Dr. Rishikesh Balvalli
@PathoGuy
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Ophthalmic Pathologist & Head of Laboratory Services @ Sankara Eye Foundation | Dermpath | Image Analysis Enthusiast | Translational Research
Bangalore
Joined October 2013
@angryoldman27 Another colleague was expected to hand wash entire families clothes as her father in law did not believe in machine washed clothes. These are our generation of PG doctors. I was appalled to know this.
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During my residency, I had a colleague who has engaged. Her fiancee, a senior resident doctor at that time, expected her to come and clean his hostel room and do his laundry. Another married colleague was expected to hand wash entire families clothes as the father in law did not like machine washed clothes. Both of them are highly educated post graduate doctors. Expected to do this then come and work in the hospital. This is the reality for a lot of Indian women.
The Great Indian Kitchen's biggest win is the fact that it's so frustratingly real to the point that it punches you in the gut. We treat women so so badly in this country to the point that a lot of horrific stuff they are subjected to is normalised. 😔
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@angryoldman27 During my residency in Surat, I had a colleague who has engaged. Her fiancee, an SR at that time, expected her to come and clean his hostel room and do his laundry. It's very much out there. The original movie is hard hitting.
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@angryoldman27 The point is not about cooking a chapati. They are already there on the table. It is cooking hot chapatis on demand. About expecting her to use a hand grinder instead of electric.
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Fascinating read.
Genentech is the flagship example of an industrial research organization. Their culture of open science and free flowing publication is rooted in a strong contrarian foundation we should all remember. In the 1980s, secrecy, siloes, zero sum IP fear was far more rampant in biotech than today: Kary Mullis discovered PCR at Cetus in 1983 (tripping on acid) but it remained unpublished for two years until patents were secured. Amgen's recombinant EPO, a blockbuster candidate for the enormous anemia market, was filed secretly in 1983, partially published in 1985 and fully described on patent approval in 1987. Genentech was a startup of scrappy scientists (and a single brother of finance) and dead by default. The lore is riddled with the usual heroics: regular all night cloning sessions sustained with coffee, pizza and lots of beer (they called this "pizza and plasmids"). In competition with global scientific talent, they were the first to clone human insulin with recombinant DNA. They succeeded in 1978 and filed a patent. What is often glossed over is they then immediately published a detailed description of how they did this in a now legendary paper. Enough information for anyone to copy it. Well before their patent was approved and sabotaging their lead commercializing the tech. It seems kind of stupid to give every enormous and well-capitalized pharma juggernaut an actual blueprint to cannibalize your product. Sure the founding team achieved eternal scientific fame with this discovery but they could have met the same fate in the capital markets as our friend Kary Mullis: a $10K bonus from Cetus, a nobel prize (very nice) and a later life surfing in sunny La Jolla coping hard on the $300M sale of his PCR patent by Cetus (of which he received not one penny). The resources, clinical expertise and odds were stacked against Genentech and they just gave up their hand. Why? I think two big reasons. The first is very B2B SAAS coded: Boyer and Swanson needed to create a market for this new technology or their company would fail. Skepticism, from both Wall Street and the ivory tower, around recombinant cloning as a viable way to treat actual people of disease, was very high. This is a strange thing to think about with a hard science venture, where success seems purely contingent on fighting nature and making a working drug. But the mechanics of drug development are much more intertwined with normative value and human perception than one would think. From the obvious (who decides to fund you so you can live and not die) to the less obvious (great scientists need to believe in the technical viability of your mission to join your team) to the 4D chess (convincing regulators to even allow FIH trials and approve an IND before you run out of cash, convincing PIs + hospitals to then enroll their patients in trials and of course selling big pharma on the concept to manufacture + distribute the drug throughout this process) Publication in a prestigious journal like Nature created a scientific market. They raised $10M in 1979, established their young team as world leaders in arguably the most important biotechnological revolution to date and put their company on the map of every bright-eyed bioengineer hungry to change the world. This brings us to reason number two (the bigger one). When you think of the dominant technology industries today - semiconductor manufacturing, enterprise software, "AI" - their culture and structure looks very different from the siloed and paranoid biotech sector of the late 1900s. Speed and execution matter more than IP. Tacit knowledge of process and methods cannot be copied without ripping out the mesh of humans that defines the org. A competitor could steal every single blueprint, process instruction, and piece of equipment from TSMC and be hopelessly unable to fab 2nm chips. Talent and accumulated tacit knowledge is the scarce resource. Nowhere was this more true than the emerging field of recombinant protein therapies. It ran on a cottage industry of artisanal talent in molecular cloning. Hand two researchers the same bacterial pellet and one will extract high-quality, high-yield plasmid DNA, while the other gets degraded crap. The same talent might transform cells with 1 ng of plasmid DNA and get 100,000 colonies, while the other gets barely 100. Same DNA, same protocol. A company could copy a lab’s exact plasmid, bacterial strain, and IPTG induction protocol but still fail to express a functional protein. They don't know to tweak growth temperature, induce at lower OD600, or switch to a different expression host. You can't put this in a patent. You can't copy this. Boyer somehow saw the writing on the wall. It was a competition for people and a first mover advantage to build a moat of compounding process knowledge. The smartest people wanted to work with the best scientists. Those scientists were at Genentech, not Merck or Pfizer. After all, they published THE paper that established molecular cloning as a legitimate method in great detail. You have to trust them. They told you exactly how they did it. Those scientists trained the next generation, embedding even more tacit knowledge inside Genentech. This compounded over time, making the expertise impossible to replicate externally. This flywheel ended up working really, really well. They expanded their lead by tackling the next hardest problem - human growth hormone - just a year later in 1979. They followed that with two more bangers in the 1980s: recombinant interferons (cancer/antiviral therapy) and tissue plasminogen activator (tPA, a clot-busting drug for heart attacks and strokes), moving recombinant proteins past metabolic hormones into tx proteins with bigger markets. By the late 1980s, they were global leaders in mAB therapy, which would eventually revolutionize oncology and autoimmune disease treatment. And the culture of open and free publication continues to capture the best talent in the world. I stood in a standing-room only seminar in Boston last Fall where Aviv Regev described the scale and complexity of their emerging research platform. Aviv herself is a great example of continued talent capture: a world renowned researcher who picked up her lab from MIT to join gRED in 2020. She has attracted top tier machine learning and software engineers to work in tight integration with wet lab data generation at a mind boggling scale. Genentech is now a juggernaut. One of the "pharmas". But their origin, and DNA, could not be more different from Bayer or AstraZeneca. They bet on innovation, told the world exactly what they were doing without fear and moved quickly to engineer + industrialize technology. Lesson in there. Check out the OG paper, linked below, about recombinant insulin. What do you notice about the author list? Boyer isn't on there. At Genentech, researchers owned their discoveries.
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The smartest people I have heard design their talk to cater to the lowest common denominator. It makes the talk wholesome and provides an insightful takeaway to everyone attending the talk.
It should be considered disrespectful to waste everyone's time by giving a talk that is super difficult to follow and basically unintelligible to anyone in the room who doesn't work on the exact topic being discussed. There is a perverse incentive to deliver unintelligible talks because the audience just assumes the speaker is too smart to deliver the talk in any other way and often believes they themselves aren't smart enough to follow. Moreover, this format shields the speaker from having to answer any thoughtful questions at the end of their talk because only those who already understood everything could follow along. Over the last three years, I've probably attended over 100 hep-th talks, and this is a chronic issue. Everyone in the room has the intellectual capacity and background to understand what the speaker is saying if only the speaker would actually deliver their talk at an appropriate level.
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I mean it's not like he or the creators didn't know what was said. They had the choice to remove the content before publishing online. But they pushed it out probably to test boundaries. But that implies that they were 'ok' with what was said. Then what's the point of an apology?
I shouldn’t have said what I said on India’s got latent. I’m sorry.
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RT @NeilShubin: Gene editing technology began by people studying salt marshes. Ozempic began by folks studying the venom of Gila monster…
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My top picks for the role which shouldn't be reprised in the first place.
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Waiting time though an objective parameter is dependent on a lot of subjective factors. Patients want as much time with the doctor when they are with the doctor and as little time as possible in the waiting room waiting for the doctor. They experience both sides. In the end it's not a QSR or QC.
Can we have a Zepto service to meet doctors? You will meet your doctor in 10 minutes. Not sure if any OPD tries to achieve this. Dear hospitals/clinics/doctors Waiting times of 30-90 minutes for a doctor appointment is RIDICULOUS. Not sure why we cannot have an appointment system. Just a number system based on time. Appointment should be given as between 6.00-6.15 pm (15 minute). The patient will come and the doctor will see him/her by 6.15-6.30 maximum. Waiting time for patient will be 15-30 minutes. I doubt if even a single hospital has this kind of a mindset -- respecting the patient's waiting time. Love Guru
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Fix potholes properly. Every vehicle has to slow down at these leading to backlog and slowing down traffic.
Nitin Gadkari said he can fix all of India’s road problems—except Bengaluru’s traffic And this comes from the man who built 90,000 km of highways in just 10 yrs! The Crazy Part? At peak hrs, you can literally walk faster than your car THREAD: How to fix Bengaluru’s nightmare🧵
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