You have been recognized for your contributions to finance and to philanthropy, including support for biomedical science. How did your interests in finance, philanthropy and biomedical science emerge?
These interests emerged from the influences of my parents, my education at Los Angeles public schools, Berkeley and Wharton, and the multiple diseases that struck my family. My father walked with a limp—a vestige of childhood polio—my mother-in-law suffered from breast cancer (although she died from multiple myeloma), all three of my children and several of my ten grandchildren have had to deal with seizure disorders.
My new book, Faster Cures: Accelerating the Future of Health, is partly a memoir and partly a tribute to the heroes of biomedical research and public health who have done so much to give us not only longer lives, but healthier and more meaningful lives. Most of the following is adapted from the Introduction to the book, which is available for preorder here and will be published on April 11.
Our early innovations in finance turned out to be a template for much of what we’ve accomplished in the search for faster cures. That search includes our programs to accelerate the work of medical pioneers whose achievements have changed the course of history.
I’ll also touch briefly on other issues involved in my financial work: what I saw that others missed in the capacity of certain innovations to create jobs. Despite initial resistance to those innovations, they became the foundation for much of the world’s financial markets. When we provided financing for such key industries as cable, cellular phones, energy, healthcare, housing, media, and telecommunications, the goal was more than wealth creation. Everyone who worked with me understood that no matter what level of success we achieved, we all wanted meaningful lives for our children; and they wouldn’t have that unless all children in society had an opportunity. That understanding is the basis of the American dream. It provides the motivation for building our Center for Advancing the American Dream.
In the book I’ve written about matters of health including the emotional devastation of my father’s fatal illness and my children’s medical issues. How my life (and the life of my wife, Lori) was turned upside down when we thought our first son might die and when our daughter was born very small and fragile. How we bonded with parents everywhere who can never rest when faced with such unpredictable threats as childhood epilepsy, potentially fatal allergies, or type 1 diabetes.
There’s nothing wrong with writing checks to support good causes. We’ve done it extensively. But such charitable giving is not enough to change the underlying research process. Instead, we set out to build a more effective and efficient research infrastructure; to create a model that others could use in pursuit of faster solutions for all life-threatening diseases.
We began by recruiting top scientists and physicians to careers in medical research and public health, making it easier and more worthwhile for them to communicate with each other, and removing bureaucratic roadblocks that impeded their efforts. The message to other health advocates, foundations, and disease-specific organizations was inclusive. The idea was that by sharing our thinking on how to improve the research process, we would all benefit.
The focus on health and medical research is important because:
· Health affects everyone on the planet. With improved medical outcomes, we will be able to pass along more of our knowledge, wisdom, and life experiences to future generations. Effective health interventions improve the quality of life in addition to its length.
· Medical research has intersected with every stage of my life from childhood awareness of polio in the 1950s through our recent efforts to accelerate cures for a wide range of diseases.
· We’ve all learned crucial public health lessons from the COVID-19 pandemic. It has tested everything we thought we knew about treating disease and has shown the inestimable value of long-term research. Decades of previous investments underlay the astonishingly rapid development of vaccines and therapies.
· The future of bioscience is incredibly promising. We can look forward to great progress in such areas as cancer, the brain, the immune system, and infectious diseases. Scientists working on multi-cancer early detection have developed technologies that will save countless lives. Others are beginning to understand the fundamental mechanisms of aging. It’s a magnificent opportunity: For the first time in history, we can realistically aspire to eliminate much of the burden of serious disease. It won’t be easy.
We have started a discussion about incentives designed to encourage the sharing of ideas by biomedical scientists. Some of the possible incentives are based on financial innovation:
We are wondering if you could kindly comment on this initial discussion.
Over the past 30 years, we played a major role in keeping millions of cancer survivors alive. None of that was clear when we began our efforts. We knew only that previous efforts hadn’t worked very well. We would have to break the mold by disrupting and enhancing the process.
I’d noted that research institutions often acted like sports teams carefully guarding their playbooks so their “opponents” wouldn’t know what they were up to. Many researchers were concerned that if they shared the interim results of their work, they might lose credit for breakthrough ideas before publication in prestigious journals. Fair enough. If their work is that important, they’ll find funding elsewhere. We determined to fund leading-edge research by those who were willing to share the results of their work. That was a condition of our grants. Within six months, nearly all researchers agreed to it.
By enabling researchers to hear feedback on their work quickly, we started a trend that has significantly changed the medical research process. This accelerated the adoption of the “preprint” publishing model that had been launched by physicists at the Los Alamos National Laboratory in the early 1990s. Today, authors in every scientific field post preprints to obtain comments on their work before submission to peer-reviewed journals. This process greatly accelerated progress on the development of vaccines for COVID-19.
The next concern was lack of communication among different sectors of the health industry. Our experience with the Milken Family Foundation’s cancer research awards in the 1980s showed there were dedicated scientists in every sector from basic science to translational development to clinical applications. We were determined to improve communication and coordination across sectors.
Government agencies must be conservative in spending taxpayers’ money. If they take too many risks and fail, whichever political party is out of power in Washington will make it a campaign issue. But always doing what is safe is not the most direct path to real breakthroughs. We wanted to encourage risk-taking by identifying the most promising research not funded by the NIH.
We also wanted to reduce the onerous requirements that government agencies impose for federal grants. Researchers spent up to a third of their time completing applications, often attaching hundreds of pages of documentation. They said it was futile to devote months developing grant proposals that would be rejected for lack of funds. This reminded me of my early days in finance when young entrepreneurs kept getting rejected for bank loans because they didn’t have an established track record.
We decided to make it simple and encourage the world’s leading scientists to fill the pipeline with ideas. Send us an application of any length, but we promise to read only the first five pages. If you have statistical validation of your idea, that’s fine; but we’ll also consider unproven concepts that sound promising. You don’t necessarily have to spend the better part of a year developing proof of your hypothesis. Our belief was that this would attract the brightest, busiest people to submit ideas. We said we’d review applications quickly and provide an answer in no more than sixty days. If the answer is yes, you’ll get the money within thirty days after that.
Looking at five pages instead of thousands, we knew we’d miss a lot of information and perhaps fund some less-deserving projects. That was a trade-off we were willing to make because it would accelerate the science. It was a venture philanthropy model that tries many ideas in the expectation that a few will become major breakthroughs.
Several types of financial incentives have been developed to achieve social goals.
Among the most successful have been environmental incentives. Richard Sandor, founder of the Chicago Climate Exchange and a Milken Institute senior fellow, devised a cap-and-trade program for sulfur dioxide (SO2) emissions in the 1980s. The government puts a cap on the pollutant and then lets the market take over. Those companies that can reduce emissions more than a pre-determined amount can sell carbon credits to companies that fall short. As a result, participating companies reduced their SO2 emissions by 400 million tons over 15 years. Acid rain over the northeastern United States all but disappeared.
More recently, the Milken Institute and the Motsepe Foundation announced the Milken-Motsepe Prize in AgriTech. This initiative addresses the fact that the world population is expected to reach 8.5 billion by 2030 with more than half the growth in Africa. Food availability will have to grow by 60 percent, yet agricultural productivity growth in most African nations is far below that of other developing countries. Agricultural technology (AgriTech) can greatly increase crop yields, farm productivity, plant and animal health, sustainability and waste reduction. The Milken-Motsepe Prize in AgriTech is a $2-million global competition for solutions to problems faced by farmers on small to medium-sized African farms. It provides incentives for global innovators to develop Fourth Industrial Revolution (4IR) technologies—artificial intelligence, 3D printing, robotics and more—that will accelerate progress on the first two Sustainable Development Goals of the United Nations: no poverty and zero hunger.
In the first competition round, more than 3,300 applicants from 105 countries across six continents registered to submit ideas that can help farmers, alleviate poverty and transform food systems. Twenty-five finalists were chosen in 2022. Each finalist team received $10,000 to develop and test their designs. The grand prize winner of $1 million with additional prize money to second and third place winners will be announced at the Milken Institute Global Conference in May 2023.
The underpinning of the Milken Institute in its formation in 1991 was the idea that you could create financial incentives and systems to solve the problems of society. We try to figure out what are the challenges of society and then we encourage work on creating a mechanism that can solve those problems. I understand that in the case of cell-cell communication many scientists, including some well-known and recognized scientific leaders, have pointed out that improving knowledge of this fundamental process would benefit the therapy of most diseases. A comprehensive discussion of possible approaches would require the participation of a very large number of scientists from multiple disciplines. The present challenge is to maximize the intellectual effort of mankind by involving all the relevant experts in an open discussion of this problem. This challenge requires novel incentives, to reward not only the sharing of ideas but also their integration by many scientists, using a long-term perspective connected to the success of this enterprise.
I encourage the collaboration of scientific and financial experts that is needed to rise to this challenge.
- Milken, Michael “Faster Cures: Accelerating the Future of Health” William Morrow (April 11, 2023)
- Milken on Convening experts with diverse backgrounds: