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The Soon-Shiong Hype Machine

I have long been suspicious of people who use the word “moonshot” in the context of biomedical research. It’s lazy shorthand for “We’re going to spend a lot of money in a shorter period of time than usual”, and (as has been pointed out time without number), that approach was pretty suitable for the Apollo program. It was also suitable for the Manhattan project, which is the other example that things like this get compared to, although not nearly as much any more, since landing on the moon is more popular than the atomic bomb. But in both of those cases, the physical principles were not in doubt – there was just a vast amount of engineering and problem-solving to be done.

If you’re going to “cure cancer”, though, you first have to make the leap of faith that that’s possible. I tend to think (or hope) that it is, but let’s be honest about the difference. The Apollo scientists knew that reaching the moon could be done, with a large enough rocket and a good enough plan. The Manhattan Project folks knew that a runaway chain reaction would happen, under the right conditions – the problem was coming up with a design that would reliably produce those conditions. But cancer is not one problem. It’s a thousand problems or more, since (as has been emphasized here in the past) “cancer” is the name that we have assigned to the phenotype of unrestrained cellular growth, no matter how it’s arrived at. So you already have far more to deal with than the original moonshot did, because we still don’t understand those pathways all that well, and we don’t understand (in almost all cases) how best to alter them.

This all leads up to this article at Stat on Patrick Soon-Shiong’s cancer moonshot, which is not going all that smoothly, apparently. Actually, it’s worse, since that phrase implies technical difficulties. But what we have here is several rungs below that:

But a STAT investigation of Soon-Shiong’s cancer moonshot has found very little scientific progress. At its core, the initiative appears to be an elaborate marketing tool for Soon-Shiong — a way to promote his pricey new cancer diagnostic tool at a time when he badly needs a business success, as his publicly-traded companies are losing tens of millions per quarter. STAT also found several instances of inflated claims, with the moonshot team taking credit for progress that doesn’t appear to be real.

Soon-Shiong is definitely a promoter, for sure. But that’s forgivable if you deliver something after all the hype – I mean, Steve Jobs said a lot of crazy stuff over the years, too. It doesn’t appear that Soon-Shiong is, so far. Mostly he just seems to be promoting his “GPS Cancer” diagnostics platform, which has yet to be validated. (Side note: people who drag in terms like “GPS” because they’re well-known and sound effective are also to be viewed with skepticism). One thing I didn’t know is that MD Anderson is suing, because they have a trademark on the term “moonshot” as applied to cancer research (sheesh, I wouldn’t be proud of that, either, personally) and resent Soon-Shiong co-opting it. The suit doesn’t mess around:

The trademark infringement suit, which the cancer center continues to pursue, attacks Soon-Shiong in surprisingly personal terms. It claims that he has sullied the entire concept of a moonshot with his “nakedly self-enriching” behavior and his reputation as “a greedy, if not shady, billionaire businessman who oversells his ideas and falsely takes credit for other’s work.”

Just a few days ago, Soon-Shiong seems to have abandoned use of the term. But the Stat piece goes on to detail how inflated the claims of clinical breakthroughs seem to be, and it’s hard to see how they’re not right about that. The number of trials are juiced up, their significance, their results – everything is covered in heaps of glittery hype. This is a crazily hard field to make progress in, and claiming that you’re just making these incredible strides every day of the week is not doing anyone any good – well, unless your name is Patrick Soon-Shiong. You will not, perhaps, be surprised to hear that next week he’s unveiling a”genomics transcriptomics supercomputing medical reasoning engine”, which is a series of words calculated to make people who work in the field lower their heads to their desks in pain.

You will also not be surprised to hear that he’s met with officials from the Trump Administration about what he hopes will be some sort of “health czar” role. He seems like he’d fit right in. Worth keeping an eye on in case it happens.

49 comments on “The Soon-Shiong Hype Machine”

  1. Hap says:

    1) Sounds like a match made in heaven to me.

    2) ”genomics transcriptomics supercomputing medical reasoning engine” Bingo!

  2. Isidore says:

    “I’m friends with the President
    I’m friends with the Pope…”
    (The Ramones, “We’re a happy family”)

    Sorry, I couldn’t help it, Patrick Soon-Shiong’s Wikipedia entry has a picture of him accepting an award from the Pope.

    1. loupgarous says:

      Popes hand awards out to a lot of people. Neutron bomb inventor Sam Cohen made heavy weather of the gong he got from John Paul II, which might have been evidence of heavy tactical thinking on His Holiness’s part, or just impressive political log-rolling.

      1. Earl Boebert says:

        Cohen’s claim was never verified. Even Wikipedia lists it as “alleged.”

  3. SirWired says:

    ”genomics transcriptomics supercomputing medical reasoning engine”

    Do corporate exec-types undergo some kind of mandatory brainwashing so they don’t notice how this triggers the B.S. alarm of everybody with an IQ higher than a kumquat who is NOT a brainwashed executive?

    1. Calvin says:

      “I like shiny things. Shiny things all good. Must have. Must be good.”

      1. Dr. Manhattan says:

        “I’m particulary glad that these lovely children were here today to hear that speech. Not only was it authentic frontier gibberish, it expressed a courage little seen in this day and age.”

        Another schnitzengruben, anyone?

  4. Rule (of 5) Breaker says:

    ”genomics transcriptomics supercomputing medical reasoning engine” sounds sciencey enough to invest in.

    1. anoano says:

      Forgot to add Deep learning (or AI) and GPU for supercomputer

      1. Hap says:

        The people likely to be swayed by the title won’t remember the buzzwords at the beginning if you make the title too long – it’s already borderline.

      2. DCRogers says:

        Toss in a “nano”-something and you’ve got nearly all of the current favorite hits covered.

        1. BioHazard says:

          Dont forget “stem cells”.

        2. loupgarous says:

          You forgot “disruptive”, a term which has nicely ironic overtones in this case.

          1. Hap says:

            I am still assuming he ran out of room. Maybe he saves “disruptive” for the elevator pitch.

            Trademarking “cancer moonshot” seems really dumb, though – if you actually do it, it won’t care what name you put on it. I guess it works if people are dumb enough to keep believing the hype (and sending the money) when you can’t deliver, or maybe they’re being nice and trying to keep it from jumping the shark (though I think it’s too late for that).

        3. skeptic says:

          Also: “neural network”.

  5. bhip says:

    Making inflated claims about the next, sexy iphone is entirely different than hyping your company to desperate people (or even gullible investors who could throw their $ at something with actual utility).

    PS don’t forget to add biome

  6. MoMo says:

    Don’t underestimate P S-S and the divisions of Nant. Their cancer biology is breathtaking describing heterogenous phenotypes and cancer cells. But it stops there.

    Start talking drug design and chemistry with them and they look at you like bewildered dogs.

    They need a NantChem division.

  7. Andy II says:

    “GPS Cancer in their work, even though there have been as yet no published studies validating it as an effective diagnostic test. ” (from STAT News).

    If you replace “GPS Cancer” with “one drop blood testing Edison” and “Patrick Soon-Shiong” with Elizabeth Holms,” “Soon-Shiong’s cancer moonshot” seems very much like Theranos to me…

  8. loupgarous says:

    “Moonshot” is a lousy metaphor for cancer research, anyway. You’re talking about many cures for many diseases, each of which has a disparate proximal cause (ultimately, every cancer can be traced to a gene which was either an unfavorable artifact of heredity or a spontaneous mutation).

    The correct metaphor is “wide-ranging exploration of the solar system, with many probes of many objects within that system, with the eventual ability to divert asteroids from striking our home world and making it unlivable”. It’s something we’re actually in the middle of doing, which also makes it a better metaphor for cancer research.

    Any politician or billionaire who says cancer can be cured in a “moonshot” is ignorant of both space exploration and cancer. Any researcher who seriously sells what he’s doing as a “moonshot” is probably worse than ignorant – he’s actively being dishonest.

  9. Earl Boebert says:

    Welcome to the pump-and-dump economy, brought to you by the bright young things of Silicon Valley. Stocks will continue to rise forever — they always do, don’t they?

  10. loupgarous says:

    “The trademark infringement suit, which the cancer center continues to pursue, attacks Soon-Shiong in surprisingly personal terms. It claims that he has sullied the entire concept of a moonshot with his “nakedly self-enriching” behavior and his reputation as “a greedy, if not shady, billionaire businessman who oversells his ideas and falsely takes credit for other’s work.””

    “Sullying the entire concept of a moonshot” would be hard to do – if you take a hard look at the massive dead-end Project Apollo turned out to be. The spacecraft was probably the least efficient and economical device for placing objects outside the Earth’s gravity well ever conceived. There was no pressing need for that effort and (looking at it with 20/20 hindsight) plenty of better uses for the money it took. And the whole idea of a moonshot means “handing a large chunk of the national budget to someone to pursue obsolete technical solutions with obsolete methods (such as “human wave engineering”).”

    If I were running MD Anderson, I’d give “Moonshot” to Patrick Soon-Shiong with my heartfelt best wishes.

    1. REB says:

      Least efficient? By what metric?
      In 1960s terms and computational abilities, the Saturn V launch system was pretty darn efficient. The SLS, and SpaceX’s proposed Falcon Heavy, fifty years later, only offer minor, essentially incremental improvements over the Saturn V. No, the Saturn V was arguably the MOST efficient device for placing objects in the region of 50T outside Earth’s SOI that has ever been created.
      I don’t know how your reference to the spacecraft (the CM-CSM-LM) relates to placing anything outside Earth’s gravitational SOI.

      If you’re talking about efficient with money, well the Apollo project wasn’t perfect, but it was a considerable learning curve, as no object with so many parts had ever been created before, certainly nothing similar in mass and sophistication, and management and logistics techniques had to be *created* to manage the project, on the go. Arguably it should not have been as efficient as it was, as most wisdom, then and since, would have objected to such all-up testing as was conducted on the Saturn V stack, rather than each component as with the Saturn 1, 1B, The effectively single test in EO, Lunar Orbit, and single test of the LM around the moon before landing certainly saved a lot of money, but would by most standards be considered a case of economy over rigor/safety.

      1. loupgarous says:

        “Least efficient? By what metric?”

        By competitive designs from Douglas at the time, the <a href="Hyperion and Ithacus heavy lift vehicles which would have used Phil Bono‘s “plug” booster engine (which for orbiters would have also served as a re-entry heat shield, making the entire system as reusable as SpaceX’s Falcon).

        Saturn V, by comparison, stacked stages at the bottom of the gravity well instead of using jettisonable tanks to reduce parasitic mass during boost stage. ROMBUS was a well thought-out system, and its Ithacus implementation could have paid for itself just in reducing our need to maintain overseas bases for rapid response ground troops.

        Instead, we had a non-reusable wedding-cake design whose limitations were well-known and which was too expensive to serve as the foundation for sustained efforts in space – the same conclusion Nixon’s scientific advisors came to, that while we needed continued access to space, we couldn’t afford to keep using wedding cake, one-shot stacks of boosters to get there, the result being the Space Transportation System, or “space shuttle”.

        We could have had Falcon’s big brother back in the 1970s.

        1. Earl Boebert says:

          Speaking as someone who was associated part time with the Shuttle from the pre-proposal meetings to the first launch, and who also worked for a high-ranking astronaut, I can assure you that the genesis of the Shuttle program was far more complex (and uglier) than most people imagine.

          Nice airbrush work on the Bono stuff, though.

        2. Garni B says:

          I’d also add that the space program as a whole has resulted in numerous benefits to everybody on Earth. This includes the GPS system that pretty much everybody uses in developed and undeveloped countries. Also includes computed tomography technology that allows for CT and MRI scans – the workhorses of advanced medical diagnostics. Also includes telemetry for remote physiological monitoring – a technology used in pretty much every hospital for remote ECG and EEG monitoring.

          The moonshot of the Apollo program was instrumental in the development of the technologies that resulted in the SRS space shuttle program and the current space technologies. Hence, all the money invested in this program has payed out significantly and the results are a lot more relevant than the flags and mirrors left on the moon’s surface.

          Let’s hope that the PSS and MD Anderson “moonshots” will at least advance the technology necessary to help treat cancer and other disease, much like the human genome project has done for human genetics.

        3. REB says:

          Maybe, maybe, in the mid to late 1970s. But NASA’s studies into re-usability in the early 60s concluded it would be more expensive to recover, refurbish, requalify, reuse using then-current or expected materials tech than it would be to use disposable stages. Not to mention the challenges of navigating stages back to earth (landing in salt water presenting further challenges to refurbishment) – Falcon’s navigation, radars, computers, did not exist in the 60s or 70s, and the size and weight of such a navigation system (were it to be assembled using late 60s technology) in addition to the Instrumentation Unit on the SIVB would have been a hefty weight penalty to LEO, nevermind to lunar orbit.

          It SOUNDS fantastic, but as SpaceX is demonstrating, is harder to do in practice. And SpaceX is yet to launch a previously used booster, and in addition is yet to do so cheaper than a new booster, which from what I’ve read is not expected to be achieved until at least a few successful reuses. Given they launched a dozen Saturn Vs, taking half a dozen of them to get the process right (hopefully get to break even money-wise), and potentially at least 3 or 4 test resuses without manned payloads…I don’t see how that would have been economical for the missions that were completed. It’s not like NASA wasn’t already looking towards a more economical/reusable system to replace Apollo.

          Now, if Dynasoar were developed instead of Apollo…combined with reusable rockets, then maybe there would have been a continued Space presence, because NASA would have essentially had shuttle capabilities in 1970/75. But Dynasoar didn’t seem viable anywhere near soon enough for Kennedy’s goal, and the ballooning cost and time-to-delivery for the STS system (even when building on Apollo tech) demonstrated how much more challenging it would have been to do in the 60s/70s.
          STS heavily built on Apollo era tech and experience.

          1. Earl Boebert says:

            Also note the absence in the 1970s of the composite and adhesive technologies that have revolutionized airframes. There’s a reason Bert Rutan named his company what he did.

            Ever since the Wright Brothers, flying machine progress has rested on two pillars: control systems and materials science.

    2. Earl Boebert says:

      REB beat me to it. I have no idea where your assertions came from, and I knew and worked with many veterans of the Apollo program. “Human wave engineering?” What the hell is that?

      You can argue the opportunity cost of the program as part of the national budget, but that has nothing to do with how the program was conducted.

  11. a says:

    the only thing this shmuck has done is abraxane: WHICH WAS AN *existing drug* discovered and developed by someone else. He made a nice formulation of it….., bound to some albumin protein….gets to call it a “nanoparticle”: genius! $3B dollars
    revolutionary! MEH.

    1. David Young MD says:

      I agree. His company was based on a principle. The principle is that albumin bound nanoparticles improve the therapeutic index of Paclitaxel as well as obviate the need for premedications. After a decade of studies, it appears that there is no improvement in therapeutic index, perhaps, or if an improvement, it is slight. Studies were done with other anticancer drugs subjected to nanoparticle technology and guess what… they all failed. Now Celgene is stuck with Abraxane and as an oncologist, I get tired of hearing about it.

      I always that thought that “moonshot” sounded derogatory. It is too close to “crap shoot.”

  12. Anon says:

    I’m going to trademark “marsshot” before someone else nabs it.

    Is that where we’re at these days – suing each other over the use of alternative generic synonyms for “difficult goal”, given that it’s easier than actually achieving said goals?

    1. loupgarous says:

      “Moonshot” is a great metaphor for what Soon-Shiong’s doing – astronomically expensive work with other folks’s money, plenty of expansive and imprecise handwaving, and if results come, it won’t be by brilliance, but good old-fashioned blood, toil, sweat and tears – same way it’s been done for years, but with a less efficient and reasoned allocation of scarce resources.

      1. a. nonymaus says:

        Also like the moonshot (in terms of standing on the moon), the fruits of this will be reserved for the few. “… And whitey is on the moon.”

    2. Hap says:

      Getting money from people is much easier than making things or solving problems. Since lots of people aren’t necessarily interested either in making things or solving problems, but are very interested in getting money, trying to monopolize the magical words that will open up the pockets of people with lots of money but little sense is a valid (if morally bankrupt) strategy.

      The original moonshot, for all its flaws, did succeed, and people want to co-opt its terminology to make it sound as if they are working hard and single-mindedly towards their goals (and that their goals are for the benefit of humanity in general). I think that they’re probably half right.

    3. Emjeff says:

      Uranusshot ™

      1. Analonymous says:

        Damn!!!

  13. Mark Thorson says:

    A better analogy might be the transistor. In 1934, the president of Bell Labs declared that development of a solid-state amplifier was their highest priority. It took 14 years to get the first one, and it was crap. The first transistor was like the Wright brothers first airplane. Transistors were a commercial product in the 1950’s, but they were really expensive, low performance crap. It wasn’t until the 1960’s that cheap, reliable, good performance transistors became available. It was an awfully long road, much longer than anyone expected, and many more breakthroughs were required to get to something good.

    The unsung hero was a chemist, William Pfann, who invented zone refining. That breakthrough in ultrapure materials was absolutely critical to the development of the transistor. There are many possible ways to make a transistor, but all of them require ultrapure materials.

    1. eyesoars says:

      I think your (and popular) history is slightly wrong.

      IIRC, the first transistor was invented and patented in 1925 by someone named Lilienfeld. The gain was low, it was made of cadmium sulfide, but he built an oscillator with it demonstrating its gain and utility.

      The first semiconductor transistor was invented in 1947, by Bardeen, Brattain, and Shockley. It was considerably better than Lilienfeld’s transistor, but by modern standards rather poor. Until techniques for refining germanium and silicon improved substantially, and much improved, manufacturable devices were designed, they were rather poor and erratic in quality.

      Ah, it looks like even Wikipedia knows this now: https://en.wikipedia.org/wiki/History_of_the_transistor

      It points out that the Bell Labs crew knew of Lilienfeld’s work, and built working devices from his patents, which I had not known.

  14. Justin J. says:

    Dr. PSS’s NK cell program has more breakthrough potential than all the CAR-T programs combined . If you dig deep enough into his NK tech you will find that it makes a lot more sense than CAR-T both from a scientific and practical standpoint.

  15. Anon says:

    Is there a moonshot project to cure exponential debt growth and avoid imminent total global economic collapse?

    Because cancer seems a lot less scary than war, famine, plague, and eating each others’ brains just to survive.

    1. Morten G says:

      Brains are an underappreciated source of long chain omega-3 fatty acids.

      1. Bob, from the office down the hall says:

        Heya, Tom.

      2. loupgarous says:

        Rich in prions, too. Ask the Fore, or anyone else for whom brains were ever regular parts of the food pyramid. Just catch them before their nvCJD gets too far along.

  16. BK says:

    I don’t know anything about this guy other than what is published here. But in reading this hilarious tale, I can’t help but think he’s been borrowing some ideas from the Elizabeth Holmes playbook…

  17. a says:

    He’s worth $9B so he’s more succesful than Holmes

  18. David says:

    But almost everything Steve Jobs promised wasn’t new or an Apple invention, so yeah, that analogy is accurate in ways you didn’t’ intend, Derek…

  19. tangent says:

    > sullied the entire concept of a moonshot

    Oh I love this. The poor poor sullied moonshot.

    > with his “nakedly self-enriching” behavior and his reputation as “a greedy, if not shady, billionaire businessman who oversells his ideas and falsely takes credit for other’s work.”

    That would never happen in moonshot! That is not in moonshot’s DNA!

  20. Torsten says:

    i understand that the way how Soon Shiong is trying raise awareness may sound like a fairy tale to some. But in your discussion here nobody seems to be interested what the Moonshot program actually is all about. Name it as you wish but the overall goal to combine several medicines, that are normally developed as a single substance against each other, and to get Pharma to provide their investigative drugs for such personalized approaches and in combinations with comprting drugs is to the patients benefit only.
    Genetic analysis revolutionizes the way how cancer medicines have to be clinically tested in the future. its will all be personalized. it does not make sense to conduct classical phase I-III clinical trials, when each individual patient represents one group comprising 1 patient.
    Patrick Soon Shiong pulled this off to allow to find the best cancer care for patients based on whats out there and what would fit to the patients cancer genetics. PSS may appear to some people like a show makers. However, first of all he is a medical doctor who happens to have unlimited ressources compared to normal people. therefore you should not compare his goals and ambitions with those of your neighbour John.

    Compare them with those of Bill Gates and others. Some want to cure Malaria, others cancer … Cancer is likely to be translated into a chronic disease, rather then cured. However it will be a huge success to every single patient, especially young adult patients and children.

    You may have noticed that i am not a native speaker. Sorry about that

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