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For Blood and Money: Billionaires, Biotech, and the Quest for a Blockbuster Drug

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A gripping business narrative and scientific thriller about what it takes to bring a wonder drug to market―and save countless lives. For Blood and Money tells the little-known story of how an upstart biotechnology company created a one-in-a-million cancer drug, and how members of the core team―denied their share of the profits―went and did it again. In this epic saga of money and science, veteran financial journalist Nathan Vardi explains how the invention of two of the biggest cancer drugs in history became (for their backers) two of the greatest Wall Street bets of all time. In the multibillion-dollar business of biotech, where pharmaceutical companies, the government, hedge funds, and venture capitalists have spent billions on funding, experimentation, and treatments, a single molecule can stop cancer in its tracks―and make the people who find that rare molecule astonishingly rich. For Blood and Money follows a small team at a biotech start-up in California, who have found one of these rare molecules. Their compound, known as a BTK inhibitor, seems to work on a vicious type of leukemia. When patients start rising from their hospice beds, the team knows they’re onto something big. What follows is a story of genius, pathos, and drama, in which vivid characters navigate a world of corporate intrigue and ambiguous morality. Vardi’s narrative immerses readers in the recent explosion of biotech start-ups. He describes the scientists, doctors, and investors who are risking everything to develop new, life-saving treatments, and introduces suffering patients for whom the stakes are life-or-death. A gripping nonfiction read, For Blood and Money illustrates why it’s so hard to bring new drugs to market, explains why they are so expensive, and examines how profit-driven venture capitalists are shaping the future of medicine.

288 pages, Hardcover

Published January 10, 2023

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Nathan Vardi

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Displaying 1 - 30 of 140 reviews
Profile Image for Max.
349 reviews403 followers
March 9, 2023
Vardi gives us a window into the world of biotech and pharma. He follows two Silicon Valley startups developing cancer drugs through their trials and tribulations. Along the way we meet a wide gamut of people and personalities: Medical professionals, dedicated research scientists, investors, entrepreneurs, controlling and demanding CEOs. People come and go as the companies prosper or falter and personalities clash. There is no job security. People who have devoted years to developing a drug are fired if no longer needed or out of synch with the company mantra. It’s a rough and tumble world where investors put in tens or hundreds of millions of dollars and expect results. For the workers there is intense pressure but also satisfaction that you are on the cutting edge of science developing lifesaving drugs. If the company is fortunate enough to be successful those that manage to survive to the end get a generous payout. But of course, the investors take the lion’s share. In the two cases Vardi covers, after years of work the startups produced blockbuster drugs that were sold to large pharma companies for billions of dollars. Workers still on the payroll got anywhere from a million to tens of millions with a couple of leaders getting over a hundred million. Investors with a large stake became billionaires.

It's a fascinating read and I had a lot of takeaways. The book can be read as a profile of high stakes entrepreneurship. But what stood out to me is the way drugs are developed. One takeaway was realizing how many drugs have been set aside in favor of the few deemed worth the risk. Both the blockbusters described in the book were in that category until a small pharma picked them up on the cheap. Another is that it is insanely expensive to develop a drug, take it through clinical trials and get FDA approval. Thus, most drugs with potential just sit on a shelf. The large pharma’s are very picky about what they will develop. They are looking for billion dollar plus revenue streams lasting years with very little risk. Some drugs that don’t make the cut get sold if there is any interest. If a small biotech develops a promising drug enough to de-risk it, big pharma buys in. Cancer and orphan disease drugs are top priorities because the companies can charge well over a hundred thousand dollars a year per patient for them. Drugs such as antibiotics which sell for relatively little are of no interest and don’t get developed.

Then there is the issue of how competition works or doesn’t work. Drug companies patent every molecule, method and process they can. If there is a legal battle the big ones have the resources to grind down smaller competitors. Another example that was important in the book was controlling access to a drug. When one of the startups wanted to run a clinical trial for their new second-generation drug against the standard drug in use, they needed to buy it. But their competing drug company wouldn’t sell it to them. They found it through a third party but at a higher price. This was a drug that normally sold for $170,000 for a year’s supply per patient. Clinical trials run for years and enroll hundreds or thousands of patients. Only a well-financed company can even think of doing this. And of course, without a competitive product, the cost will remain high and out of reach for many patients, in this case people suffering from a deadly cancer.

Vardi gives us his account of how business is conducted, but he doesn’t weigh in on the greater implications. To me this system is clearly dysfunctional. FDA bureaucracy, arcane patent laws and a legal system dominated by rich and powerful companies shape the system. In 2022 only 37 new drugs were approved. Given the tremendous advances in science, this is appallingly small. How many people suffer without the drugs they need because they are unaffordable, the development is delayed or they are never developed. It’s a risk that doesn’t seem to be taken into account. Dr. Vincent DeVita’s discusses this in his The Death of Cancer https://www.goodreads.com/review/show.... What it would take to change this entrenched system is a much larger discussion. Hopefully someday the will and the means to do so will come together.
Profile Image for Katie.
1,117 reviews239 followers
January 10, 2023
Summary: A fascinating insider look at cancer drug development, full of cool science and people drama!

There are few topics I enjoy reading about more than drama at a biotech company. Bad Blood, about the Theranos blood testing fraud, is still one of my all-time favorite reads. So, when I was offered a chance to review this story of a startup developing a cancer drug, I couldn't say no. First this small company developed an incredible cancer treatment. Then, researchers who were crucial to the company's success, but who were let go before receiving much compensation, went on to found another company and create another successful drug.

This story was everything I'd hoped for. It's full of the high stakes, cool science, and fascinating people that make me love this kind of book. It read less like a thriller than Bad Blood and there was, fortunately, no fraud. Still, the author clearly showed how important this story was, both for cancer patients and the scientists involved. I couldn't put it down!

I was surprised to find that the financial side of this story was also interesting to learn about. The author writes for Forbes and was able to make the business side of the story quite engaging. I liked getting a better understanding of how funding works for start-ups and venture capitalists. Watching big companies compete to acquire successful startups was compelling too. While this wasn't identical in feel to Bad Blood, it had a lot of similar elements, so I'd definitely recommend this to any fellow fans.This review was originally posted on Doing Dewey
Profile Image for Nghi.
46 reviews5 followers
April 10, 2023
I’ve been in the biotech industry for over a decade and can attest to the accuracy of this book. The author did such a fine job at describing the huge personalities, the luck, and the Herculean effort of drug development. What a book. I finished the book at 2am!
14 reviews11 followers
January 29, 2023
I think that everyone that works at cancer centers should read this book. It was a fascinating look into the development of breakthrough treatments and the unbelievable amount of money that investors and pharmaceutical companies make. I’m still sorting through all the ethics questions I have after reading this book.
Profile Image for Anita Lawson.
61 reviews
February 7, 2023
As someone with a rare blood cancer who has taken Imbruvica for 9 years, I found this fascinating! Patients rarely get insights into the development of the medications they take. The detailing of finances involved explains why the drug that keeps me alive is so expensive.
Profile Image for Sandra The Old Woman in a Van.
1,205 reviews43 followers
February 11, 2023
What a ride! If the biotech industry fascinates you - read this book.

Full disclosure - I worked for J&J and was a project team member of the ibrutinib drug development team (representing one of the less prominent disciplines, preclinical safety - not mentioned in the book at all). I had first or almost first-hand knowledge of much of the information in this book. I could not identify any notable errors or misrepresentations. (However, some of the poor behaviors of the principles were a bit downplayed, IMO- public temper tantrums were unfortunately pretty common with this team and leadership.)

But the book tells an accurate story.

Did the principles get lucky, or are they just brilliant? While many are indeed brilliant and creative, they mostly got lucky. They picked an asset everyone else had discarded, and it worked. I've been involved in hundreds of small molecule drug discovery and development programs over my 30+ years in the industry - each program comes with a team of people who believe in its promise to save lives. Ibrutinib is one of only two I was personally involved with that actually made it across the finish line. And that's because it does save lives. Working on this medicine was one of the highlights of my career - and the crazy, crazy ride with many of the characters in this book made it all the more memorable. Of course, I was NOT one of the people that made their riches with this program The J&J folks got their salaries but not PCYC stock.
Profile Image for Maukan.
82 reviews34 followers
September 5, 2023
An interesting read on the world of biotech start ups from the vantage point of multiple people such as the CEO/founder, researchers, traditional corporate people brought into the fold and investors. For those of you who may not know, tech and pharmaceuticals follow a power law distribution. Which basically means 1 winner and thousands of losers in whatever sub domain or field they belong to. One company usually garners all the winnings from a successful product. The winnings from the product can be determined by the degree of difficulty the problem solves. In this case, life saving drugs. This can be in the billions, the stakes are high as fortunes can be made, lives can be changed and an immense amount of power can be born out of nothing. The tolerance for errors is low, the pressure is high and as a result it creates a very tense environment. This book appealed to me for reasons perhaps the author did not intend.

For those of you interested in the science behind the various drugs featured in the book, the science behind it is surface level. Its shallow and it does not go too deep into that part. Its more so a business book than a science book. Mixed in with some corporate boardroom cut throat politics.

What stood out to me was a man in the book who had a number of successes in business ventures throughout his life but no experience in pharma. He would go onto takeover a company, replace the board and turn a 50 million investment into a 3.5 billion investment. The most interesting part was not about how successful this man was but that he was a scientologist. There are some scientology teachings about 25 psychological traits that supposedly represent a genius. The business person I am referring to studied this religiously, never mind the fact that these are just characteristics some psychologist pulled out of his ass with no scientific backing or study to represent prove this. The man believed it whole heartedly.


It reminds me of a story of a first generation immigrant migrating to America, with no college degree, no high school diploma and no money. Becoming wealthy and reaching the echelons of upper middle class along side doctors and lawyers. This immigrants culture yearned to be around other people who migrated from the same country as him who were also first generation immigrants. he wanted to be accepted by this community for a feeling of belonging and respect. The community of first generation immigrants from a specific country that I am purposely not mentioning were extremely competitive and snobbish. An elite level contempt for people not "educated". These were the type of people with advanced degrees, doctors, lawyers, professors etc etc. They never respected the immigrant who was wealthier than them because this man had no education. They resented this man because they thought they were the ones who should have been as wealthy as him. The people that have prestigious diplomas on their walls, who graduated top of their class, who never gotten anything less than an A. They resented him in a way because they thought that being better at taking standardized tests made them more worthy.

This brings me to my conclusion, you can be extremely successful and still have beliefs that make you look like a charlattan. This is not a pejorative. You can be a great business minded person but you can still have deeply stupid opinions on an array of subjects. We like to think that the wealthiest people are the smartest, that they're the ones who become valedictorian and are at the top of their class. In reality to be a great entrepreneur or successful business person does not revolve around excelling at taking tests, getting good grades and graduating from well respected universities. It comes from factors that IQ tests or schooling cannot account for at this point. The only problem is when the successful person starts influencing/speaking at political events where because they think they're wealthy, that they know better than the rest. In America, rich people start speaking and because they're rich, we just stick a microphone into their face and give them influence on TV because we conflate money as the qualification to speak on every subject. We have all seen clips of spectacularly wealthy people with ridiculous opinions.

It goes both ways but the thing this book brings to life in my eyes is that being successful in business adventures doesn't transfer to all area and being good at taking tests means nothing in terms of success. Overall, this is a 3 star book for me but I bumped it to 4 given what I pulled from the story.
Profile Image for Christina.
202 reviews7 followers
February 9, 2023
This book sits too close to home for me to enjoy it. Overall, the result was great for patients— there is no denying that. Sadly, I really struggled with how this book was written— it seems like a literal day by day account of what transpired, but from a few points of views only. I can confirm from my own experience that this story is not unique to how early stage biotechs operate. The book is just a drag to read and sometimes generates a few eye rolls. (Do we need to be reminded that Teslas are obnoxious in the Bay Area? Or how big and small biotech cultures and approaches clash? The absolute worst was calling JPM the Super Bowl of biotech.)

Biotech needs better champions and authors of its stories. The industry has transformed healthcare in many ways. Unfortunately, I’ve read a handful of biotech books, and they’re all the same. No one can quite master the art of telling an engaging story, translating the science and process to get a drug to market, while also cutting out the fat and unnecessary opinions of those being interviewed. Maybe better luck next time.
Profile Image for Brad.
57 reviews4 followers
January 13, 2023
Fantastic book. Drug developers, investors, everyone in the biotech ecosystem will love it.
Profile Image for Eray.
2 reviews
June 14, 2023
As a scientist with PhD deeply entrenched in the realms of discovery side of the biology, I found "For Blood and Money" to be crucial to gain second hand experience of blending both science and business of drug discovery worlds.

Vardi did a great job of highlighting the science behind and the struggles of biotech start-ups that became an awe-inspiring potential to combat cancer. I genuinely liked hearing the scientists sides of the story as much as rich venture capitalists. It is a great source to hear every phase of a drug discovery world and a shortened MBA course on profit-driven decision-making.

I highly recommend it to people who consider biotech as their career path to experience the intersection of science, business, and medicine while still keeping it entertaining with his story-telling that general audience would like!

5/5
Profile Image for Yiying Zhao.
55 reviews
November 7, 2023
I finished the book in 2 days, isn’t that enough of a testament for a non-fiction?
Profile Image for BookStarRaven.
201 reviews5 followers
January 14, 2023
For Blood and Money by Nathan Vardi is an in-depth look at how new drugs are created in Silicon Valley through the hard work of scientists and the investors who back them. Vardi follows the progress of two biotech startups researching a little know molecule called a BTK inhibitor to treat Leukemia.

Verdi’s storytelling is exceptional and I was invested in the story from beginning to end. I was able to see how the drive for money and success drove these companies forward on the business side as well as the desire for a better drug drove the scientists.

Overall, Verdi’s message was very optimistic. On the one hand,I enjoy hearing a story that ends in success not scandal but I also think it is not a common story. Many drugs in the biotech industry will not come to fruition and they investors, wanting a quick return on their investment hurt the science.

I enjoyed this book and would recommend it to anyone interested In the Silicon Valley, the biotech industry or how new drugs are developed.
Profile Image for Chloe Adams.
86 reviews3 followers
June 10, 2023
This is a super well researched book that covers small molecule drugs and the formation of multiple biotechs around them. Unfortunately, the writing felt a bit too dry for me. I like non fiction but this felt like reading page after page of Wikipedia articles and it sometimes felt like the author was repeating himself.
313 reviews3 followers
May 24, 2023
Gripping? Not particularly. Thriller? Not at all.

A look at the dominance and twisted priorities of individual and corporate greed inherent to late stage capitalism; this time through an examination of drug development related to blood cancer treatment. Treatment is the operative word there, because neither drug cures the cancer and neither drug makes people live longer (the author points out there is no statistical significance to the survival rate of patients using either drug). But one has fewer side effects from taking it.

Most importantly, and the author makes sure we don’t lose sight of it: there is a whole lot of money to be made along the way. Meanwhile the science, the scientists, and the pursuit of a cure gets pushed aside. There isn’t as much money in a cure, after all for the investors and shareholders and CEO salaries.

A reader with a heart instead of a fat wallet can be left asking why it has to be this way. So many other examples of misplaced priorities exist that I didn’t need to read this book to confirm it pervades and perverts the American innovation agenda.

The US spends by far the most on life science R&D and heath care with middling comparative results and a declining life span. But, as this book presents the current approach does a fantastic job in furthering the concentration of wealth among rich individuals and fewer and fewer corporations.
Profile Image for Joshua Samsoondar.
22 reviews1 follower
February 19, 2023
3.5 stars, interesting story and pretty quick read, but really lacked depth when it came to the science or getting into the clinical results. It glosses over some pretty awful clinical trial designs (although that would probably spoil the narrative of BTKi being miracle drugs in CLL).
Profile Image for Mizuki.
185 reviews
May 5, 2023
I'm quite familiar with BTK inhibitors as a chemist, and this story shed light on a little different aspect of the drug - I didn't think of the history of the drugs from a 'money' point of view and it was interesting to read it anyway.
Profile Image for Jesse Field.
778 reviews42 followers
June 4, 2023
For Blood and Money is a valuable account of what it takes to bring a major new drug to market, in this case two of the many new cancer drugs that have been coming out in the last few years. We learn that producing such drugs involves not only hundreds of millions of dollars in investment, but close cooperation between FDA officials, physician-scientists, and strong business leaders.

This last category is really a distinct and colorful set of characters. For Blood and Money lingers most on Robert Duggan, an intrepid entrepreneur who somehow combines dreamy, loosely associative thinking with a dogged pursuit of profit. If Bob Duggan lived in the 16th century, he'd no doubt have earned his marks as a privateer, sailing the open seas and plundering the Spanish at every opportunity. Starting instead in the 1960s, Duggan learned to research companies with early-stage IPOs, to read federal anti-trust complaints as 'how-to' manuals, and to bake cookies -- but only so he could open a multi-store franchise, even as he was mourning the death of his son from cancer and reading up on Scientology, whose church he promptly joined and became a strong supporter of. The strangest take of this book is that it was Duggan whose vision, determination, and general bossy nature proved crucial to bringing the blood cancer drug Imbruvica to market, from his position as investor-turned-CEO of Pharmacyclics.

Duggan and the other major business and finance type, Wayne Rothbaum, get the lion's share of attention, as it's their executive decision-making that wins investment and lays in production strategy. They rely on facts and theories generated by physician scientists like Raquel Izumi, whom we learn is a gifted expert at the writing of drug trial protocols, a complex and demanding genre of writing that requires specific instructions for hospital clinicians to follow, while at the same time expositing the science behind the drugs in the best possible light. "Izumi’s protocols were beautifully written scientific stories," says Vardi, and impressed even the relentlessly demanding Wayne Rothbaum.

The central conflict in this book is that business leaders excel at management, if anything, but have to learn some science if they want to profit in pharmaceuticals; physician-scientists excel at science, if anything, but have to learn management if they want to develop new drugs. A pharmaceutical company is a kind of working marriage, or alliance, between these characters, with the CEO and major investors balanced agains the CMO, or Chief Medical Officier, and the other researchers and clinicians, including officials at the FDA, who look to evaluate multi-phase double-arm studies, meaning staged clinical trials in which one population gets the new drug, while another population gets some previously established drug or other treatment, like chemotherapy, acting as a 'control.'

The endeavor is rife with ethical dilemmas: if the new drug is a major improvement, then in phase 2 and 3 trials in particular, isn't it cruel to keep denying the improved treatment to the control group patients? Cancer patients have to suffer and die so that the FDA can observe evidence the new drugs do work. Physician-scientists like Izumi write the trial protocols, but their audience is not just the hospitals and FDA officials, but also their bosses, like Wayne Rothbaum and Robert Duggan. These men, a trader with a passion for biotech, and a cagey entrepreneur, learn the scientific theories behind the drugs -- in this case, it's the evolving theory that kinase inhibition stops cancer growth. These men, in turn, have input on crucial decision points like what is the maximum dosage, what diseases should they apply to the FDA to treat, or even what compounds to select and develop. Duggan and Rothbaum, seeking big profits, have gut feelings that kinase inhibitors are good choices for gathering investment and pushing the drug through trial, application, and marketing.

Part of me thinks, well, that's how capitalism is supposed to work, right? For the patients described in this book, like an old woman in Houston who was on death's door with chronic leukocyte leukemia, or CLL, and who made a recovery when she got Imbruvica, Duggan and his company are heroes. Only millions of dollars and the top scientific minds and equipment can bring such things into being. And only democratic and capitalist societies are any good at all at communicating, planning, and gathering investment to make it all happen. Scientists like Izumi, or Ahmed Hamdi, a prominent CMI featured in the book, are driven by what McCloskey Deidre calls 'improvement through trade.' They want money, yes, but they also want to stay as serious as possible about their craft, and they want the social status that accrues to the top innovators in their field.

And then, of course, another part of the mind can't help but think, this is not the way to do drug development. Why should these whiny, cultish business bosses be the ones driving our resources? And what do we make of the fundamental rule of the market: investment will flow only where potential profit is judged to be likely?

Vardi wisely stays away from any head-on discussion of these questions. I admire the way he cogently blends personal portraits with light scientific exposition, and also explanation of the systems behind investment, clinical trials, and the FDA process. There are many more branches to go down; one is left wondering just why Duggan pursued profit in antibiotics after his success in cancer drugs, when the conventional wisdom is that antibiotics development does not lead to profit. That is perhaps a fitting subject for a whole other book. And aside from the ethical questions, humans like Duggan are interesting case-studies of our ambivalent and troubled relationship with power and capital. Neither Foucault, nor Marx, nor Adam Smith have ever gotten this relation quite right, as we can tell by deeper readings in true stories like these.
13 reviews
December 25, 2023
Insane story and makes me re-evaluate my life choices to be a scientist (unfortunately sunk cost fallacy keeps me going)

The story of how ibrutinib went from a molecule only intended as a research tool is a pretty interesting example of just how luck-involved drug discovery is. It's also sobering to realize that at the time, irreversible covalent inhibitors were not in vogue for safety reasons, but it took someone to actually try it and realize that this could be therapeutically beneficial despite clear risk of off-target binding that is irreversible to realize that the clinical benefit was still worth the risk.

Overall, it made me question again how much you can ever truly know/optimize a therapeutic, and how much is just up to fortune and chance. How do we challenge the conventional wisdom/way of doing things? Do we just have to be delusional at some level and proceed forward (probably). Then the drama that takes place behind closed doors and the competitiveness and end results kind of make me sad for the extent to which egos can and will dominate the process of bringing a drug to market.
Profile Image for Radwa Sharaf.
45 reviews5 followers
July 10, 2023
I LOVED this book - probably my favorite one for this year. The story follows a group of scientists/clinicians who work to develop a novel BTK inhibitor, get it approved for CLL patients, the ups and downs and layoffs involved and how they were motivated to repeat the success once more by starting up a new company to develop yet another BTK inhibitor. Captivating read and the author has a great style. First time too I could relate to one of the key characters in a story like this given our shared Egyptian background.
This entire review has been hidden because of spoilers.
28 reviews
May 21, 2023
Well written book that draws the curtain back on the world of biotech. Shocking to read how the scientists that invent and research new cancer drugs end up with none or nearly none of the financial rewards investors receive for a blockbuster treatment. “Labor does not get paid, capital does.”
Profile Image for Piotr (Księgo Zbój).
87 reviews1 follower
March 18, 2024
Możemy się obrażać na kapitalizację systemu ochrony zdrowia, ale tak on niestety działa. Autor przedstawił wszystko doskonale z dużym obiektywizmem, hamując się z komentarzami. Świetna i wciągająca książka.
Profile Image for N N.
148 reviews22 followers
May 1, 2023
A page turner on the development of the blood cancer drugs Imbruvica and Calquence, and along the way some interesting exposure to how the biotech industry works
Profile Image for Lisa Barceló.
54 reviews1 follower
August 23, 2023
Fascinating peek behind the biotech curtain. One could be forgiven for getting lost amidst the endless names, both human and pharmaceutical. But I found this to be an interesting glance into a world most of us only encounter from the other side of the Walgreens counter.
Profile Image for Kai.
120 reviews5 followers
February 1, 2024
Can this be a TV show? Can there be a book like this for every blockbluster drug out there? Best biotech book I’ve read in years
Profile Image for Sharon.
1,364 reviews35 followers
August 2, 2023
Fascinating behind the scenes look at biotech, and the ridiculous amount of money that people are making off of these new drugs.
Profile Image for Michelle.
303 reviews
June 20, 2023
I normally don't read non-fiction, but this was the pick for my work book club. Because it was based in CA and Silicon Valley, I liked reading about companies I knew and places I have visited before. I found the whole process of drug discovery & taking a drug to market to be fascinating - but also so crazy and cutthroat as well. The amount of $$ that some of the players made was staggering and the fact that some of the original creative scientists got cut out of the action and didn't get credit or get published along the way was heartbreaking.
Profile Image for Jocelynn Pearl, PhD.
100 reviews4 followers
January 19, 2023
I sped through this one. Science happens incrementally, but Vardi manages to keep you on the edge of your seat. I learned so much about the people behind the BTK inhibitor successes; deal flow, meetings, interactions with pharma and what it takes to make these things happen. A great read for biotech veterans and newbies alike!
Profile Image for Natalie H..
24 reviews
September 20, 2023
An interesting perspective on the biotech industry from an executive perspective along with the BTK story. Definitely recommend for the science nerds
Displaying 1 - 30 of 140 reviews

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