Hard Drugs

Should everyone be taking statins?

Heart disease is the leading cause of death worldwide, but it’s also one of medicine’s biggest success stories. Since the 1950s, the risk of dying from cardiovascular disease has fallen dramatically, thanks to public health efforts, emergency care, medical innovation, and surgeries. In this episode, Jacob and Saloni explore the cholesterol revolution: from statins discovered in fungi to new drugs that cut LDL cholesterol by 60% and last for months, driven by breakthroughs in genetics, monoclonal antibodies, RNA therapies, and modern medicinal chemistry. They talk about how cholesterol travels through the bloodstream, how it causes atherosclerosis and heart disease, and why it took nearly a century for scientists to form the consensus that lowering cholesterol saves lives. Hard Drugs is a podcast from Works in Progress and Coefficient Giving about medical innovation presented by Saloni Dattani and Jacob Trefethen. You can watch or listen on YouTube, Spotify, or Apple Podcasts. Chapters:  0:00:00 Introduction 13:35 The decline in heart disease mortality 31:02 Surprising facts about cholesterol 55:40 The lipid hypothesis: 7 lines of evidence for the harms of LDL cholesterol 1:22:15 How cholesterol works 1:30:40 The discovery of statins 1:48:44 Should everyone be on statins? 1:57:10 PCSK9 drugs and beyond 2:22:56 Summary  Saloni’s substack newsletter: https://www.scientificdiscovery.dev/ [https://www.scientificdiscovery.dev/] Jacob’s blog: https://blog.jacobtrefethen.com/ [https://blog.jacobtrefethen.com/]  Acknowledgements: * Aria Babu, editor at Works in Progress * Graham Bessellieu, video editor * Abhishaike Mahajan, cover art * Atalanta Arden-Miller, art direction * David Hackett, composer Works in Progress & Coefficient Giving Correction: In the episode, Saloni makes an error in converting the number of heartbeats per lifetime. It is roughly 2.5 billion beats, not a trillion. Books * Daniel Steinberg (2007) The Cholesterol Wars. * Jie Jack Li (2009) Triumph of the Heart: The Story of Statins. Blog posts * James Stein (2025) Lipid and lipoprotein basics series. https://jamesstein18.substack.com/p/part-i-lipid-and-lipoprotein-basics [https://jamesstein18.substack.com/p/part-i-lipid-and-lipoprotein-basics]  Articles * Akira Endo (2017) Discovery and Development of Statins https://doi.org/10.1177/1934578X1701200801 [https://doi.org/10.1177/1934578X1701200801]  * Joseph L Goldstein, Michael S Brown (2010) History of discovery: The LDL receptor. https://pmc.ncbi.nlm.nih.gov/articles/PMC2740366/ [https://pmc.ncbi.nlm.nih.gov/articles/PMC2740366/]  * Patty W. Siri-Tarino and Ronald M. Krauss (2016) The early years of lipoprotein research: from discovery to clinical application https://pubmed.ncbi.nlm.nih.gov/27474223/ [https://pubmed.ncbi.nlm.nih.gov/27474223/]  * Eun Ji Kim and Anthony S. Wierzbicki (2020) The history of proprotein convertase subtilisin kexin-9 inhibitors and their role in the treatment of cardiovascular disease https://pubmed.ncbi.nlm.nih.gov/32537117/ [https://pubmed.ncbi.nlm.nih.gov/32537117/]  * Patrick W. Siri-Tarino et al. (2010) Saturated fat, carbohydrate, and cardiovascular disease. https://www.pnas.org/doi/10.1073/pnas.94.9.4312?utm_source=chatgpt.comhttps://www.pnas.org/doi/10.1073/pnas.94.9.4312 [https://www.pnas.org/doi/10.1073/pnas.94.9.4312] * Saloni Dattani (2025) Death rates from cardiovascular disease have fallen dramatically — what were the breakthroughs behind this?  [https://ourworldindata.org/cardiovascular-deaths-decline?utm_source=chatgpt.com]https://ourworldindata.org/cardiovascular-deaths-decline [https://ourworldindata.org/cardiovascular-deaths-decline] * Cholesterol Treatment Trialists’ (CTT) Collaboration (2010) Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. https://www.thelancet.com/article/S0140-6736%2810%2961350-5/fulltext?utm_source=chatgpt.comhttps://doi.org/10.1016/S0140-6736(10)61350-5 [https://doi.org/10.1016/S0140-6736(10)61350-5] * E. J. Mills et al. (2011) Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170,255 patients from 76 randomized trials. https://pubmed.ncbi.nlm.nih.gov/20934984/ [https://pubmed.ncbi.nlm.nih.gov/20934984/] * Julia Brandts and Kausik K. Ray (2023) Novel and future lipid-modulating therapies for the prevention of cardiovascular disease.  https://www.nature.com/articles/s41569-023-00860-8 [https://www.nature.com/articles/s41569-023-00860-8] Videos * Ninja Nerd (2018) Lipoprotein metabolism https://www.youtube.com/watch?v=wQY0xpwqPfQ [https://www.youtube.com/watch?v=wQY0xpwqPfQ]

The first cancer vaccine

Hepatitis B is a tiny virus that causes hundreds of thousands of deaths from liver disease and cancer each year. The vaccine against it became the first of many milestones: it was the first viral protein subunit vaccine, the first recombinant vaccine, and the first vaccine to prevent a type of cancer.  In this episode, Jacob and Saloni follow the trail of strange jaundice outbreaks that scientists traced to a stealthy liver virus, how scientists turned one viral surface protein into a lifesaving shot for newborns, and how it was all built upon breakthroughs in immunology. Hard Drugs is a new podcast from Works in Progress and Coefficient Giving about medical innovation presented by Saloni Dattani and Jacob Trefethen. You can watch or listen on YouTube, Spotify, or Apple Podcasts. Chapters: 0:00:00 Introducing the hepatitis B vaccine 0:15:46 The mysterious trail of jaundice outbreaks 0:28:03 How a tiny virus causes cirrhosis and liver cancer 0:53:19 Maurice Hilleman's purified hep B vaccine 1:17:36 Turning the hep B vaccine recombinant 1:29:14 The impact of hep B vaccination 1:39:27 The 19th century battle for immunology 2:01:34 How the body makes an almost infinite number of antibodies 2:30:57 How subunit vaccines took over 2:45:33 Conclusion Saloni’s substack newsletter: https://www.scientificdiscovery.dev/ [https://www.scientificdiscovery.dev/] Jacob’s blog: https://blog.jacobtrefethen.com/ [https://blog.jacobtrefethen.com/]  Books: * Paul Offit (2007) Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases * Arthur M Silverstein (2009) A history of immunology * Ronald W Ellis (1993) Hepatitis B Vaccines in Clinical Practice * Sally Smith Hughes (2011) Genentech: The beginnings of biotech Articles: * Timothy M. Block et al. (2016) A historical perspective on the discovery and elucidation of the hepatitis B virus https://doi.org/10.1016/j.antiviral.2016.04.012 [https://doi.org/10.1016/j.antiviral.2016.04.012]  * Naijuan Yao et al. (2022) Incidence of mother-to-child transmission of hepatitis B in relation to maternal peripartum antiviral prophylaxis: A systematic review and meta-analysis https://doi.org/10.1111/aogs.14448 [https://doi.org/10.1111/aogs.14448] * Jill Koshiol et al. (2019) Beasley’s 1981 paper: The power of a well-designed cohort study to drive liver cancer research and prevention https://pmc.ncbi.nlm.nih.gov/articles/PMC5866222/ [https://pmc.ncbi.nlm.nih.gov/articles/PMC5866222/]  * William J. McAleer et al. (1984) Human hepatitis B vaccine from recombinant yeast https://doi.org/10.1038/307178a0 [https://doi.org/10.1038/307178a0]  * Chunfeng Qu et al. (2014) Efficacy of Neonatal HBV Vaccination on Liver Cancer and Other Liver Diseases over 30-Year Follow-up of the Qidong Hepatitis B Intervention Study: A Cluster Randomized Controlled Trial https://doi.org/10.1371/journal.pmed.1001774 [https://doi.org/10.1371/journal.pmed.1001774]  * Anthony R Rees (2020) Understanding the human antibody repertoire https://doi.org/10.1080/19420862.2020.1729683 [https://doi.org/10.1080/19420862.2020.1729683]  Correction: Urea was mentioned as a protein, but is actually the product of a protein breakdown process, not a protein itself. Acknowledgements: * Aria Babu, editor at Works in Progress * Graham Bessellieu, video editor * Abhishaike Mahajan, cover art * Atalanta Arden-Miller, art direction * David Hackett, composer Works in Progress & Coefficient Giving

The history of vaccines

Before vaccines became routine, they were risky experiments. In this episode, Jacob and Saloni travel back to the world of smallpox, cowpox, and cow-based “vaccine farms” to see how scientists stumbled toward the first vaccines against infectious diseases: smallpox, rabies, TB, polio, and more. Through the stories of milkmaids and aristocrats, secret lab notebooks, microscopes and cell culture, they explore how trial and error turned gruesome folk practices into the science of immunization, and how it all began with a single pustule. Hard Drugs is a new podcast from Works in Progress and Coefficient Giving about medical innovation presented by Saloni Dattani and Jacob Trefethen. You can watch or listen on YouTube, Spotify, or Apple Podcasts. Saloni’s substack newsletter: https://www.scientificdiscovery.dev/ [https://www.scientificdiscovery.dev/] Jacob’s blog: https://blog.jacobtrefethen.com/ [https://blog.jacobtrefethen.com/]  Books: * Gerald Geison (1995) The private science of Louis Pasteur * Thomas D. Brock (1998) Robert Koch: a life in medicine and bacteriology * Mervyn Susser and Zena Stein (2009) Eras in epidemiology : the evolution of ideas * Angela Leung (2011) Chapter: “Variolation” and vaccination in late Imperial China, ca. 1570–1911. History of vaccine development by Stanley Plotkin * Florian Horaud (2011) Chapter: Viral vaccines and cell substrate. History of vaccine development by Stanley Plotkin * Samuel Katz (2011) Chapter: The role of tissue culture in vaccine development. History of vaccine development by Stanley Plotkin * Hervé Bazin (2011) Chapter: Pasteur and the birth of vaccines made in the laboratory. History of vaccine development by Stanley Plotkin Articles: * Andrew Shattock et al. (2024) Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00850-X/fulltext [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00850-X/fulltext]  * Saloni Dattani (2020) The story of Viktor Zhdanov https://worksinprogress.co/issue/the-story-of-viktor-zhdanov/ [https://worksinprogress.co/issue/the-story-of-viktor-zhdanov/] * José Esparza et al. (2020) Early smallpox vaccine manufacturing in the United States https://doi.org/10.1016/j.vaccine.2020.05.037 [https://doi.org/10.1016/j.vaccine.2020.05.037]  * Paula Gottdenker (1979) Francesco Redi and the fly experiments https://www.jstor.org/stable/44450950 [https://www.jstor.org/stable/44450950]  * Donald Angus Gillies (2016) Establishing causality in medicine and Koch’s postulates * Burt A Folkart (1993) Dr. Albert Sabin, Developer of Oral Polio Vaccine, Dies https://www.latimes.com/archives/la-xpm-1993-03-04-mn-283-story.html [https://www.latimes.com/archives/la-xpm-1993-03-04-mn-283-story.html]  * Saloni Dattani (2025) Measles leaves children vulnerable to other diseases for years https://ourworldindata.org/measles-increases-disease-risk [https://ourworldindata.org/measles-increases-disease-risk]  Acknowledgements: * Aria Babu, editor at Works in Progress * Graham Bessellieu, video editor * Abhishaike Mahajan, cover art * Atalanta Arden-Miller, art direction * David Hackett, composer Works in Progress & Coefficient Giving

Will AI solve medicine?

Artificial intelligence is transforming how we discover and develop new medicines. But how far can it really take us? In this episode, Jacob and Saloni trace the path of drug development from discovery to testing, manufacturing, and delivery. They explore where AI could speed things up, and where it still hits the limits of biology, data, and economics. They ask what it would take, beyond algorithms, to actually cure and eradicate diseases. Hard Drugs is a new podcast from Works in Progress and Open Philanthropy about medical innovation presented by Saloni Dattani and Jacob Trefethen. You can watch or listen on YouTube, Spotify, or Apple Podcasts. Saloni’s substack newsletter: https://www.scientificdiscovery.dev/ [https://www.scientificdiscovery.dev/] Jacob’s blog: https://blog.jacobtrefethen.com/ [https://blog.jacobtrefethen.com/]  Chapters: 0:00:00 Intro 0:09:56 Drug discovery 1:02:20 Animal models 1:49:09 Drug efficacy 2:32:56 Drug safety 2:58:29 Manufacturing and healthcare 3:43:23 R&D funding 4:00:56 Trust and ambition 4:16:01 Summary Blogposts: * Claus Wilke (2025) We still can’t predict much of anything in biology https://blog.genesmindsmachines.com/p/we-still-cant-predict-much-of-anything [https://blog.genesmindsmachines.com/p/we-still-cant-predict-much-of-anything]  * Elliot Hershberg (2025) What are virtual cells? https://centuryofbio.com/p/virtual-cell [https://centuryofbio.com/p/virtual-cell]  * Jacob Trefethen (2025) Blog series. 1) What does AI progress mean for medical progress? https://blog.jacobtrefethen.com/ai-progress-medical-progress/ [https://blog.jacobtrefethen.com/ai-progress-medical-progress/] 2) AI will not suddenly lead to an Alzheimer’s cure https://blog.jacobtrefethen.com/ai-san-francisco/ [https://blog.jacobtrefethen.com/ai-san-francisco/] 3) AI could help lead to an Alzheimer’s cure https://blog.jacobtrefethen.com/ai-optimism/ [https://blog.jacobtrefethen.com/ai-optimism/]  Articles: * Wendi Yan (2024) Discovering an antimalarial drug in Mao’s China https://www.asimov.press/p/antimalarial-drug [https://www.asimov.press/p/antimalarial-drug]  * Jason Crawford (2020) Innovation is not linear https://worksinprogress.co/issue/innovation-is-not-linear/ [https://worksinprogress.co/issue/innovation-is-not-linear/]  * Shayla Love (2025) An ‘impossible’ disease outbreak in the Alps https://www.theatlantic.com/health/archive/2025/03/als-outbreak-montchavin-mystery/682096/ [https://www.theatlantic.com/health/archive/2025/03/als-outbreak-montchavin-mystery/682096/]  * Alex Telford (2024) Origins of the lab mouse https://www.asimov.press/p/lab-mouse [https://www.asimov.press/p/lab-mouse]  * Jonathan Karr et al. (2012) A whole-cell computational model predicts phenotype from genotype https://pmc.ncbi.nlm.nih.gov/articles/PMC3413483/ [https://pmc.ncbi.nlm.nih.gov/articles/PMC3413483/]  * Wen-Wei Liao et al. (2023) A draft human pangenome reference https://www.nature.com/articles/s41586-023-05896-x [https://www.nature.com/articles/s41586-023-05896-x]  * Per-Ola Carlsson (2025) Survival of transplanted allogeneic beta cells with no immunosuppression https://www.nejm.org/doi/pdf/10.1056/NEJMoa2503822 [https://www.nejm.org/doi/pdf/10.1056/NEJMoa2503822]  * Saloni Dattani (2024) Antipsychotic medications: a timeline of innovations and remaining challenges https://ourworldindata.org/antipsychotic-medications-timeline [https://ourworldindata.org/antipsychotic-medications-timeline]  * Saloni Dattani (2024) What was the Golden Age of antibiotics, and how can we spark a new one? https://ourworldindata.org/golden-age-antibiotics [https://ourworldindata.org/golden-age-antibiotics]  Books: * Sally Smith Hughes (2011) Genentech: The beginnings of biotech Theses: * Alvaro Schwalb (2025). Estimating the burden of Mycobacterium tuberculosis infection and the impact of population-wide screening for tuberculosis. Acknowledgements: * Aria Babu, editor at Works in Progress * Graham Bessellieu, video editor * Abhishaike Mahajan, cover art * Atalanta Arden-Miller, art direction * David Hackett, composer Works in Progress & Open Philanthropy [Minor correction: Since the 1980s, malaria challenge trials no longer involve hundreds of bites; in the past, volunteers received many bites for the exposure part of the trial rather than the challenge part.]

The art of protein design with AI

What if you could design a protein never seen in nature? In this episode, Jacob and Saloni explore how researchers are using new tools like RFDiffusion, AlphaFold, and ProteinMPNN to ‘hallucinate’ entirely novel proteins: designing them from scratch to solve problems evolution hasn’t tackled. They talk about how these technologies could transform medicine, agriculture, and materials science. Along the way, they reflect on the surprising ways AI is changing the process of science itself. Hard Drugs is a new podcast from Works in Progress and Open Philanthropy about medical innovation presented by Saloni Dattani and Jacob Trefethen. Saloni’s substack newsletter: https://www.scientificdiscovery.dev/ [https://www.scientificdiscovery.dev/] Jacob’s blog: https://blog.jacobtrefethen.com/ [https://blog.jacobtrefethen.com/]  Courses: * EMBL-EBI. AlphaFold: A practical guide https://www.ebi.ac.uk/training/online/courses/alphafold/ [https://www.ebi.ac.uk/training/online/courses/alphafold/]  Articles: * Tanja Kortemme (2024) De novo protein design—From new structures to programmable functions https://www.cell.com/cell/fulltext/S0092-8674(23)01402-2 [https://www.cell.com/cell/fulltext/S0092-8674(23)01402-2]  * Jie Zhu et al. (2021) Protein Assembly by Design https://pubs.acs.org/doi/10.1021/acs.chemrev.1c00308 [https://pubs.acs.org/doi/10.1021/acs.chemrev.1c00308]  Lectures: * Rosetta Commons (2024) Diffusion models for protein structure generation (and design) https://www.youtube.com/watch?v=OEnY2yA3jy8 [https://www.youtube.com/watch?v=OEnY2yA3jy8]  * Rosetta Commons (2024) AlphaFold – ML for protein structure prediction https://www.youtube.com/watch?v=SVrn8_8aKO8 [https://www.youtube.com/watch?v=SVrn8_8aKO8]  * Rosetta Commons (2024) MPNN – ML for protein sequence design https://www.youtube.com/watch?v=6z4XmUAwdNA [https://www.youtube.com/watch?v=6z4XmUAwdNA]  Acknowledgements: * Aria Babu, editor at Works in Progress * Graham Bessellieu, video editor * Rachel Shu, on-site editor * Anna Magpie, fact-checking * Abhishaike Mahajan, cover art * Atalanta Arden-Miller, art direction * David Hackett, composer Works in Progress & Open Philanthropy