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