be large-scale within a fine scale
00:03:26
domain I delegate to others so for example a classical decision would be whether to develop a medicine or not
00:03:36
I've never made one of those decisions dictatorial ii but i would lead that decision and and try to urge people to
00:03:44
see the benefits of developing a medicine for a particular disease and hopefully there's altom utley a
00:03:49
consensus to do so so that's in something that I would lead exactly how you go about developing the drug for
00:03:57
that disease involves literally thousands of sub decisions that have to be made in terms of for example a
00:04:04
clinical trial the the most important part of a clinical trial is what's the
00:04:09
endpoint a clinical trial is an experiment it's an experiment involving human beings therefore you have to have
00:04:17
a hypothesis and the hypothesis has to be stated in such a way that there's going to be sort of an either/or answer
00:04:23
that either-or answer is the endpoint depending on what that endpoint is a clinical trial which will take you
00:04:31
know millions of dollars and years of effort can either be set up to fail can be set up to succeed or can be kind of
00:04:41
of indeterminant failure or success um it's really somewhat in the in the science in the randomness whether it's a
00:04:48
successful or failure so I won't be the person that that sets the end points I
00:04:56
won't be the person that decides the main elements of the trial but I'll
00:05:01
definitely be the person that questions every decision that's made and I and
00:05:06
even them so my main job on the lower level is to question people's decisions
00:05:13
and to do the best I can to see that they have thought through the decision interesting so I know that in the
00:05:20
company there's a line one hears often once I think sees on your website certainly I've seen it written about you
00:05:26
that a motto or guideline to identify the corridors of indifference and run like hell down them what does that mean
00:05:35
so what that means it's it's actually it's great to them here at Wharton and
00:05:39
you're talking about that because it's a concept really I learned in business
00:05:43
school that originally I think that this principle was best identified perhaps by
00:05:49
Jack Welch the the iconic CEO of General Electric who said to be successful in the business you need to be either
00:05:58
number one or number two in that business and if you enter business you're not number one or number two
00:06:04
you're going to have to spend an amount of money equal to the revenues of number
00:06:08
one or number two which often could be a huge sum especially if you're just entering the business so instead it's
00:06:17
always better in business to be a big fish in a small pond to put it in a very cloak wheel sort of way then a small
00:06:27
fish in a big pond and I really absorb that lesson from business go at UCLA's
00:06:33
Anderson School and hence when we say identify the corridors of indifference that really means look for the small
00:06:41
ponds we're there are no fish and then run like hell down them that means jump in that pond
00:06:46
and become the big fish in that small pond and was just part of the the philosophy that led you to think I can
00:06:54
actually start a company and we'll make this a successful company around an orphan disease as I said the disease
00:07:00
that your daughter has um I can't really say that I was very intellectual about
00:07:06
founding the company to go after my daughter's disease I'm reminded of a great line that I read
00:07:14
just last weekend Diane Von Furstenburg most recent book the moment kind of whom
00:07:19
I want to be where she says she's built DVF into a huge enterprise and she said
00:07:24
she never had a business plan she just pursued her passion which for her was fashion for me as I had to save
00:07:31
Genesis my daughter and I didn't really think through it so much like okay this
00:07:37
is an orphan disease I'll be a leader in this business segment frankly I didn't
00:07:41
care if I made a penny in this entire area I just wanted to save my daughter right right so let's talk a little bit
00:07:48
more about the company United therapeutics you've had a run of successful medicines drugs but now are
00:07:56
moving to think about lung transplantation and xenotransplantation why the why the shift or why this
00:08:03
progression help us understand that choice sure so what we're trying to do is to develop a market for manufactured
00:08:12
organs and manufactured organs such as lungs for example are really just another type of medicine it's a medicine
00:08:20
that you take just one time and it pretty much cures your disease people are used to thinking of medicines as
00:08:28
something that you know are pills in a bottle or something that's injected in a
00:08:33
in a syringe but they don't have to be that way I mean for a number of years
00:08:37
there has been skin as a product for people who have terrible burns and it's
00:08:42
possible to grow skin as layers and lay it down for other conditions there have been tissues which are collections of
00:08:51
literally millions or even tens of millions of cells which are provided patience my original inspiration in in
00:08:59
manufactured organs was in fact from my maternal grandmother who required a porcine heart valve because she had
00:09:06
cardiac valvular disease and she would have died of a heart attack they removed her heart valve and put in the heart
00:09:14
valve from a pig this was in the seventies so it's been around for a while yep so that was my initial kind of
00:09:21
interest arm and and the credibility that I gave this field our daughter's condition and pulmonary hypertension is
00:09:29
treated by our medicine and in fact our competitors also have medicines for this
00:09:34
disease but not one of these medicines is a cure for the disease and the disease involves at least three and
00:09:41
maybe five different things going wrong in the body that's probably why it's an
00:09:46
orphan or rare disease because you need to have three to five different things all go wrong to end up with this disease
00:09:52
and as a result of that coming up with a cure like a silver bullet is pretty darn
00:09:58
hard because then you need actually like five cures you know to cure it it so happens that when you replace a person's
00:10:06
lung they never get the disease again so whatever causes the disease its resident
00:10:11
in the lung so to me developing an unlimited supply of manufactured lungs was just developing a better medicine
00:10:19
for my daughter and everybody else with pulmonary hypertension and where how far
00:10:26
away are we from a point when we will have this this ready supply of lungs lungs are in short supply now people die
00:10:32
all the time from unable to get transplanted lung and other transplanted organs how far in the future do you
00:10:39
think it is before I don't know yet over a replacement lung will be as common I
00:10:44
would imagine as a replacement hip yeah exactly so a question like this Katherine by its very nature you're
00:10:51
going to have like a bell curve of distribution of people's opinions that's
00:10:55
always the case when you're developing the next technology some people will say
00:11:00
that it's you know 20 years in the future other people will say it's it's
00:11:05
two years in the future the reality is probably a bit more finely granulated than that
00:11:11
because new technologies they don't pop into being fully formed and perfect if
00:11:17
you take a look at something that people love right now the iPhone well it began
00:11:22
as a hi pod and if you're old enough to have had like you know an iPod one or
00:11:27
iPod two they look pretty weird compared to like a iPod Nano today so the manufactured organs will start small and
00:11:37
grow larger and larger to get to the point of today where pretty much anybody that needs an artificial hip can have an
00:11:44
artificial hip there's two or three manufacturers to choose from I think you'd be looking at the end of the 2020s
00:11:50
and I would say that that would be not so much just my opinion but sort of like the center point of of the bell curve
00:11:58
and you'll find some people that would say that point would be in the 30s you'd
00:12:03
find some people would say it could be earlier in the 20s I think you'd be really hard-pressed I would certainly
00:12:08
say this less than 5% of any medical experts in scientists would say that there will never be an endless supply of
00:12:17
manufactured organs this is a engineering challenge not requiring new laws of biology to be discovered yeah
00:12:25
fascinating fascinating so you you talk about developing technologies and you've
00:12:31
written recently the book virtually human the promise and peril of digital immortality digital immortality what the
00:12:40
what in the world is digital immortality so digital immortality is what is what you have when you combine big data with
00:12:49
AI so big data is the outside of our device storage of all the different digital data points about our life all
00:12:59
of our Amazon eeper choises all of our social media tweets and posts all of our emails all of the surveillance data from
00:13:08
when we swipe an ID card to enter a building public surveillance all of this stuff is stored ultimately and they're
00:13:17
out there with them actually multiple cloud provide and so that's big data AI or artificial
00:13:25
intelligence is an operating system that tries to replicate one or more functions
00:13:32
of the human mind so there is AI that for example can navigate your way around a new city just like your mind would try
00:13:41
to navigate your way around a new city there's AI that can recognize multiple
00:13:47
on the can recognize Kathryn or Martine out of a list of 50 different photos many of us even have that AI now on
00:13:54
Google photos on our phone so it's a kind of operating system so what happens
00:14:00
with a virtual human is when ie AI gets better and better and better and cobbles
00:14:07
together dozens hundreds even thousands of different types of AI software programs and is mated with the part of
00:14:16
big data that is Catherine's or Martines part of big data you then can have a
00:14:22
digital simulcram or a digital doppelganger that will certainly look like you it will sound like you a voice
00:14:31
and images are not that difficult but more remarkably we'll begin to think and
00:14:36
analyze and perhaps even feel like you because it will have had access to so much of your history this is such a wild
00:14:45
thought so a few a few questions about this I think what many of us think about artificial intelligence we think about
00:14:51
sort of thinking thinking thinking programs memories we can map problem solving you know yes a computer can play
00:14:59
chess we get all that part of the something that I certainly hadn't thought about before reading your book
00:15:05
was oh it's gonna look and sound like me it's gonna be a clone of me why would we
00:15:13
want that well I think people want it in a number of different applications it's
00:15:18
remarkable to me Catherine how many new technological developments have arisen from trying to help with a human
00:15:25
disability for example the telephone which we all take for granted that grew out of Alexander Graham Bell's efforts
00:15:32
to help the deaf another example of the scanner which we use to every scan me this PDF me that that arose out of Ray
00:15:40
Kurzweil efforts to help the blind find a way to read things other than Braille information so what's happening right
00:15:48
now is that as with the aging population there are larger larger numbers of people who are suffering from dementia
00:15:54
and Alzheimer's and my own company United therapeutics has already received a patent on what we call an Alzheimer's
00:16:02
cognitive an abler and this would be a software system that would employ visual recognition image recognition voice
00:16:10
synthesis and voice recognition to be able to interact with family and friends visiting an Alzheimer's patient who has
00:16:18
lost the ability to interact on their own wow that is that is mind-boggling so I'm reminded of discussions about you
00:16:26
know and when if we sign an agreement you know do not resuscitate if we're when we would make a decision that we're
00:16:32
ready to die but this might be our body our doppelganger our mind clone is making the decision for us based on our
00:16:41
thinking our thoughts encoded in this machine when we can't think them any way
00:16:47
absolutely Catholic but whoa flashback fifty years ago okay imagine like our grandparents yeah
00:16:53
can you imagine our grandparents signing a do not resuscitate order I mean they would say what do you mean resuscitation
00:16:59
I mean my heart stops I'm dead the notion of like there being an AED every hundred feet in in a shopping mall that
00:17:06
could bring a dead person back to life that doesn't exist fifty years ago and now we think it's routinely possible
00:17:13
that if you code in a hospital the odds are not 100% but are pretty good that they can bring you back and hence lawyer
00:17:21
said you know you if you don't want to come back with the tube in your mouth
00:17:25
and tubes out your nose and whatnot you better sign a DNR order so and so it is for the 21st century generation they'll
00:17:33
get comfortable with the fact that there will be mine clones some people will want their mine clone to continue to go
00:17:39
already there are apps on Twitter for example the tagline is when your heart stops beating you keep tweeting
00:17:47
okay I saw that in your book that is so creepy yeah but you know it's it's
00:17:52
creepy to actually bring a dead person back to life yet we do that routinely so I have in my book what I call a social
00:18:00
acceptance of weirdness chart and things that are creepy or weird whatever word we want to use they change over time in
00:18:09
society there was a time when there would have been nothing creepier than the notion of in vitro fertilization and
00:18:16
a test-tube baby was considered an abomination there are now something like 2% of all births in America are IVF
00:18:23
burst I mean it's a common way to be it's a big minority group and I do believe that as we move forward with
00:18:30
these virtual humans a future version probably not passed the 2020s of DNR orders are going to include my mind
00:18:40
clone and and it would seem to me that this really will could change so many things including in some fundamental way
00:18:48
perhaps our our relationship to death our sense of I mean it would assume a lot of rationality on our parts I might
00:18:57
to not be sad to leave my family but I'm leaving my mind clone behind you'll
00:19:02
interact with my mind clone more amazing to me Katherine is how it's going to
00:19:06
redefine our vision of life because for the first time in our lives we will be able to talk to ourselves outside of
00:19:13
ourselves I mean I don't think I'm more or less vain than the actual than the
00:19:18
average person but it's pretty hard to like pass a mirror in the morning without checking yourself out you know
00:19:24
and all the time every single person bounces ideas back and forth in their head should I do this shouldn't I do
00:19:32
this should I go out with this person shouldn't I go out to this with this person to have a chance to actually
00:19:37
discuss those things in a coherent objective way with our mind clone is I think going to make our lives much more
00:19:44
vibrant much more interesting and people in the next few decades will wonder how
00:19:49
the humans ever get through life without a mind clone really it is it is a it is
00:19:53
a mind-boggling proposition maybe what it does to therapy right and maybe you could just tell people all the time I
00:20:00
say you know the two best professions I recommend for people in the 21st century is cyber psychology
00:20:05
and that by that I mean a cyber psychology by that I mean being a psychologist who is an expert on on
00:20:12
cyber consciousness or what might be also called cognitive commuting computing is a more secular turn left
00:20:20
less loaded term than cyber consciousness people would say what that implies that there is consciousness
00:20:25
cognitive computing means sort of the same thing but it's a little bit less of
00:20:30
a loaded term so cyber psychologists I think are going to be a huge profession and these will be psychologists who are
00:20:37
experts in determining whether or not some software that purports to be conscious that purports to be autonomous
00:20:43
that purports to be empathetic that purports to value its life actually is or whether it's just a fancy puppet and
00:20:51
I point out in my book you know it's a transgendered woman I went through a similar experience when I transition
00:20:56
from male to female I it was necessary for my legal documentation as a woman to meet with psychologists for a period of
00:21:05
years and they were looking at me and talking to me and analyzing is this somebody who really feels like a woman
00:21:12
is this somebody who really is a woman although without the female female phenotype is this somebody who their
00:21:19
soul is that of a woman soul and you know they had to reach a judgment so there's a subset of psychologists that
00:21:25
work on that cyber psychologists would be much much larger the second grade field I I recommend to people in the
00:21:32
future and I know a lot of people gonna hate me for this but cyber law ultimately the way although I mean I
00:21:39
know a lot of people feel we have enough lawyers and you know we do have a lot of
00:21:42
lawyers but there are very very few of the lawyers out here right now who are prepared to deal with questions of cyber
00:21:50
law of the legal rights and obligations of mine clones are these virtual humans are they agents of the biological human
00:21:58
so that everything that the virtual human does is in fact the responsibility of the biological human that created
00:22:05
them these are going to be major legal issues the civil rights issues will be almost as big as the women
00:22:13
and gay and african-american civil rights movements all combined and you and so you would like to get the world
00:22:22
thinking about these issues and preparing for them and the reason I waited to write the book Katherine is I
00:22:27
think that it's always better to be prepared for something and that's certainly been a big business adage of
00:22:35
mine is to look around the corner one of the reasons why I'm excited about manufactured organs is I see how all the
00:22:43
hard work we did on small molecules the ones that produce most of our company's
00:22:47
revenues today is then under threat by generic companies after just a few years biologics which are more complex type of
00:22:56
medicines made in living cells are much harder for companies to genera size but they too are under threat from a type of
00:23:04
generic called a biosimilar so I'm trying to think of like you know what would be very hard for somebody to kind
00:23:10
of gobble up all the value that we work so hard to create and certainly creating
00:23:14
a whole organ is is sort of like the mother of all biologics it's a very very
00:23:20
complicated thing to knock out but I digress a little bit only to say that if we if we don't think about these issues
00:23:29
ahead of time I think mine clones will inevitably be created from the technological forces I mentioned at the
00:23:36
beginning conscious mind clones I think will inevitably arise or at least many humans will feel they are conscious just
00:23:43
as many humans feel their dogs and and their pets are conscious and some of those conscious cyber humans will be
00:23:51
treated horribly because people do horrible things you know not all humans are good and and I believe that the
00:23:59
psychic pain and the mental anguish to a cyber human is just as bad as a psychic
00:24:06
pain or mental anguish to a flesh human pain pain is pain and pain is bad and this cyber human is not a machine it is
00:24:14
something that is feeling pain it's not just a program that these bad things
00:24:19
mean I feel that's not I mean that's something ultimately I think for psychologists and
00:24:25
and lawyers to determine mostly psychologists on whether or not the pain is authentic there's a big diversion
00:24:32
distribution of points of view on that some people feel that only something that is structured as the human brain
00:24:39
could ever feel pain could ever feel emotion other people say well let's say
00:24:44
if I built a replica of the human brain molecule by molecule with nanotubes and little nano machines wouldn't it still
00:24:53
feel the same pain and the first camp then says some of them would say well upon birth you know God breathed the
00:25:01
spirit into that flesh brain and only the spirit infused flesh brain could feel pain the so-called materialist
00:25:10
philosophical point of view would say well if God breathed spirit into a flesh brain why would God
00:25:16
not breathe the same spirit into the mechanized brain you are indeed a philosopher in addition to your many
00:25:23
rules let me ask one more question about this these these cyber clones these money close as I contemplate them and as
00:25:31
I contemplate this kind of technological advance it sounds very first world and and I wonder how you envision these
00:25:40
developments affecting you know emerging economies economies where people living
00:25:45
in extreme poverty what does that look like have you thought about that I have thought about a lot and and the book for
00:25:53
two human covers it quite a bit it talks about the fact that nothing spreads faster and more democratically than does
00:26:01
software it has zero manufacturing costs associated with it in the short span of
00:26:08
our adult lives we went from only the wealthiest people having access to the world's knowledge
00:26:14
at their fingertips with a Bloomberg terminal or being in a big academic library to the fact that now almost
00:26:21
three-fourths of the world's population has a smartphone those smartphones can
00:26:26
access Google and and other search engines and have access to the entire world's knowledge and apps such as on
00:26:35
messaging apps are in fact free Facebook Twitter most of their customers are in fact
00:26:41
outside the US there are more social media users in China than there are in all of the previously considered first
00:26:48
world Google one of the most successful companies in history is devoting a full-fledged
00:26:54
effort to wire all of Africa by floating stratospheric balloons that will provide
00:27:00
high high speed bandwidth all over all of Africa already the rate of cellphone adoption in Africa is faster than it was
00:27:09
in the United States so I believe that the the thing I like best of all about this field of virtual humanity is I
00:27:19
believe that it will democratize faster than any technology in history fascinating and let me just to wrap up I
00:27:26
mean some some folks have referred to you as sort of a transhuman trans everything certainly your you you have
00:27:33
this passion of breaking through boundaries of all of all kinds technological communication gender so
00:27:41
coming back to you where where does that that passion come from has this always been part of you to push through the
00:27:46
boundaries well I I think it's too much to say that like I pushed through all
00:27:50
boundaries and I'm trans everything I am transgendered I do believe in the transhumanist philosophy especially the
00:28:00
ethical transhumanist philosophy I I am very much of a pro migration PEEP person
00:28:09
I believe that if there aren't tariffs on porkbelly's and semiconductors and
00:28:16
there shouldn't be tariffs on people and people should be free to go wherever
00:28:19
they want to go where that comes from I to me it's just kind of logical deduction actually I mean I was brought
00:28:28
up in tradition of two schools of thought that boasts both promoted freedom of movement one I was brought up
00:28:38
Jewish and the Jewish history is basically one of being kicked out of this country kicked out of that country
00:28:44
kicked out of another country and it was kind of beaten to my head as a little kid in
00:28:50
in in the Hebrew day school that learning is important because people can take away everything that you have but
00:28:58
they can't take away what's inside your head and then the other tradition I was
00:29:04
brought up in was the American tradition of freedom and it's the notion that we
00:29:09
came here to escape tyranny from Europe or poverty from Asia and then once we got here there was a quote unquote
00:29:19
manifest destiny to reach from shore to shore so this instinct for movement there's a word called transhumance T RA
00:29:32
NS h um ance it's not as well known as trans human but humans the root of that
00:29:41
word is houmous which is the Latin for earth and human the argument is made that human populations are by nature
00:29:49
transhumance because we moved out of africa at least four different times and before we settle down with agriculture
00:29:58
we constantly move back and forth with the with the with the animals and the food sources that we've lived off of so
00:30:08
I feel that I'm not so much a trans everything but I'm just like a human to
00:30:13
the core yeah fascinating fascinating discussion thank you so much you know you you've brought us from traditional
00:30:19
your childhood roots and and you know traditions to cyber clones in the future and everything in between thank you so
00:30:27
much for being with us thanks for talking with me Catherine you