Open Door Salon

"Some of the best companies were founded during some of the worst times. It's almost Darwinian."

That's Mike Goguen — founder of Two Bear Capital, 20 years as a general partner at Sequoia Capital. With him is Rob Williamson — serial entrepreneur and 35+ years in drug development.

A 30-year venture capitalisst and a serial drug developer on surviving biotech's worst times, the AI bubble, and why founders should "beware the kindness of strangers."

In Today's Episode:

• "The best companies start in the worst times" — Darwinian survival
• "Where's the beef?" — spotting real AI vs window dressing
• Biotech can't compete for AI talent — half a million out of school
• Are we in an AI bubble? Lessons from multiple crashes
• Quantum AI — the revolution after the revolution
• "Thank you for giving me another Christmas" — why it's worth it
• "I've called it my vow of poverty" — why biotech over tech

Timestamps:

(00:00) Cold Open — "I'm Not Sure I Want to Say What I'm Really Thinking"(04:17) The Current Investment Landscape — Capital Efficiency Matters(08:00) Minimizing Dependence(12:00) First-Time Founders vs Experienced Operators(16:00) Product-Market Fit in Biotech — What Pharma Wants(20:00) M&A Is Slower Than Expected — Why Deals Are Stalling(24:00) The AI Revolution in Drug Discovery — What's Real(28:00) AlphaFold, Digital Twins, and the In Silico Loop(32:00) "Where's the Beef?" — Real AI vs Window Dressing(36:00) Biotech Can't Compete for AI Talent(40:00) Are We in an AI Bubble?(44:00) Quantum AI — The Next Revolution(48:00) "Thank You for Giving Me Another Christmas"(52:00) The Hardest Decision — Going All-In

SHOW NOTES

Mike Goguen — Founder & Managing Partner, Two Bear Capital20 years as General Partner at Sequoia Capital (1996-2016). Two Bear Capital invests at the intersection of tech and life sciences.LinkedIn: https://www.linkedin.com/in/michael-goguen-23314/

Rob Williamson — Founder & CEO, Traverse Therapeutics35+ years in drug development. Multiple drugs to market. Former BCG partner. AI-enabled drug delivery across the blood-brain barrier.LinkedIn: https://www.linkedin.com/in/robwilliamson/

Description

"Our transplant doctor at Hershey wrote us off and never spoke to us again. We signed her out against medical advice. And it saved her life."

Tom Whitehead is the co-founder of the Emily Whitehead Foundation and father of Emily Whitehead — the first pediatric patient in the world to receive CAR-T cell therapy. In 2012, when Emily was 6 years old and facing end-stage leukemia after two relapses, they defied medical advice, enrolled in an experimental trial at CHOP, and Emily became cancer-free 23 days later. She's now 21 and 14 years cancer-free.

Victoria (Tori) Lee was the 10th pediatric patient to receive CAR-T at CHOP. Diagnosed at 5, she went through four years of chemo and radiation before receiving CAR-T in 2013. Now 13+ years cancer-free, she's a health policy student presenting at ACRP on the bioethics of CAR-T access.

In Today's Episode:

• "We signed her out against medical advice — it saved her life"
• Only 20% of eligible patients get CAR-T — 80% don't
• "You're not sick enough yet" — when can patients get CAR-T?
• 45,000 lives saved — from one patient to tens of thousands
• Under $50K, under a week — manufacturing is advancing
• Trials leaving the US — patients going to Italy, Beijing
• Fighting insurance denials with AI
• "Emily is as famous as Taylor Swift to my daughter"
• "It's hard to talk about the worst days of your life"
• Advice for parents and patients seeking cell therapy

SHOW NOTES

Tom Whitehead — Co-Founder, Emily Whitehead FoundationFather of Emily Whitehead, the first pediatric CAR-T patient. Author of "Praying for Emily."

• Emily Whitehead Foundation (Co-Founder)LinkedIn: https://www.linkedin.com/in/tom-whitehead-08ba32102

Victoria (Tori) Lee — CAR-T Survivor | Health Policy StudentThe 10th pediatric CAR-T patient at CHOP. 13+ years cancer-free.

• Emily Whitehead Foundation (Patient Advocate)Story: https://www.emilywhiteheadfoundation.org/patient-stories/tori-lee/

Resources:Emily Whitehead Foundation: https://www.emilywhiteheadfoundation.org/CHOP Cancer Immunotherapy: https://www.chop.edu/centers-programs/cancer-immunotherapy-program"Praying for Emily" (Book): Free to patients and caregivers

✨ Support the Mission: The Emily Whitehead Foundation helps families find life-saving trials and advocates for wider access to cell and gene therapies.👉 Learn more or donate: https://www.emilywhiteheadfoundation.org/donate

Jim Kremidas spent 24 years at Eli Lilly and started the industry's first Patient Recruitment Department. Then he got bladder cancer — and couldn't find a clinical trial using the tools he helped build.

Elisa Cascade has 30+ years in clinical research technology. Former CPO at Science 37 and Advarra. Past Chair of ACRP. Built a 2.7 million patient community for direct-to-patient recruitment.

In Today's Episode:

• "Impossible to find a study" — even for industry insiders
• It took 6 people to connect Jim to a clinical trial
• ClinicalTrials.gov is wrong 80% of the time
• ChatGPT is now recommending clinical trials
• The hidden barrier: patient compensation varies wildly
• "I fell into clinical research" — time to reframe
• Why sites don't call patients back for 5 days
• The "Generations" study: how messaging changes everything

SHOW NOTES

Jim Kremidas — Executive Director, AMRC35+ years in healthcare. 24 years at Eli Lilly. Former Executive Director of ACRP. Bladder cancer survivor.

• AMRC (Executive Director)
• ACRP (Former Executive Director)LinkedIn: https://www.linkedin.com/in/jimkremidas/

Elisa Cascade — Chief Growth Officer, TrialScreen30+ years in clinical research. Former CPO at Science 37 and Advarra. Past Chair, ACRP. Wharton MBA.

• TrialScreen (Chief Growth Officer, Head of Americas)
• ACRP (Past Chair, Fellow)LinkedIn: https://www.linkedin.com/in/elisa-cascade/

Resources:AMRC: https://amrc.org/TrialScreen: https://www.trialscreen.org/CISCRP: https://www.ciscrp.org/

Sunitha Malepati is the Founder and CEO of the Buffalo Initiative. When her daughter was diagnosed with a rare neurogenetic condition, the doctor told them: "Go home and love your kid. There's nothing we can do." She refused to accept that answer.

Craig Lipset is a clinical innovation leader, former Head of Clinical Innovation at Pfizer, and co-chairs the Decentralized Trials & Research Alliance.

In Today's Episode:

• "Go home and love your kid" — what one doctor said after diagnosis
• Why pharma can't — and won't — solve ultra-rare diseases
• 7,000+ rare conditions with no treatments
• "Lemonade stands and bake sales" funding clinical trials
• The Buffalo Initiative: bundling and blending patient capital
• California leading state-level rare disease investment
• "This IS an investable proposition"
• Advice for biotechs, patients, and pharma

SHOW NOTES

Sunitha Malepati — Founder & CEO, Buffalo InitiativeAttorney turned rare disease advocate. Two-time Chan Zuckerberg Initiative grantee. Speaker at the White House Cell and Gene Therapy Forum.

• Buffalo Initiative (Founder & CEO)
• CACNA1A Foundation (Vice President)
• COMBINEDBrain (Governing Board)LinkedIn: https://www.linkedin.com/in/sunitha-malepati-5959952/

Craig Lipset — Clinical Leader, Buffalo Initiative | Co-Chair, DTRA20+ years transforming drug development. Former Head of Clinical Innovation at Pfizer.

• Buffalo Initiative (Clinical Leader)
• Decentralized Trials & Research Alliance (Co-Chair)
• Foundation for Sarcoidosis Research (VP, Board)LinkedIn: https://www.linkedin.com/in/lipset/

Resources:Buffalo Initiative: https://www.buffaloinitiative.org/DTRA: https://www.dtra.org/CACNA1A Foundation: https://www.cacna1a.org/

Jesús Zurdo is a scientist — molecular biology, drug discovery, manufacturing, company creation. Three and a half years ago, he was diagnosed with Philadelphia-positive acute lymphoblastic leukemia. 92% of his bone marrow was cancer cells. His donor was a stranger in Florida.

In Today's Episode:

• Diagnosed in one day — the UK system
• Nobody told me about brain fog — it stays for years
• Finding a donor: "He is my hero"
• "40% of us in this room will not make it"
• You go in with one disease, come out with two
• "I don't like when people talk about cures"
• Lisa — same diagnosis, didn't make it, survivor's guilt
• "This is my purpose in life — in neon letters"
• Scientists don't understand healthcare — until they become patients

Dr. Karla Loken is an OB-GYN who spent 20+ years in clinical practice before moving into industry. Three months ago, she was diagnosed with appendix cancer — 1 in 200,000. One month ago, she had major surgery. Now she's back to share what the system looks like from the other side.

In Today's Episode:

• Why she went public with her cancer
• The physician network that got her answers in hours
• Survivor guilt: "I'm lucky I had the network"
• Every patient is an N of one — there's no cookbook
• The waiting is the worst part
• What industry can do: the light side of the dark side
• "Your brain is still valuable" — advice for physicians facing illness
• Advice for patients: bring someone, write it down, find a navigator

Konstantina Katcheves is Chief Business & Strategy Officer at Acadia Pharmaceuticals. Former SVP at Bristol-Myers Squibb. Led BMS through the Karuna Bio and RayzeBio acquisitions in a single month. Now at Acadia building rare disease capabilities.

Daphne Karydas is President & CFO of Flare Therapeutics. Former CFO at Syndax, Head of Corporate Strategy at Allergan, and 15+ years on Wall Street. It took her 7 years to leave — she calls it "commitment phobia."

In Today's Episode:

• Why the CBO and CFO must be locked arms
• The ecosystem: large companies need small, small need large
• How long does it take? Years of relationship building before a deal
• You need an internal champion — often multiple
• M&A is actually cleaner — partnerships are harder
• "Every deal is bespoke" — no cookie cutter deals
• Advice: grit, resiliency, and trusted advisors

Jeff Fischer is Co-Founder and President of Longhorn Vaccines and Diagnostics — developing monoclonal antibodies that target chronic inflammation upstream, before it starts.

Steve Butts is Co-Founder and CEO of Arrivo BioVentures. His lead drug for depression works in women but not men. Then investors asked: "Is there really a market for that?"

In Today's Episode:

• Longevity isn't living to 120 — it's expanding healthspan
• SIRT6: DNA repair, mitochondria, glucose, inflammation
• Chronic inflammation: the upstream trigger most biologics ignore
• Why estrogen levels affect gut permeability and inflammation
• The depression drug that only works in females — and why that's a feature
• GLP-1s are tightening gut junctions — here's what that means
• Longevity for the few vs. longevity for the many

Tina Valbh, BS Pharm, RPh is a pharmacist with 28 years in life sciences — Managing Partner at Pharma Connect and founder of Tina's Warriors. She builds patient access programs. Then she got cancer — and discovered none of it worked the way the slide decks said.

Karla Loken, DO, OBGYN, FACOOG practiced OB-GYN for 20+ years before leading clinical development and medical affairs roles at Hologic, Roche, HerMD, and FEMSelect. She was diagnosed with appendix cancer 3 months ago. She's navigating the system she helped build.

In Today's Episode:

• The biggest gap right now: misinformation from TikTok to pharma
• "I got the same drug info 5 different ways — none of it matched"
• "I'm so tired of hearing 'we mapped the patient journey' — no you didn't"
• Clinical trial enrollment and the trust deficit
• "I got a denial yesterday. I haven't picked up the phone."
• Why reimbursement is 30% higher for the same surgery on men
• Advice to industry: fund the advocacy groups — it's the first line item cut

Matt Hewitt is CTO of the Manufacturing Business Division at Charles River Laboratories.

Jeff Holder is Partner and Managing Director at LEK Consulting, advising biopharma and investors on cell and gene therapy strategy since the first CAR-T approvals in 2017.

In Today's Episode:

• JPM 2026: Is cell & gene therapy interest real or cooling?
• Why manufacturing cost isn't the real barrier to adoption
• "Do boring better" — the 2026 investor thesis
• Should cell therapy be reimbursed as a procedure, not a drug?
• "The cheapest patient is a dead patient" — European payer realities
• Only 20% of eligible US patients get cell therapy (5% globally)
• The biologics benchmark: it took 12 years to get the first blockbuster antibody
• Why this space is "ADHD" — and why that's a feature, not a bug