- Welcome to "The Minor Consult," where I speak with leaders shaping our world in diverse ways. I'm your host, Dr. Lloyd Minor, Dean of the Stanford School of Medicine and Vice President for Medical Affairs at Stanford University. Today, I'm delighted to be joined by Regina Dugan, a trailblazing technologist, entrepreneur, business executive, and former government executive who has spent her career pushing the boundaries of what's possible. Described by "Fortune Magazine" as, "One of the world's leading experts on product innovation." Regina has led global teams at some of the world's most influential organizations, including Google and Meta. She was the 19th director and first woman to lead DARPA, the Pentagon's Defense Advanced Research Projects Agency. And she now serves as the CEO of Wellcome Leap, a nonprofit focused on accelerating breakthroughs in human health. Regina, thank you very much for joining me today.

- Oh, it's great to be here, Lloyd. Good to see you.

- It's great to see you. And Regina, early in your career, you didn't hesitate to seek out hands-on experience, and that included experiences such as driving in landmine-protected vehicles through the mine fields in Mozambique to remove mines that threatened the village. Why did you believe that it was important to be there as a leader to step out from behind your desk?

- Well, Lloyd, I went to DARPA in 1996 as a program manager, and the goal of the program was to develop new sensor technologies that could be used to detect buried landmines. And as you may recall, the threat of landmines was really understood globally as significant at the time, a humanitarian issue, and also, of course, a military concern. So you know, I've always felt that as a scientist, as an engineer, it's important to roll up my sleeves and get directly involved in the problems. And it's interesting that the trip you describe about Mozambique created a little bit of, let's say, an international incident when the State Department decided that I was missing in action while on this landmine clearance trip. Now, I knew when I was leading this program that if we were really going to solve the landmine detection problem, if we cared about impact, we were going to have to understand the real constraints of the work in the field, the kind of constraints that you can't appreciate from behind a desk. So I would go to the, no kidding, operational field once a year, and I would bring those teachings back to the researchers on the program. And that's how I ended up clearing mine fields in Mozambique actually driving these mine-protected vehicles through the mine fields in Mozambique.

- That's amazing. What types of changes did you have to make based upon your real-world testing of the technology and how did that inform your leadership of the team back here and elsewhere that was furthering the technology and modifying it based upon your experiences?

- Yeah, well, you know, one of the things that happens when you're in the field, I mean, as you're driving this vehicle through a minefield, each explosion is a little rattling, let's just say. But every fifth explosion is what we called a jumper. And a jumper has two explosions, one to explode the mine up, and then a second to explode all the shrapnel at waist-level and it's a very deadly weapon system. And what, you know, in so much as the explosions themselves rattle you, when the jumpers come, there's this ra-ta-tat cross the windshield, and you never quite get used to those. And so I think the thing that was important about this work is being proximate to the people who were living with this threat every day and how urgent it felt to them to clear these landmines. Now we were doing it with brute force, but there had to be a better way, and that was part of the motivation for the program.

- As you mentioned, you joined DARPA in 1996, and then in 2009 you were appointed as its director.

- Yeah.

- The first woman to serve in the role of director.

- Yeah. Yeah.

- And for those who aren't perhaps familiar, DARPA is the agency within the U.S. Department of Defense that takes on breakthrough, high-risk, high-reward technology efforts. So why did the high-risk, high-reward framework of DARPA resonate with you, and how did those experiences steer both DARPA's approach and your work since your time at DARPA?

- Yeah, well, Lloyd, you and I have talked about this before. So you know some of my history. Look, when I was nine years old, I was diagnosed with catastrophic ovarian cancer. I was not expected to live. And there's something really interesting that happens when you encounter a fight that intense so early in your life. You know, I underwent three major surgeries. I did two and a half years of chemo. And I believe that it forged my spirit. It was a very hot fire at a very young age. And it changed the way I think about risk. Right? It changed the way that I think about living boldly and how I think about failure. So, you know, I couldn't put words to it when I was young, but as I got older, I felt like cancer really taught me three things. And the first is that the odds don't matter. If what you're trying to do is important and you see a shot, you should take it. The second thing is, if the odds don't matter, every moment does. Nobody is promised tomorrow and we should live life big. And the third was, and this is the one that's always a bit hard for me to talk about 'cause it feels so emotional. And the third is that if you wanna make a difference in someone's life, showing up is key. And I learned this from my parents because literally every night when I fell asleep in the hospital, my father was sitting at my bedside. And when I woke up in the morning, my mother was sitting there. They would switch in the middle of the night. They didn't always know what to say, they didn't always know what to do, but they always showed up. And these are the principles that have basically shaped every bit of work that I've done since then.

- You know, Regina, I've heard you talk about that before, but every time you mention it and the passion that you relay your life experiences, I'm moved by it as I know everyone who hears your experiences and who has a privilege of learning from you about what you've been through and how that made you even more positive about the future and even more dedicated to your impact on the future.

- You know, Lloyd, I think it's so true. I mean, we often talk about emotional engagement almost as if it's a bad thing, right? But I feel the exact opposite. Right? In all of my work in chasing breakthroughs, what I've discovered is that you can't get breakthroughs without a team that's emotionally engaged, right? Without a team that understands that the work really matters. They're working together to accomplish something that they can't accomplish alone, right? There's the same principles are embedded in that. They show up for each other, they take the shot, they're living with urgency. It's really important to the work. That kind of emotional engagement is the fuel that we use to get breakthroughs.

- Regina, talking a little bit more about DARPA. During your tenure as director, you led a number of initiatives covering a variety of fields impacting the lives of millions and technologies in so many different areas. Can you talk about the accomplishments you're most proud of and now that it's been a few years since you completed your tenure at DARPA looking back on it, what lessons have stayed with you since you led DARPA?

- Yeah, you know, the productivity, Lloyd, of DARPA is so high, it's almost hard to choose among the things that you worked on. You know, I think if I were to begin a list, I would say that, you know, the return to large-scale data analysis and some of the AI work that we did at DARPA after the agency had had almost a 10-year break from that kind of work was very important to re-institute that work in service to national security. I think the hypersonics program was very important. And of course, the agency's pivotal work on new capabilities for biological medicines, in that case, RNA vaccines that we believe now we understand now could be used to treat thousands of diseases from cancer to infectious disease and do so faster and cheaper on a global scale. You know, I think the thing that's most interesting to me, though, is that I'm not sure I would've been able to pick them even at the time. So it's, as you said, it's a bit in retrospect that you start to get a sense of which of the programs really created that kind of impact in the world. And, you know, I think when you optimize for breakthroughs, you naturally take on a lot of risk in the programs. And that means when you start, that's the moment of the highest uncertainty. That's the moment of the highest uncertainty. And so it's only through doing the work that you really begin to understand where the impact is going to be realized.

- Let's turn now to Wellcome Leap. Regina, you've now been CEO for over five years. And what inspired you to take the role? I remember conversations we had when you were thinking about the role when you were helping to shape the role, because it's very much a role and you'll, I'm sure, describe it a very much a role and an organization that you helped to conceive and then to lead, of course. And what have been the opportunities that you've pursued and what are you most excited about in terms of what you've done and what you're going to do?

- So, it's an interesting story. You know, sometimes your work finds you. And I had stepped out of Silicon Valley work just a few years prior, and I was shaping and thinking about what I might do next. And the search firm, a headhunter approached me with the opportunity for Wellcome Leap. And as they described it to me, the then director of Wellcome Jeremy Farrar, he's now the number two at the World Health Organization. What they described is his assessment of the landscape in health research, which is that it had become too risk averse. It had become too siloed and too slow. And, you know, they felt like there may be, in the way that they fund, some limitations to achieving some of the opportunities in the research community that could lead to breakthroughs. That the very nature of how they funded the work was partly inhibiting some of those big ideas from seeing the light of day. And I thought, you know, "This sounds really familiar." It sounds like the same challenge that the Department of Defense faced after the launch of Sputnik. And I have to say, Lloyd, when I saw the job description, I thought it must be a joke, right? I thought they had written it exactly for me, like my background and my experience up until that point was precisely what the role was really calling for. And I believed that there was indeed an opportunity to address some of those concerns that Jeremy and Wellcome were articulating at the time. And, you know, I felt on a personal level, I felt like it was almost as if my life had come full circle, right? That my encounter with cancer at a very young age, I survived really only because of the work and the breakthroughs that others had made in the treatment of cancer. And I went on through my PhD and then to DARPA, Silicon Valley. And I had this sense that it was almost as if my whole life had been in preparation for this opportunity to give back to the very people and field that had made my life possible at all, quite literally. So that it just like, as I said, I think sometimes your work finds you. And that's definitely how I felt about it. So, you know, in the time that we have had Wellcome Leap stood up, we have launched 12 programs. We are working in 28 countries. We have committed over half a billion dollars globally. And we have about another, just over another half billion to go. And we are starting to see exactly the kind of breakthroughs that we would've hoped to see with this style and concentrated effort.

- Regina, can you describe some of those leaps and breakthroughs? Realizing that many of them are still in the development stage, but many things have been deployed. And maybe also you could talk a little bit about your vision for the next five years. And like you were saying, innovation is something that has to be constantly created, nurtured, rejuvenated. And so I'm certain you're thinking about not only the successes, but where things are going to go.

- Sure. Well, I'll give you one example, Lloyd, from one of the programs. So we have a program called In Utero. And In Utero is focused on reducing the burden of stillbirth globally. So many people don't understand how significant a health problem this is, right? So every 16 seconds in the world, a child is born still. That's 2 million babies a year. Now we are still treating pregnancy basically with the tools that we've had since the 20th century. We've made very little advance or progress in doing that. And yet we know that about 93% of these stillbirths are potentially preventable. So we went after this particular challenge, and within two years, we had line-of-sight on a maternal blood test that could, with better than 80% reliability, predict a woman's pregnancy risk for fetal growth restriction, preeclampsia, gestational diabetes, and as early as 12 weeks in the pregnancy. It's a big advance. And it is mirrored by other advances in that very same program, which are dedicated to transforming antenatal care so that it is modern, so that the risk is reduced, and so that we have fewer deaths from stillbirth and fewer families suffering grief. So that's one example. But I can tell you that of the programs that we've launched, there are many examples that look like that. We have catalyzed at this point over $300 million in follow-on funds. We have catalyzed over a dozen startup companies, done multiple licenses. We've started many clinical trials at this point. We've supported multimodal, multi-user, multinational databases to get at some of the research and reduce some of the limitations to getting the breakthroughs that we need. So the list is quite long and we're just getting started. So that's five years in the making. And then I think looking forward, you know, the two primary risks I thought we faced in bringing this model, this use-inspired basic research model to global health, were, would the life sciences come to it in the same way that the physical sciences have practiced it for many years. It's much more familiar in the physical sciences than the life sciences. That was the first risk. And the second risk was, could we do it at global scale? Could we actually execute it at global scale? And the answer, five years in, to both of those questions is unequivocally yes, we absolutely can. So if we're asking the question then of, we've built the breakthrough engine, what else might we point it at? At the very top of the list has got to go women's health research. And you and I have talked about this, you know, for quite some time. It's a significant issue. We are dramatically underfunded in women's health research and we've simply got to do something about it. And I'm happy to tell you some of what we're doing in that regard.

- Please do, would you? Yeah.

- Yeah, of course. So let's just talk about the landscape. So we know that women experience health issues differently, disproportionately, and uniquely. We know that. 80% of autoimmune disease is felt by women. 99% of the studies on aging are done without a suitable model for menopause. We talked about stillbirth. We know about heavy menstrual bleeding. One out of three women are impacted by heavy menstrual bleeding. And in fact, despite the fact that women live longer than men, a bit, not a lot, but a bit, they spend 25% more of their lives in poor health because of many of these issues, things that should be normal, treatable conditions, and we act almost as if they're medical mysteries, right? Now, if you look at the amount of funding in women's health research, the picture is really not good, right? So in 2020, that was the last year we had comprehensive data on philanthropic spend. In that year, $470 billion were invested philanthropically, 2% of that went to programs devoted to women and girls. 0.3% of it went to women's health. And it was not for research, it was mostly for care and support. The NIH budget in '23 was 10% devoted to women's health research in '24, it was 6%. Like, we have so many challenges for improving the lives of billions of women and girls globally. And we are dramatically underinvested in getting them solutions. So our belief is, like, it's time. Women have waited long enough. So we have launched, in the time that we have been operating, three programs that's $150 million devoted to women's health research, we will launch another program by end of year, that's $200 million in investment. And my belief is that number should be 5x what it is in the next five to seven years. So we are moving. There is a lot more awareness on this subject, and we are biased for action.

- Regina, if we stay on the topic of women's health in the first, the overall importance and the fact that, as you said it, it's a field that comparatively has been neglected. It also brings up something I know you confront every day in terms of the projects you're evaluating, in terms of the way you're assessing the progress of projects, and that is how you balance the urgency of a problem and the manifestations of a problem with the fact that, in particular, in biomedical topics and in biomedical areas, the scientific and technological course towards getting impact, getting real-world impact, can be long and also fraught with pitfalls along the way. But one of the goals that you've pursued very successfully, both at DARPA and now at Wellcome Leap is to have a startup mentality and to focus, yes, on scientific rigor and also on projects that will deliver results in a defined period of time in intangible ways.

- Yep. Yep. Well, I think, you know, Lloyd, it's always interesting to me that these two things, right, scientific rigor and a sense of urgency, are often presented as if you have to choose between the two, right? Which I just reject as a false choice, right? That's a false choice. And there are many things that we do in the course of our work which are really focused on removing the obstacles for the scientific work, right? So sometimes, like we can only move so fast sometimes in the science itself, but it's remarkable how many things are often in the way of us making progress on the science. So let's just talk about some of those things, like nobody wants to talk about them, 'cause they're not so sexy, but in fact they are obstacles that are in the way of us making progress, right? So let's talk about making selection decisions, right? So there's this sense that an application comes, like, let's look at the normal timeline for evaluating scientific applications. That's 12 months, right? 12 months. Now, I have never known anybody who sat on study section and said they read applications, one a week, for the entire lead up to the study section, which happened a year after applications were due. I don't know anybody who ever does that. Everybody reads them the week or two weeks before study section. So what we did is said, "Well, why can't we then have study section 30 days after the applications are due?" Now because of the work that we do, we also don't seek consensus because bold innovation often cannot get promoted with consensus-making decisions. So we have oftentimes a few advisors in specialty fields, but we do not rank order proposals and then try and achieve consensus. We're trying instead to knit together the aspects of the proposal that would lead us to success against the program goals. And that's the program director's job to do that, to do that work. And it's just all of those things that we do, what we're just sort of pushing against the obstacles and clearing the way. Contracting is another place, right? Very often after selection decisions, contracting will take another, if we're lucky, several months, sometimes a half a year to do. And we do all of our contracting in 30 days. Now, what I want to emphasize here is that just think of what this does for the culture of the work, right? A researcher is sending their best and boldest ideas to us, and seven to eight weeks afterwards, they have a selection decision. If they've been selected, they are under contract. Many of them already have money to start the work, and they are at a global kickoff meeting with a team of researchers who are all devoted to working together to solve a problem that they cannot solve alone. And what that's doing is it just changes the pace and the agility of the entire team's perspective on how we're gonna work towards that goal. Those are the kinds of things that we're doing, just pushing and leaning on all the time.

- Following those thoughts, you've devoted a lot of time and effort and very thoughtful analysis to timelines and to milestones and to how to track the progress of projects and engage with investigators on assessing their progress. And in particular, I'm curious in that context of what principles you've developed and how you apply those, and in particular, how you view, and I'll put it in quotation marks, how you view view failure and its role along the, a lot's been written about it, of course, and it's a popular topic in the startup world, but I think you have some unique insights in that regard, and we'd love to hear them.

- Yeah. Well, let me start with failure, because I do think it's a very curious topic for many people, right? In all of my experience, Lloyd, in doing this kind of work, right, where the risk is high, the stakes are high, there's urgency, the work really matters. You know, failure in working towards the goal is an inherent part of the work. Like, you always encounter failure along the way when you're trying to do something that's never been done before. I don't think failure is the problem. I think fear of failure is the problem. Fear of failure is what causes people to set their sights too low, to aim too low. And there's an interesting relationship between that and the inspiration of the work, right? In all of my experience, what tends to happen, because people are afraid of failing, is they work really hard to minimize risk. So what they do then is they set the goal a little lower, maybe not so ambitious, a timeline not so aggressive, the science maybe not so bold, all of this in the name of reducing the risk of failure because the fear of failure is significant, right? Now, the interesting thing about that, here's how that bites us, is that when you do that, when you are pushing to reduce risk because one is afraid of failing, you actually, because of the human component, inadvertently increase your failure rate. And here's what happens, right? When you reduce the ambition, when you reduce the scientific objectives, when you make it less urgent, so the stakes are lower, what happens is the team is not inspired. The team is not inspired. And so you've reduced risk in the name of trying to reduce failure and in fact, you've introduced all sorts of human components which actually lead to failure. And so what I've observed over many years now of doing this is that when you set the ambition high, when the science is really interesting and challenging, when the work is hard, when it requires the team to band together, that's when the brave shows up. That's when the best shows up. And despite the fact that the risk is higher, success comes more often. It's such an interesting human dynamic about what inspires us, how we do our best work, and how we get to breakthroughs.

- In addition to the advice of setting your ambitions high, what other advice would you give to the next generation of scientists, engineers, entrepreneurs, technologists, as they contemplate their careers and as they strive to have impact in the world on hard problems with real-world impact?

- Yeah. So I have a particular question that I always ask, right? And that is for a young researcher, or frankly any of us, I would ask this of you too, Lloyd, right? What's inside your burning building? More precisely, what would you be willing to run into a burning building to save? What matters enough to you that you would run into a burning building to save it? And my belief is that answering this question is really how you conquer this paralyzing sense of fear, right? This paralyzing emotion called fear. And it's also how we build a life that is full of meaning, right? So my sense, Lloyd, is that for the vast majority of people, fear is an obstacle, right? They have a tendency to be ashamed of it, to consider it a sign of weakness, to turn their back on it, to walk away. That's not how I think of fear. I think of fear as a signal. It's a signal that something matters to me. I mean, after all, I'm not afraid of failing at something that doesn't matter to me. So if I think of fear not as a stop sign, but as a compass, over time, I can develop the muscle to walk straight at the things that I'm afraid of failing at. And that's because I have found a way to move towards things that matter to me. And you know, in so much as I never wish anybody a life of burning buildings, you know, I wish everyone a life that is full of people and purpose and passion worth running into a burning building to save. That's what I think is so important that we figure out how to use that signal to build a life of meaning and purpose.

- Regina, this has been a wonderful conversation, and I wanna end with two questions that I ask all my guests. First, what do you think are the most important qualities for a leader today?

- Yeah. Well, we've talked a little bit about this and there are two things that I think are really important, right? The first is this emotional engagement, right? The sense that we commit to emotional engagement in our teams, that we not shy away from that. That's where you get breakthroughs. That's where we get progress. I mean, after all, we're not robots, right? We are researchers. We are people who are trying to achieve amazing things. We're innovators. We're not automatons. And caring, caring, is why we pursue the work in the first place. It's what gives us a sense of mission. So that's the first thing. The second thing is that I just, I think about leadership as service. I always have. And I believe that as a leader, like job number one is to know your team and take care of them. Know your team and take care of them. I remember my dad telling me that since I was a little girl, right? Know your team, take care of them. And when I was in Silicon Valley, I would often give talks to, you know, large rooms. And I would ask, "Who in this room, by show of hands, knows who the director of DARPA was or who the program manager was when the internet was invented?" And almost not a single hand goes up in the room, right? And this is part of the principle of leadership that I believe in, right? Leadership as service, in service to: mission, to objectives. It's not about awards or recognition. It's not about that. It's about a life of purpose. It's about moving teams to be better than even they knew they could be. That's what I think is so important right now.

- And finally, what gives you hope for the future?

- Oh my gosh. Well, you know how optimistic a person I am.

- I know. It's wonderful.

- Lloyd, right? So many, many, many things. Many things give me hope about the future. But I think, look, we also have to, we also have to be sober, right? There are tensions that are rising around the globe. People are desperate for solutions. And I think we have to be reflective in understanding that oftentimes when they've looked to science for the answers they need, when they've needed us to match the urgency they feel, they've been disappointed. And there's this sense that the world is racing ahead and too often we're moving still taking baby steps. And so in a moment like this, you know, I think people need more. They need extraordinary breakthroughs, not in the future, but now. And so we need to do better, we need to move faster, we need to fix more things. And we need to, in my world, one breakthrough at a time, turn a disillusioned world more towards possibility and have the sense that, together, we can turn a doubting world towards hope. And, you know, in so much as we created Wellcome Leap to increase the number of breakthroughs and to get them faster, we also created Wellcome Leap for that very reason, to instill a sense of hope. Because we have an entire generation, maybe multiple generations that are disillusioned by institutions that have told them, "The old way is okay, you should be satisfied with how things have always been done." And they deserve to have somewhere to put their faith. And it's our mission to reward that faith, not with promises, but with progress. And we do that one breakthrough at a time. And I would just say hope embedded in that principle, those ideas, is in the work that we do every day at Wellcome Leap.

- Regina, thank you so much for this conversation and for all that you have done and all that you are doing. And thank you for listening to "The Minor Consult" with me, Dr. Lloyd Minor. I hope you enjoyed today's discussion with Regina Dugan, CEO of Wellcome Leap. Please send your questions by email to theminorconsult@theminorconsult.com and check out our website, theminorconsult.com for updates, episodes, and more. To get the latest episodes of "The Minor Consult," subscribe on Apple Podcasts, Spotify, or wherever you listen. Thank you so much for joining me today. I look forward to our next episode. Until then, stay safe, stay well, and be kind.