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Explore every episode of the podcast Hard Drugs

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TitlePub. DateDuration
Lenacapavir: The miracle drug that could end AIDS11 Jun 202504:53:46

Lenacapavir is a new HIV drug that blocks infections with an efficacy rate of nearly 100%, and it could completely change the fight against HIV worldwide. Saloni and Jacob talk about the development and prospects for this new drug, as well as the history of HIV, the initial discovery of retroviruses, and how HIV was transformed from a death sentence to a manageable condition.

Hard Drugs is a new podcast from Works in Progress and Open Philanthropy about medical innovation presented by Saloni Dattani and Jacob Trefethen.

Chapters:

00:00 Intro
03:52 How was HIV discovered? Where did it come from, and how does it attack the body and cause AIDS?
38:10 Antiretrovirals: How did scientists develop breakthrough HIV drugs — from azidothymidine to protease inhibitors to PrEP?
1:51:35 How does prevention and treatment work today?
2:19:03 HIV’s capsid and the breakthrough of lenacapavir, the first-approved HIV capsid inhibitor
2:50:36 How to develop long-lasting treatments
3:14:45 Lenacapavir’s near 100% efficacy in clinical trials
3:48:40 The impact of global programs against HIV, and can we now end HIV?

Saloni’s substack newsletter: https://www.scientificdiscovery.dev/

Jacob’s blog: https://blog.jacobtrefethen.com/ 


Books:

Retrospectives:

Articles:


Videos:

Image credits:

  • Mini-Lecture Series: HIV Capsid Inhibitors: Mechanism of Action — David Spach, National HIV Curriculum (2024) [Multiple diagrams of HIV capsid and lenacapavir’s effect.]
  • Saloni Dattani; Our World in Data (2024) Highly active antiretroviral therapy transformed the lives of people with HIV. [Graph of decline in HIV/AIDS mortality after HAART was introduced.]
  • Engelman and Cherepanov (2012). The structural biology of HIV-1: mechanistic and therapeutic insights. [Diagram of HIV’s entry into the cell.]
  • Susan Moir, Tae-Wook Chun, Anthony S Fauci (2011). Pathogenic mechanisms of HIV disease. [Diagram of HIV replication rates over time, contrasting acute and chronic infection.]
  • Saloni Dattani, adapted from Patel et al. (2014). Estimating per-act HIV transmission risk: a systematic review. [Bar chart of risks of contracting HIV from different sources when unprotected.]
  • Thomas Splettstoesser under CC-BY. [Diagram of HIV’s internal structure.]
  • Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women — Bekker et al. (2024) [Chart of lenacapavir’s efficacy.]
  • Our World in Data based on Joint United Nations Programme on HIV/AIDS (2024). [Chart of global HIV deaths over time.]

Acknowledgements:

  • Douglas Chukwu, researcher at Open Philanthropy
  • Sanela Rankovic, Acting Instructor at the Institute for...
Coming soon: Hard Drugs09 Jun 202500:00:59

Hard Drugs is a new podcast about medical innovation: how to speed it up, how to scale it up, and how to make sure lifesaving tools reach the people who need them the most.

Presented and written by Saloni Dattani and Jacob Trefethen. Brought to you by Works in Progress and Open Philanthropy.

Are miracle drugs hiding in plain sight?24 Jul 202602:31:43

GLP-1 drugs like Ozempic and Mounjaro have transformed the treatment of obesity as well as diabetes, help treat heart disease, kidney disease, sleep apnea, and maybe even Alzheimer’s. But they are far from the only medicine with more than one use. Aspirin, colchicine, minoxidil, and Viagra were all found to treat more conditions than expected, and about a third of drugs end up with a second approved use.

In this episode, Jacob and Saloni explore the idea of drug repurposing: taking a medicine made for one disease and finding it works against others. They trace how GLP-1 drugs emerged from an adorable Gila monster, why some drugs have multiple uses, why so many of those uses go untested, and how patents, competition, prizes, and platform trials shape whether we ever find them.

Hard Drugs is a podcast from Works in Progress about medical innovation presented by Saloni Dattani and Jacob Trefethen.


You can watch or listen on YouTube, Spotify, or Apple Podcasts.

  • (00:00) - Introduction
  • (13:20) - The origins of GLP-1 drugs
  • (46:07) - GLP-1s for everything?
  • (01:03:33) - Promiscuous drugs
  • (01:25:04) - Why isn't drug repurposing more common?
  • (01:56:39) - How to fix the incentives
Click here to view the episode transcript.

Saloni’s substack newsletter: https://www.scientificdiscovery.dev/

Jacob’s blog: 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


Blogs

Videos

Articles & reports

Web

Inventing the second malaria vaccine with Katharine Collins27 May 202602:15:08

Malaria is caused not by a virus or bacterium, but by a complex, shape-shifting parasite that has evolved alongside us for millennia. This has made vaccine development a brutal challenge.

In this episode, Jacob and Saloni are joined by Katharine Collins, who co-invented the second malaria vaccine, called R21, during her PhD. They discuss the gruelling process of reverse-engineering a vaccine and eureka moments along the way. They ask whether the biggest barriers to new vaccines are scientific or financial, and what it will take to finally eradicate one of natureʼs most vicious killers.

Hard Drugs is a podcast from Works in Progress about medical innovation presented by Saloni Dattani and Jacob Trefethen.

Timestamps:
00:00 Introduction
05:08 Our favourite parasites
10:12 How to invent a vaccine during your PhD
34:18 Why is it called the R21 vaccine?
37:32 Moving from the bench to billions of doses
41:43 The vicious life cycle of malaria parasites
46:15 Malaria research IN MICE
53:03 The murderer in malaria research
55:51 Would you volunteer to get infected by malaria?
1:08:21 Why did the first malaria vaccine take so long?
1:18:26 Could we have had the vaccine sooner?
1:40:48 Vaccine versus vaccine: which one’s better?
1:46:53 If we did this again today, could we make better vaccines?
2:04:55 Conclusion and our reasons for pessimism and optimism

You can watch or listen on YouTube, Spotify, or Apple Podcasts.

Saloni’s substack newsletter: https://www.scientificdiscovery.dev/

Jacob’s blog: https://blog.jacobtrefethen.com/ 

Acknowledgements:

  • Aria Babu, editor at Works in Progress
  • Graham Bessellieu, video editor
  • Alice Edwards, captions
  • Abhishaike Mahajan, cover art
  • Atalanta Arden-Miller, art direction
  • David Hackett, composer

Works in Progress

Thesis

  • Katharine Collins (2014). R21, a novel particle based vaccine for a multi-component approach to malaria vaccination.

Books

  • R. Killick-Kendrick (2012). Rodent Malaria.
  • Michael Kremer and Rachel Glennerster (2004). Strong Medicine: Creating Incentives for Pharmaceutical Research on Neglected Diseases.

Articles and reports

Should everyone be taking statins?27 Feb 202602:54:47

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/

Jacob’s blog: 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

Articles

Videos

The first cancer vaccine22 Dec 202502:58:47

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/

Jacob’s blog: 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:

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 vaccines26 Nov 202502:06:23

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/

Jacob’s blog: 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:

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?29 Oct 202504:34:48

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/

Jacob’s blog: 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:

Articles:

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 AI15 Oct 202501:00:21

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/

Jacob’s blog: https://blog.jacobtrefethen.com/ 


Courses:

Articles:

Lectures:

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

Hacking proteins with AI01 Oct 202500:54:36

Nature didn’t evolve all the proteins we need, but maybe artificial intelligence can help. Jacob and Saloni explore how tools like AlphaFold and ProteinMPNN are helping researchers re-engineer proteins, to make them safer, more stable, and more effective. They talk about how new technologies could help make a long-sought vaccine against Strep A, which causes scarlet fever and rheumatic heart disease, and how similar tools have already led to breakthroughs against COVID and RSV.

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/

Jacob’s blog: https://blog.jacobtrefethen.com/ 

Courses:

Articles:

Lectures:

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

[Correction: The structure of RSV's prefusion F protein was initially determined by X-ray crystallography by Jason McLellan and colleagues, rather than cryo-electron microscopy, although the latter was used to visualize antibody binding and confirm its structure.]

100 years of insulin in 15 minutes16 Sep 202500:17:31

A hundred years ago, insulin was scraped from pig pancreases. Today, it’s made by bacteria in giant tanks. In the second part of a mini series on proteins, drug development and AI, Saloni tells the story of how insulin went from a crude animal extract to the first genetically-engineered drug, kickstarting the biotech industry along the way.

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/

Jacob’s blog: https://blog.jacobtrefethen.com/ 


Books:

  • Genentech: The beginnings of biotech by Sally Smith Hughes

Articles:

Podcasts:


Acknowledgements:

  • Aria Babu, editor at Works in Progress
  • Adrian Bradley, on-site producer
  • Anna Magpie, fact-checking
  • Abhishaike Mahajan, cover art
  • Atalanta Arden-Miller, art direction
  • David Hackett, composer

Works in Progress & Open Philanthropy

Proteins: Weird blobs that do important things03 Sep 202500:19:49

This episode kicks off a mini-series on proteins, drug development and AI. Saloni and Jacob explore the world of proteins, including how proteins fold into complex shapes, why that complexity matters and how crowded and dynamic the inside of a cell really is; and they exchange surprising statistics about proteins.

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/

Jacob’s blog: https://blog.jacobtrefethen.com/ 


Books:

Articles:

Image credits:

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