Josh Geballe: Building Yale’s Innovation Engine

Transcript

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get closer to the truth about health and healthcare. Our guest today is Josh Geballe, but first we like to check in on current hot topics in health and healthcare. What are you going to have to talk about today, Harlan?

Harlan Krumholz: Well, there’s a topic that caught my eye. A surgical paper published last year cited 30 references that could be verified and another 18 that were fake—not mistyped, not the wrong number, actually fake references in the paper. The papers didn’t exist. They’d been invented. They had real-sounding names, plausible journals, real surgeons named as authors. It was a surgical paper. These look perfect. These are the receipts of a paper. It’s like you make an assertion, and then you tag it with a reference so that people can follow up with it. It’s why they trust what you say. But these studies that were put out there were ghosts. They really didn’t exist. And this isn’t an isolated story. A new audit that was published just this week in The Lancet went through 2.5 million biomedical papers and 97 million references. And in 2023, they were found that it wasn’t an insignificant number of papers that had at least one fabricated citation.

Now by early 2026—now remember, 2023 is right, you know, the cusp of when the new large language model’s being put; ChatGPT comes in November 2022. And so at that time it’s like one in 3,000. It’s not insignificant because there’s so many papers published, but by 2026, it was about one in 300, more than tenfold rise just in those three years. So the world of generative AI is now built into the scientific record. You’re seeing authors somehow not even checking their own references and using AI so it’s bleeding into their papers. And what should bother every one of us is that these fabricated references don’t look fabricated. They’re correctly formatted. The authors are real people, often. The dates are plausible. The titles sound like papers that should exist. The only thing is, they don’t. So why should this matter? Why do people listening care about this?

Well, science is a chain. The guidelines cite reviews, reviews cite the trials and the papers and the studies. They cite earlier studies. If we can’t trust what’s being published because now it’s being polluted with information that’s not real, even among maybe authors who are credible but are taking shortcuts and not checking their work, we have a big problem. Ultimately, authors have to own every reference. This is about people not rolling up their sleeves and fully investing. If you cite it, you better have read it. It better have been real. AI can help you write; it needs to be checked. The work needs to be checked. Journals have to verify. Automated reference checking exists today, but the barrier is institutional, not technological. There’s no excuse if you’re a peer-reviewed journal for letting this stuff get through. And all of us, readers, clinicians, editors, we have to take seriously these citations.

And it’s just the tip of the iceberg, because it really raises this question, what else is getting through? And so as we enter this AI world, the scientific literature is now vulnerable. It’s vulnerable. I’m not talking about frank fraud or fabrication of actually the science, and that happens too, and we need to be careful about that. But this is papers where there is a real study there, but they’re not being careful enough. They’re taking shortcuts, and it’s going to undermine trust. The answer is, I hope, not to trust science less but to make science more worthy of the trust. And that starts with getting everyone who’s involved in science to not just take these shortcuts.

Howard Forman: Do you think that we are tying the hands of reviewers a little too much? I noticed... I just did a review this week, and so I just noticed it one more time where it literally says, “Do not input the paper into a chatbot at all.” And I don’t. I happen not to do any of that. I don’t use AI, at least so far in my reviews, but you could imagine that reviewers could also be helpful in weeding out some of these problems if they were allowed to put it in a chatbot and say, “Can you check this? Can you check the math on this? And can you make sure that every reference is properly lined up and accurate?”

Harlan Krumholz: Yeah. I think that’s more the job of the journal because you want to have an automated reproducible process where every paper is vetted for that.

Howard Forman: Good point.

Harlan Krumholz: But I think you’re raising a good point. There’s lots of people who are saying, “Authors need to disclose use of AI.” And they’re prohibiting reviewers from using AI.

Howard Forman: Yeah.

Harlan Krumholz: The point you’re talking about is this issue about sharing the paper broadly with the LLM. Could it train on it? This is confidential information people submitted. But we at Yale have got a version, an enterprise version of ChatGPT where you could even put protected health information on it. It’s HIPAA-compliant, it’s safe.

Howard Forman: And it’s internal. Yeah.

Harlan Krumholz: And at JACC at least, at the journal I lead, you know, we’ve taken the view that we want people to use AI. Why not? Authors should use it if it helps them. Reviewers should use it if they’ve got a secure place to put the papers. But people still have to use their noggin. It’s like you can’t defer yield to the AI. The AI has to be a tool. And when we’re giving it to reviewers, some people are letting AI write their reviews. What do we need the reviewers for if they’re going to do that?

Howard Forman: I totally agree. Yeah. And, look—

Harlan Krumholz: We really need to tell people, “Use your head.” Right?

Howard Forman: No, I know. And I was talking to someone just yesterday about the idea of like, can AI replace editors? Can AI replace reviewers? And the answer probably is yes, but with huge risks, at this moment in time. And I don’t think we’re ready to take those risks.

Harlan Krumholz: Well, and so like everything, the question’s going to be, how can we optimize this tool to make things better? How can we minimize the chance of unintended adverse consequences? But this definitely was... This was a correspondence in Lancet. It was disturbing. It just shows people have to take their work seriously and take ownership, and there should be some consequence to it too, that somehow...

Howard Forman: I agree.

Harlan Krumholz: Anyway, let’s get to Josh. This’ll be a great interview today.

Howard Forman: Josh Geballe is senior associate provost for entrepreneurship and innovation at Yale University and managing director of Yale Ventures. He is responsible for programs that help students, faculty, and the New Haven community to launch start-ups, access entrepreneurship, training, and build external research partnerships. Before leading Yale Ventures in 2022, he served as chief operating officer of the state of Connecticut under Governor Ned Lamont, where he modernized government operations and became the face of the state’s nationally recognized response to the COVID-19 pandemic. Prior to public service, he spent his career in the tech industry, spending 11 years at IBM before becoming CEO of Core Informatics, a scientific software company acquired by Thermo Fisher Scientific, where he served as vice president and general manager of digital science. He holds an MBA from Yale School of Management and a BA from Yale University and continues to serve on the boards of several nonprofit organizations including Climate Haven, Connecticut Innovations, Advanced CT, and BioCT.

And I will point out, he first joined us almost exactly three years ago for his last appearance on the podcast. So we’re really so pleased to have you back, and so much has happened over those ensuing years. And one of the reasons why we scheduled you today is that the Innovation Summit is coming up just 13 days from the date that we release our podcast, and we’re really excited about it, and it has grown to be an enormous conference. People can go on the website right now—we’ll put the link in the show notes—but give us an idea of what your aspirations are for this conference and what you hope to gain for Yale and what people who are visiting are looking to gain.

Josh Geballe: Sure. Well, thanks, Howie and Harlan, for having me back. I love the pod. I listen every week, so it’s always fun to be with you. Yeah, the Yale Innovation Summit has been growing every year, about 10%. Last year we had 2,400 people attend, so I’m sure we’ll be more than that this year. The Yale Innovation Summit is May 27th and 28th, right here on campus, hosted primarily at Yale School of Management, but also across the street up on Science Hill. Just as a reminder, it’s got six tracks of programming. So really covering the full breadth of innovation across the university and the Connecticut economy. So we have “Arts,” “Biotech,” “Health,” “Climate,” “Civic,” and “Tech.”

And so in each of those tracks, there are panels of experts talking about the emerging trends in that field, there’s keynote speakers, and there’s pitch competitions of start-ups that are innovating, both Yale start-ups and start-ups from throughout Connecticut, competing for, this year, it’ll be $400,000 in prizes. So there’s a lot on the line, but it’s really just an amazing place to see cutting-edge innovation, to meet investors or industry partners, or meet a co-founder. And just learn and take it in and hopefully build connections that help people advance their ideas.

Howard Forman: And just before I turn it over to Harlan, can you give us an idea of some of the keynote speakers? Because I know those are just amazing guests that you have.

Josh Geballe: Yeah. So the main keynote this year is going to be a fireside chat between Joe Tsai, the co-founder of Alibaba, and Yale’s president, Maurie McInnis. So super excited about that. For those of you that don’t know Joe, Alibaba, of course, is one of the most consequential companies in the world of our generation and is often known as e-commerce in China, but they’re now on the forefront, of course, of AI as well. And their Qwen model is one of the leading open-source AI models in the world right now. And so Joe is on the front lines of AI innovation, and I’m sure a lot of the discussion will center around that, which should be fascinating.

Another fun new feature this year is we have a Yale alumni founder reunion happening. So this is the 25th anniversary of the Yale Entrepreneurial Society. So a lot of the YES folks are coming back, and we’ve built a whole Yale alumni founder reunion around that. So if there are Yale alumni founders in your audience, I know there are a bunch of them out there.

Howard Forman: There are.

Josh Geballe: For some reason we haven’t gotten them on our list yet. Reach out. We’d love to have you there. So those are just a couple of the new fun things we’ll have this year.

Howard Forman: Great.

Harlan Krumholz: Josh, we’ve talked about this before. One of the remarkable things is how you’ve made Yale the place for innovation. I mean, you and your team, the way that Yale Ventures has pursued this, there was always a strong group here. And I just want to call out, Jon Soderstrom is a friend of mine, Jon preceded you and did a lot of great work. Since you’ve taken over, there’s been a real inflection. The university has aligned behind you. You’ve gotten the policies, procedures, the culture. For people listening, take a look at what’s going on at Yale because it really is amazing. I wanted to ask you, when you came on, what was your vision for this? Because one of the, I think, key things that you were able to do was to move the institution from being suspicious of efforts to scale and entrepreneurism to embracing it as a means by which science can disseminate and actually have even a bigger effect as it moves out.

And so that’s what I feel in the university. I mean, for many years it was like, “Wow, somebody’s trying to spin something off, what are you trying to get away with?” As opposed to “Let’s try to work with you to figure out how we can put you in a position to make sure the science you’ve done can get out in the world.” Did you have a vision of that when you started? And how have you been able to navigate that? Because that cultural shift in the university is profound, is really profound.

Josh Geballe: Well, I’m glad you feel that, Harlan. I think, listen, we’re a 325-year-old institution, so things change slowly, but certainly they have been changing and certainly Jon Soderstrom, as you mentioned, built a really strong foundation of innovation and commercialization of Yale research. I was fortunate to join at a time when the university had decided that they really wanted to do more. They wanted to invest in supporting these types of activities you were just describing as a way to be very consistent with the mission of the university and the role that we can play in helping to solve major problems in society. And so we had seen over the years some Yale innovations make it all the way through clinical trials and FDA approval and get drugs on the market that were changing patients’ lives for the better. And seeing more and more of the research faculty that were coming to Yale view that as a part of what their goals for their career were, to have high-impact scholarship, to be wonderful teachers and help build the university but also to see that real-world impact of their research and their innovation.

And so, it’s one of the main reasons I wanted to come back to do this is I saw the university leadership as Peter Salovey and Scott Strobel at the time, along with the deans of the major schools, Nancy Brown and Jeff Brock and Megan Ranney, and now Steve Wilkinson at FAS, all incredibly supportive of both investments and people and programs that we run that can provide support to our faculty and students. But as you said, also willingness to look at some of the policies that maybe didn’t have incentives aligned the way we wanted them to really support and encourage the translation of research for the benefit of humanity. And so we’ve made a lot of progress in the last years, but there’s still a lot more to do. I think we’re still just getting started.

Howard Forman: One of the criticisms of elite universities is that somehow they’re steering away from their mission because people look at the number of non-faculty employees compared to the number of faculty employees. And I consistently push back against that because, sitting where I sit, I see an awful lot of very important individuals who are not faculty members who make this machine work, make our innovation engine work and help facilitate the transmission of knowledge as well as the development and commercialization of intellectual property. I just thought if you could say a few words, when I look at the people that work with you at Yale Ventures, a few words about why such talent is necessary, why you have people involved in business development, intellectual property, commercialization, and so on, I think it would help our audience better understand this challenge.

Josh Geballe: Yeah, thanks for the question, Howie. I think it’s important because there is, I think, a lot of misperceptions on this topic. Certainly I’ve worked at, as you said in my bio there, a number of other very large organizations, a couple of Fortune 100 companies and state government. Any large organization is going to have some amount of structure necessary to be able to function in an organized way and stay in control of its finances and business processes. So in some respects, large universities like ours, you should expect that. We also have to comply with a lot of regulations that come at us that we don’t have a lot of control over, in particular from the federal government. I sit in the research, vice presidential research office, and I hear my colleagues who are responsible for a lot of the compliance activity. It’s a ton of work, and it keeps growing constantly.

But in our world, our team has grown quite a bit, but the team, the folks that we’ve added, are 100% in support of our faculty who are looking for help, specifically to do the work, to take their research discoveries and translate them out into new start-up companies or into partnerships with industry so that that idea could be invested in and hopefully developed into something impactful. And our faculty are amazing. They’re pretty consistently the leading scholars in the world in their particular fields, but not many of them have a business background or prior start-up experience. So the help that our team provides can often make the difference between whether that discovery ends its journey in an article, in a paper, or whether it takes the next steps into the private sector and into industry and turns into something useful.

And so we’re still underwater most days, right? We still don’t have enough people to really serve our faculty and students to the level I aspire us to, but we’re continuing to grow. We’ve added a couple of new programs this year, but also people should keep in mind, half of our budget comes from philanthropy. So much of what we do is not at the expense of anything else going on in the university. It’s incremental funding that’s coming in because we have incredibly generous alumni and donors who see this type of work and want to support more of it, and that’s helped facilitate a lot of our growth.

Harlan Krumholz: One thing I wanted to ask you was, you know, there’s this balance between trying to inspire people about what they can do with regard to entrepreneurial opportunities—how you can think about a bigger life for some of your ideas, how it can scale—and the reality of how hard it is. Because I think sometimes people look at successful companies or big-time tech titans and think, “Okay, great, I want to do that” or “I want to be...” Or they look at Craig Crews and see the success that he’s had and say, “Okay, I want to be like Craig.” But they don’t really know how hard it was. It was great to have the invention or it’s great to have the idea, but it’s only the start of really getting all the way through to where you can provide something to the public or provide a product.

How do you guys balance that? Because you want to actually have people have a learning and an appreciation for the craft of developing something to market, but at the same time, you don’t want to be a bummer and say, “Hey, by the way, this thing is really hard.” It’s like, we have hackathons, we try to spark ideas. But how do you do that balance when you’re out there talking with faculty to let them know the realities, but at the same time be encouraging?

Josh Geballe: Yeah, you’re of course correct, Harlan. These are very high-risk endeavors, right? The odds of success are low, but it’s important that people take on these challenges because in the end, these are the innovations that move the world forward. And if no one was willing to take these risks, we wouldn’t have the treatments we have for a lot of diseases. We wouldn’t have a lot of the incredible technology innovations and renewable energy and other things that we have today. So we view our role largely as taking guidance also from the faculty members because sometimes, like you said, we have some folks we support who do have a lot of experience in this area and who have a very clear vision of what they want to do and how they want to do it and people that they want to work with. And on the other extreme, we have people who actually have no interest in this at all.

They do recognize that they’ve discovered something that could have significant benefit, but they’re incredibly busy with their lab and their teaching and their administrative responsibilities and just don’t want to carve out any extra time for it. And I don’t blame them. You guys have really hard jobs. And so our job, I think, is to figure out what the right balance is for the person that we’re dealing with. And in some cases, we really need to pile in there and provide an enormous amount of support, and we’re prepared to do that and connect faculty with outside experts and investors and operators and folks from our own team who can take as much work off of the faculty member’s plate as they want us to take and, at the same time, leave as much to them as they want to keep.

We’ll always provide our opinions and our thoughts and recommendations about the best path forward. But in the end, we try to be very deferential to the faculty member. This is your life’s work. We want to support you and help make the most out of it, but in the end we also want to really be respectful of their vision of how they want to proceed.

Howard Forman: Do you have some examples you want to offer now of.... The last time you were on, you showed us, in your old office, examples of companies that Yale had been involved in creating. Do you have examples over the last few years of specific things that you’re most proud of, whether you were involved or not, but just for the university?

Josh Geballe: Yeah. Well, I mean, just the last few weeks, I can give you a couple incredible milestones that have been achieved. And again, people know these successes don’t happen overnight, especially when you’re talking about developing a new therapy. It often takes a decade or more. And there’s a couple really incredible milestones I’ll just highlight quickly. So one, Harlan, you mentioned Craig Crews. One of his start-up companies, Halda Therapeutics, a couple months ago had some incredible data out of a Phase 1 study on a new platform that they developed called RIPTAC, which had demonstrated incredible effectiveness in a prostate cancer study, and they were quickly acquired by Johnson & Johnson for $3 billion upfront.

Howard Forman: Wow.

Josh Geballe: They’re going to continue to invest, and it’s a really exciting new platform, so that’s a huge win. Another recent acquisition was Quantum Circuits Inc., which is the big quantum computing start-up that Yale has funneled a lot of the intellectual property out of our incredibly world-class applied physics and quantum computing research team here, led by Rob Schoelkopf and Steve Girvin and recent Nobel laureate Michel Devoret. So they were just acquired for over half a billion dollars by a publicly traded quantum computing company called D-Wave, which is going to keep growing.

Cool thing about both of those acquisitions are they were both companies that founded in New Haven, grew up in New Haven, and now, post-acquisition, the acquiring company has committed to double down on New Haven. It’s going to continue to grow the research presence here, which is a nice endorsement of our local market too. Last one I’ll mention is again, back on Craig. So Craig’s second start-up company was Arvinas, and just a week ago, Arvinas got their first FDA approval for a new therapy called, it’s going to go by, marketed by the name VEPPANU, which is a treatment for breast cancer and has shown significant benefit for a number of breast cancer patients, a great improvement on the standard of care.

And so reaching that milestone and now having a therapy that will be in the hands of patients and also is the first FDA approval of a PROTAC, this new platform for using protein degradation is a technology that inspired dozens of other start-up companies pursuing the same technology. So yeah, we’ve been on a bit of a run the last few months. These are really exciting milestones, and we’re excited about what’s still to come.

Harlan Krumholz: Yeah, that’s amazing. It’s good for the university, good for the faculty member, good for society. It’s a real great win. One of the things that you’ve been able to do that I think is very interesting, and actually surprising, I think even at some other universities how we’ve been able to navigate this at Yale, is to say that you can continue to work on your science, that science can still be related to the enterprise, and we can build out ways for the management of the conflict of interest so that you’re working on groundbreaking science that’s making a difference in the world. There’s a commercialization strategy for that science. You don’t have to stop and say, “Well, that’s a conflict because you’re working on this and you’ve got interest in the company,” but that we’re able to navigate that—as we should, because why would you want someone to stop doing something that is actually making such a big difference in the world?

That was always a point of friction. It was like, “Well, wait a minute, now there’s commercial interest.” And I actually would like to see it even put into, for younger people who are doing this, part of the promotion package is a consideration about whether or not your stuff is scaling out to the world. Because in some ways, it’s a measure of the value of what you’ve produced, that knowledge. Again, now we’re talking about in the parts of the university where people are doing this, and the humanities is something entirely different, but if you’re in medicine, one of the best and highest ways you can contribute is to help patients have better outcomes. And if you’re doing that, we don’t want you to stop.

I just want to commend you for helping us, as a university, to navigate that. And for people to hear, you want to come to Yale as a faculty member and you’re interested in seeing your stuff come out, it’s a great place to be because of the work largely Yale Ventures has been able to navigate in terms of doing that. I mean, I think that’s distinctive, Josh. I mean, do you feel that way?

Josh Geballe: No, it is. I mean, I talk to my peers at the other big research universities, and I can say pretty confidently at this point, thanks to the support of our academic leadership, we have made changes over the last several years to a number of policies that I think put Yale in a position at this point that we are one of the leaders in terms of having policies and programs and a culture emerging now, too, that is supportive of entrepreneurial activities and the translation of research discoveries. And so we’re well positioned now. Doesn’t mean there’s never any friction in the process. Howie and I both sit on a conflict of interest committee and we see some interesting cases, but for the most part people understand the rules and we’ve got things going pretty well, and we’ve given our faculty, I think, a lot more leeway than most of our peers to be active in this area, and for the university to be able to support them in this area.

Harlan Krumholz: And just to be clear at the end of this, just say, it is actively managed. I mean, so it’s not a matter of reducing the standard, it’s a matter of putting together policies and procedures that ensure that we can maintain integrity, that the science is untethered to the commercial interest, but that people can continue. So I just want to say that I don’t think there was any reduction in the standard, but it was just that the processes were put together so that they were proactively working to say, “We have a common goal. Let’s make it so you can continue to do your work. Now let’s figure out how that can work so everyone can be satisfied, can be transparent, clear, and show integrity at every angle.” So I think that’s good.

Howard Forman: I just want to add to that, though, that it really does take someone like you with your vision to be able to help guide the provost’s office to be able to change a faculty handbook so that it doesn’t obstruct innovation, because there were features in our handbook that historically could be seen as obstructing innovation, and now we have the opportunity to actually allow people to foster innovation at the earliest stages without feeling like they have to leave the university. And just that as a single example, I think, is a way in which Yale is doing what it needs to do to help people be the best version of themselves, be able to innovate, commercialize, and make the world better for everybody, not just for themselves.

Josh Geballe: Yeah. Well, you’re giving me too much credit here. I mean, I’m happy to be part of the team that’s been pushing this, but it starts at the top. None of this happens unless you’ve got President McInnis and Provost Strobel and the deans in unison of the view that this is an area we want to take steps forward and we want to be really supportive, and then that gives us the room to go execute. But we’re very fortunate here that we’ve got academic leadership that is very focused in this area and very committed to making sure that Yale’s one of the best places in the world for translational research, and having the programs in place to see that research turn into products and services that can really make the world a better place.

Harlan Krumholz: What do you see as the next horizon? So as you look ahead, what are the next innovations that Yale Ventures is going to do?

Josh Geballe: Yeah. So we’re just in the process right now of standing up two new accelerator programs. So these are programs that provide grant funding and a lot of support and mentorship to a select number each year of the most promising new innovations. So we just launched one called HealthTech Works, which is focused on digital health in particular. Harlan, I know you’re super interested in this. A lot of AI applications in healthcare, and all the way upstream into drug discovery. And then we launched another one called Planetary Solutions Impact Accelerator, which is focused on climate technologies and sustainability and other technologies that can help protect the planet and sustainability. So we’re in the process of standing those up. With those two now, we’ve got an accelerator program with coverage across the full research enterprise at Yale.

So in terms of what’s next, it’s going to be continuing to grow these programs because we still have a supply and demand mismatch. We still get many more applications that are incredibly exciting and promising than we have the resources to support. I still spend some time working with our alumni and our donor community to add more resources there, but we’re excited about scaling those up. We’re also working closely with Dean Brock at the School of Engineering. As that school grows very rapidly, as it just became an independent school a couple of years ago, we’re really excited about his vision to expand support, particularly in engineering for entrepreneurship and innovation. We’re working together on some new things that I think you’ll be seeing some announcements in the coming year. So a lot of exciting stuff going on across campus.

Howard Forman: As we get to wrap up, I just want to ask you, we’re talking to you from your office on College Street. You’re physically within a thousand feet of the med school, the School of Public Health, and you’re across the street from the Alexion building, which is a great success of Yale innovation as well. But where you physically sit is also an incubator of types. Biohaven is there, and they have multiple pods set up for people to be able to do early innovation around it. Do you want to just speak very briefly about how important it is for you to be physically there and working with both the private sector and the university at the same time to help this process forward?

Josh Geballe: Yeah. The density matters. If you’re up in Kendall Square and up in the Boston area, you see the benefits of having a lot of people working on similar problems clustered around each other, and the collaboration and the collisions that happen that open up new opportunities. And so it’s great to be here next to BioLabs, because most of the biotech start-ups we’re spinning out now get started at BioLabs. They’re doing really well, and so it’s nice to be near them. But we do have a presence still on central campus as well. Howie, I think I see you almost every day walking back and forth to central campus. So you know I’m up there all the time.

Howard Forman: It’s hard not to. That’s where I live and work. Yeah.

Josh Geballe: That’s right. That’s right. And so we think that’s important too, to be very present at engineering and up on Science Hill. But this area, the 101, 100 College Street, you’re going to see in the next couple of weeks an announcement about another new building that’s going to be going up in this neighborhood. And there’s some other already announced projects headed down towards the train station. So this whole area is going to continue to fill in in the coming years and really continue to establish New Haven as a really vibrant, thriving ecosystem of innovation.

Harlan Krumholz: We’re just so lucky to have you because you do have this view of the whole university, but you’re such a great champion for New Haven and for the area. And anyway, we all owe you a debt of gratitude for what you’re doing every day. It’s tremendous.

Howard Forman: It is great to have you here. We appreciate it.

Josh Geballe: Oh, it’s great fun. We have a blast. It’s so much fun to get to work with our students and faculty and alumni and just brilliant folks... working on important problems. So it’s really an honor.

Howard Forman: Looking forward to seeing you at the Innovation Summit in less than two years.

Josh Geballe: Yeah. One last thing about the Innovation Summit. So people should go register. You go to ventures.yale.edu, easily find the registration site. There is a fee to register, but we never want cost to be a barrier to anyone attending. So if the fees are too much, write to us, we’ll give you a ticket, but we look forward to seeing everyone there.

Howard Forman: That’s awesome. So can we call it the Health & Veritas discount?

Josh Geballe: That’s it. That’s it. And I think Health & Veritas is going to be recording a live episode at the summit.

Howard Forman: We are. Unfortunately, Harlan will be away, but me and Megan Ranney will do the live podcast from the summit.

Harlan Krumholz: I said I’m not going to do this again, but I’ve got one more big thing I got to go to in China. So I actually am going to miss it. I’m really sad to miss it, but I know it’s going to be great, and I won’t let that happen again.

Josh Geballe: Howie, you said you’re going to stay a little late and sign autographs for folks afterwards?

Howard Forman: I’m always available for autographs.

Josh Geballe: Perfect.

Howard Forman: Thank you again. He was great.

Harlan Krumholz: As expected, he’s just terrific. He’s just terrific. Hey, Howie, let’s get to one of my favorite parts of the podcast, what Howie Forman is thinking this week.

Howard Forman: Well, it’s the same thing as last week. I just want to take a couple of minutes and update you on antivirus outbreak, because that’s continued to unfold after this Dutch cruise ship, the MV Hondius, has now disembarked all passengers and most crew. As of today, there are 11 total reported cases, nine of which have been confirmed. Three people have died. Passengers have been repatriated to more than a dozen countries. And in the United States, 18 Americans have returned home. Sixteen are being monitored at University of Nebraska Medical Center, and two were sent to Atlanta for further evaluation. One American has tested positive for the virus but has no symptoms. A second is showing symptoms but has not yet tested positive. Different countries are responding very differently. The Netherlands, France, and the U.K. have all implemented mandatory quarantines of 42 to 45 days, reflecting the maximum known incubation period for the Andes virus.

The United States has taken a different approach—for the most part, voluntary home monitoring with passengers asked to stay in touch with their local health departments and limit outside contact. Whether that’s the right call is a legitimate public health question. One important piece of reassuring news, to the best of our knowledge there has been no documented secondary transmission from any repatriated passenger, not on the flights home, not in communities. That reinforces what we know about the Andes virus. It requires close, sustained contact to spread person to person. There is still no evidence of presymptomatic transmission. People don’t appear to spread this before they get sick. That’s a meaningful distinction from COVID. I do want to flag one deeply concerning development, and that is a French woman infected on the ship is now critically ill in Paris on what we call an artificial lung, or what we clinically call ECMO, or extracorporeal membrane oxygenation, due to severe lung and heart failure.

That is Hantavirus Pulmonary Syndrome at its most serious, and it’s a reminder of how rapidly this disease can deteriorate. The case count will likely rise further. Formal outbreak protocols weren’t in place for the first two weeks, meaning exposures occurred without precautions. The World Health Organization director general has been direct. There is no sign of a larger outbreak beginning, but given the long incubation period, more cases in the coming weeks remain possible. What I’ll leave you with is this. Until now, our entire understanding of Andes hantavirus has been built on a very small number of cases studied under difficult conditions. This outbreak is being studied in real time. Genomic sequencing, rigorous contact tracing, international coordination. What we learn from this tragedy will fundamentally advance the science. That’s the cold comfort for those who have lost loved ones, but it is a genuine silver lining.

Harlan Krumholz: The one puzzle for me is, why wasn’t... wherever they picked it up from—they had been traveling extensively before they got on the boat, the patient zero people—that there wasn’t an outbreak there. It seemingly they got it, then they brought it to the ship, they’ve transmitted it. But why wasn’t there an outbreak wherever it was that they picked it up?

Howard Forman: I think the timing was what it was. The ornithologist from the Netherlands who had been on a three-month expedition looking at birds, went to this apparently notorious dump site with lots of garbage where lots of rats were, where it’s apparently a great site to find certain birds. And most people in the area know to stay away from that dump because it’s dirty and infested. He was there specifically looking for these birds. And he’s a trained ornithologist. He knew what he was getting into. He got infected there at the end of March, got on board the ship at the beginning of May—at the beginning of April—and the rest is history. It took a few weeks for him to get sick, spread it to his wife, and so on and so forth.

Harlan Krumholz: It’s also puzzling, this incubation period. It’s like you think this virus is brewing in people’s bodies. What takes it so long to manifest? And then when it does manifest, it can be so catastrophic.

Howard Forman: Yes.

Harlan Krumholz: It’s not like you get this and you get really sick. It’s like you get this and it can sit with you for a while, and then it can make you really sick.

Howard Forman: I bet someone like Akiko Iwasaki or someone else who fundamentally understands either infectious disease or immunology or both would tell us more about why that happens. But it’s true. There are some people that do seem to be converting in 10 or 15 days, and there are the outliers at 40 to 45 days. A lot of people just get it in this two-to-three-week block. At least for this outbreak, it seems to be in that two-to-three-week zone.

Harlan Krumholz: But then it can be explosive. It’s like it’s in that zone and then it just explodes.

Howard Forman: But I think it may be an immune reaction. It may be a dysfunctional reaction, but I don’t know enough to say.

Harlan Krumholz: And Ebola was like that too, I think. It’s just—

Howard Forman: Horrible.

Harlan Krumholz: ... horrible. Well, thanks for keeping us up to date. Didn’t your Instagram last week, it just blew up, right? You had this thing—

Howard Forman: We got a lot of attention on Instagram. We got to tell people to join our Instagram at campus.

Harlan Krumholz: It’s like 100,000 people listened to Howie last week on this topic.

Howard Forman: Well, and we did also okay on TikTok and on YouTube and I think on Facebook. So kudos to our social media team.

Harlan Krumholz: No, I was going to say, kudos to you for being a good educator around these topics. There’s lots of people out there who don’t know what they’re talking about. You do the homework. You’re communicating well. And we really appreciate you, Howie. You’re doing a great job.

Howard Forman: Thanks.

Harlan Krumholz: You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.

Howard Forman: So how did we do? To give us your feedback or to keep the conversation going, email us at health.veritas@yale.edu, or follow us on any of social media.

Harlan Krumholz: Yeah. Give us feedback. You can see Howie’s hot now, baby, Howie’s hot. So you don’t want to miss the social media, but also give us some feedback. We appreciate it.

Howard Forman: Health & Veritas is produced with the Yale School of Management and the Yale School of Public Health. To learn about Yale SOM’s MBA for Executives program, visit som.yale.edu/emba. And to learn about the Yale School of Public Health’s Executive Master of Public Health program, visit sph.yale.edu/emph.

Harlan Krumholz: And hat tip to our superstar undergraduate students, Donovan Brown, Gloria Beck, Tobias Liu, who’s about to graduate, to our fantastic producer, Miranda Shafer. And I’m just grateful to work with the best in the business every week, Howie Forman.

Howard Forman: I appreciate that. And to everybody out there, Yale’s graduation is this coming Monday. And to Tobias and all of our upcoming graduates, congratulations.

Harlan Krumholz: Congratulations. Yeah, it’s a fantastic day at Yale. Talk to you soon, Howie.

Howard Forman: Thanks, Harlan. Talk to you soon.