The 36-Year Cancer Fight That Led To A Nobel Prize

the Nobel Prize in Medicine. James Patrick Allison, perhaps better known as Dr Jim Allison, joins us here in our eleven Trio studios. Dr Allison, thank you very much for being here and congratulations on your Nobel Prize. And I'm wondering if you could just describe before you tell us about how you play the harmonica, and you know you've got a musical side that I think it's pretty interesting. When did you learn that you had won the Nobel

Prize along with your counterpart in Japan? Yesterday morning? My son called me about five thirty and so, Dad, you did it, you know, And and uh, I thought, what what I was just waking up, you know. And then uh then a call came in from Sweden after that and uh, you know, confirming it. So it's rather than nice that my son was first though. Tell me, uh, well,

congratulations again, Dr Alison. Can you just give us a sense of how hard it was to do the research and persevere with it when a lot of people thought that your field of immuno oncology was voodoo science. Yeah it was. It was you know, voodoo or snake oil or various terms were used. You know, I just didn't

pay much attention to that was just background noise. I focused on really understanding mechanisms of how the immune system worked until I had the details down and could just knew exactly what I thought, at least exactly what we needed to do. So what is this amano oncology. Well, it's it's using your immune system, either targeting it or in my case, just unleashing it to attack cancer cells.

Because you've got these cells called T cells that go all around your body and they're kind of the soldiers of the immune system and they recognize things that ought not to be their virus infected cells or cancer cells or whatever, recognize them Um, it's a wonderfully complex and interesting process that I've been working on since nine two, and um, you know, it's it's just a beautiful thing, and we finally learned how to manipulate it, to direct

it to ourselves to actually attack cancer. Dr Allison as the professor and also Chair of Immunology and Executive Director of Immunotherapy at the MD Anderson Cancer Center, can you, uh, maybe describe how your discovery can not only apply to specific cancers that people may have, but for the whole understanding of how to fight cancer when it's diagnosed. Yes, well, well, this this approach is radically different from most approaches to

cancer theory, which target the cancer cell. This has the therapy itself has nothing to do with the cancer cell at all. It has to do with manipulating the immune system just generally, so potentially it could work against any kind of cancer, at least when I conceived of this in the mid nineties, that was the idea. Since you're not treating cancer, you're treating the immune system, it could work against anything, and it turned out that that was

not quite right. But but it works very well well against melanoma, for example, Patients that just get a a single round of treatment with with the drug I developed, and we're live ten years. I mean they're basically cured. Their live ten years after therapy and when added to a second drug that that Hanjo played a major role in discovering. The response rates about sixty and we don't

know how long they're going. But it's been approved by the FDA now not only for melanoma, but for lung cancer, kidney cancer, bladder cancer, Hodgkinson and Foma, had neck cancer, and the list goes on and on, merken cell cancering, um, you know, so it is broadly applicable. But unfortunately, what we've learned in the last few years since these approval started coming in is there are cancers that don't response. There's a clear blastoma and pancreatic cancer, and the response

rates and other cancers are um. You know, it's not everybody. It's somewhere or in combinations up to our job now hours to get that up as close to a percent as we can and in as many kinds of cancer.

And that's the goal of the minotherapy platform and INMDI Anderson that that run together with Dr pad biny Sharma, who's an oncologist that yes, yes, Dr Allison, I'm wondering, You've been working on this particular type of cancer treatment for nearly four decades, and over that time, I'm wondering, do you feel like we are much closer to a fundamental breakthrough to make cancer less fatal? Yes, I think we're are, and i think we're already there in some

kinds of cancer. As I said, six melanoma patients. When we started this work, the median survival after diagnosis of metastatic melanoma was eleven months. It was basically a death sentence, and there were no drugs that had ever had any impact on that at all until we came along. And now, like I said, twenty percent of people alive ten years after treatment, and you know even more when you're using combinations. So uh, but there's you know, so this is a

fundamental shift and how to treat cancer. Again, you don't treat the cancer, You treat the immune system and unleash it to go after the cancer on its own. And so this is going to be I would predict, not not replace chemotherapy and radiation and things like that, but together. That's the unique thing about immunotherapy is that it can be used together with these other kinds of therapy to

improve their their efficacy. And the one thing that one key thing that the immune therapy is offered that the others don't is that once you've got a T cell, you've got it for the rest of your life. Just real quick, Which companies you're working on to develop actual applications? A lot several companies, but key and helping us developers a little company called Meta Acts. It's since been by Bristol Myers squib so we do a lot of work with them, but we also work with a number of

other companies. Dr jam Melissa, congratulations, Thank you so much for joining us. Truly a pleasure to speak with you and thank you for what you do. A lot of people I know are very grateful. Dr Jim Allison, Professor in Chair of Immunology at the MD Anderson Cancer Center in Houston, also the winner of the Nobel Prize for Medicine, Thank you so much and really an inspiration with respect the perseverance for nearly four decades on something that a

lot of people dismissed. Really a pleasure having you here. We are broadcasting from the Bloomberg Interactive Broker's studios. This is the time we talk about trade. And indeed, after yesterday's public airing of the details of the U S m C A much more and much more. Yes, you have new concessions for US farmers, new rules for digital commerce,

and rules for US content for automobiles. Here to help us understand the trade agreement is Duncan Would, director of the Mexico Institute at the Wilson Center, and he joins us now from Washington. Do you see Duncan Wood, thank you very much for being with us. What can you tell us about the details of this agreement and what do you believe the ramifications of the agreement will be for all three of the economies Mexico, the United States,

and Canada. Well, let's say, yeah, that's a pretty big question, considering the economy is to combine, their trade is more than fort of one point four billion trillion dollars UM. But what I can say is that I was happy to see a continuation of general principles of NaSTA UM in this new agreement. I think that we have actually ensured that the free trade environment in North America will

continue pretty much across the board. UM. There are some areas where the Trump administration was successful in in winning

concessions from his partners. Now to say that, obviously, you know, we talked a lot about the dairy industry in Canada, but we've also talked about the weakening of Chapter eleven investor they dispute mechanisms UM and you know, and also we've we've seen you know, this insistence on higher regional content in the auto sector as well as um A content a minimum content level of forty percent coming from

factories where works makes sixteen an hour or more. So, you know, I think that perhaps the most interesting element of all of this is to say that business is going to accept it. Business is going to celebrate the fact that they now have legal certainty that investments can continue in the region, and they're going to work with the rules of the of the new agreement to try to deepen the integration that we've already seen in North America.

So I take it as a positive step forward. It's far from perfect as an agreement, but which free trade agreement is um and you know, this is one thing that I think that you know, as we read be the text and great. So we're finding that despite all of the little irritance that are still there, um, and some precedents that have been set which are uncomfortable for free traders. It's a step in the right direction, all right.

One thing that I'm struggling with is does this agreement move more toward freer trade with fewer barriers or more towards sort of more protectionist approach. And I'm thinking in particular the sixteen dollars an hour provision, which will effectively either forced Mexico to dramatically increase pay or else produce things in the US more. Yeah. I mean that you've identified one of the clearest examples of a less free

trade approach. UM. And uh, you know, I think that that's that's the thing that will stand out for for a lot of people. UM. We also have to recognize that the you know, the this new agreement doesn't resolve the problems over Section to Study two on aluminum feel. Um, it doesn't really resolve the dispute over the potential application of Section two study to on or the automobile sector.

Because whilst Canada and Mexico have carved out UM an exemption from that up to two points six million vehicles a year UM, that they're still going to be subject to it, which you know goes against the principles of free trade. However, you know, on the positive side, I would say this, what we've seen is we've seen a modernization of a of an agreement that you know, is more than two decades old, that was considered to be

an old Lady of free trade agreement. We've included new issues so that the new agreement applies to areas of digital trade, intellectual property. You know, there's some interesting work there on on financial services, and so these are I mean, it looks much more like a twenty first century free trade agreement than the NAFTA did, and I would say that that extends the reach of free trade in the North American region. Can this agreement or parts of this

agreement be used in future negotiations with China? I think that's certainly. Um. What's what's behind a lot of the year, at least some of the language that's been there, um. I mean, the most obvious stand out here is that is the question of currency manipulation. There was no reason to include currency manipulation provisions in a NAFTA. Biggest neither

Canada nor Mexico engage in that kind of behavior. But clearly the United States wanted to establish a precedent whereby they could take this language to any potential um future free tech trade deal. And you know, the Japanese have already um signals that they're nervous about that, they know that that's coming to their for their their negotiations with

the United States. And of course this set the president for China in particular, Dungan, I'm struck by the fact that you think that disagreement will be good for US

energy companies. Can you explain? Yeah, I think that it is that it's good for US energy companies because, first of all, Mexico was excluded from the original provisions energy provisions of the NAFTA UM and you know it, it's specifically required that it was excluded from the free trade of of of oil and gas because Mexico's system at the time was a closed system UM. Since two thousands thirteen,

Mexico has opened up its oil and gas sector. Mexico now has a market oriented energy sector and that has been under threat with the With the new government's coming into power in December in Mexico, the government of Andersman, while lops Overdorf, who was opposed to private investment in the oil and gas sector. But what this treaty ensures is two things. One that there will continue to be the free trade in molecules and electrons across the North

American space. And to that Chapter eleven um provisions in in other words, investor states dispute settlement mechanisms will apply continue to apply to the energy sector, in particular to oil and gas. And so that gives a lot of the investors American companies that are invested in Mexico, that gives them legal certainty which they wouldn't have had otherwise.

Duncan Wood, thank you so much for joining us and for analyzing uh the agreement to in such a short period of time to give us such a deep insight. Duncan Wood is director of the Mexico Institute at the Wilson Center in Washington, d C. The topic now is student loans and helping us here to understand this is Brendan Coughlin. He is the president of consumer Lending at

Citizens Bank. Brendon, thanks very much for coming in. Maybe just set this stage, because you know, I keep hearing a lot of numbers like one and a half trillion dollars in student loan debt. But the student loan market includes private debt, it also includes debt that in many cases is guaranteed by the federal government. Can you explain the marketplace and what we're facing. Yeah, absolutely, and thanks for having me here today for what's I think one

of the country's biggest challenges. The student loan um that did just cross one point five trillion. It's growing at about twice the pace of inflation, and projections put it out at three trillion um in in just another ten years. So just a very alarming situation that we're dealing with here that the country is going to be living with

for a long time. You are right, when you get a new loan to go first to go to school, about of the time that that loan is issued by the federal government through a variety of programs, and about seven percent of the time it's issued by a bank which has full underwriting UH and an assessment of your ability to repay, versus the federal government, which which has very very limited underwriting. So you just put out a survey where you talked to a number of younger individuals

in America about their student debt loads. Regret is sort of laced into every result of this survey, just to regret that they incurred so much debt. I'm just wondering, apart from going over some of the details of the actual survey, what could they have done to ameliorate some

of these uh regrets. Yeah, you know, this is it's it's highly emotional when when you're entering school and the discussion between parents and children often is not detailed enough, and folks don't understand what they're truly signing up for, and they're not having the hard conversation of return on investment.

And as you make your choices, whether it's which school or how much you're gonna pay, or how to pay for it, and really all of it comes back to that doing your homework and being more prepared so you make these decisions eyes wide open um going into school. How many smaller or I guess for profit universities do you think would shutter if people did more of this

sort of risk reward but benefit analysis. Yeah, there's certainly a handful of decent for profit schools, but but by and large, many of them would be in real, real challenge. If you looked at the return on investment on some of these, and and did an assessment of the tuition you'd pay versus the um the salary, and the graduation rates coming out. And keep in mind the graduation rate across the entire country, including four year public and private institutions,

is right around fifty. So most of our issue in the country is that these kids are not matriculating to graduation. UM. When you do get to graduation, you have a much higher success rate of um of of of getting a good job, but it's particularly exacerbated in the for profit sector. For sure. There was a report there is a report from the Brookings Institute about student loans, and one of their conclusions is that by three forty percent of borrowers

made default on their student loans. We're talking about five hundred and sixty billion dollars in unpaid debt. Does that make sense to you? Well, so, the data, as as we kicked off here, with most of the debt being issued by the federal government, the data is not um readily publicly available UM to digest in a way that

makes that easily answerable. But that does seem consistent with all the information I've heard UM and and in the federal portfolios, customers are considered performing even if they're on a um A plan to repay, which could be as little as a five dollar a month payment. So if you owe seven hundred and you're paying five dollars a month from from a statistical perspective, that's not considered um in default. But you know, that's pretty darn close to

default in my book. So we've got a lot of customers out there in the marketplace and the federal program that are not paying back. You know, if you juxtapose that against the banks, our default rate is about two percent as a as an industry, Citizens is at below one percent. So it's a very very stark difference between bank loans and government loans. All right, I want to get this more clear. So Brendan, you're the president of

Consumer Letting It Citizens Bank. We know that student loans have become an increasing problem as its surges in the total outstanding and people talk about how to drag on the economy. Basically, these young people have so much debt they can't save anything, and they can't spend on a house, and they're they're they're postponing their family formations and not

having kids because they're really expensive. Um. One thing that I'm wondering from you, how does a private organization play in this space ace and profit from this space at a time when there is such this this huge weight out there that is sort of weighing down everything. Yeah. Look, we we can't control the entire environment. Obviously. The biggest issue here is the ever increasing tuition costs across the country,

and it's going faster than inflation. So the only place that families are finding their way to pay for it is either you know, postponing retirement or or taking out debt. What we can do is is inside of the framework of a bank. We've done a couple of things, so we put a more affordable option out there than most of the government programs, at least the ones that aren't subsidized.

So when you go to school, we will give you a rate that's better, and we will underwrite you to make sure we think you have a reasonably good chance to pay the bank back, which is good for us in the student hold on second, I want to want to press you on that. So in other words, you decide, is this person competent? Are they studying something that's actually going to give them some leg up when they go try to apply for a job. Are those some of the things that you look at. We don't. We don't

look at their their intended degree. Um, there's a lot of risk of redlining and unfair treatment on things like that. But we do look at their income. Their parents are typically co signing, which is forcing this conversation and the family and the household around is this the right decision for us? We both have some skin in the game. Let's make sure so all those things lead to a better and more informed decision, which dramatically improves the ability to repay for the student at the end of it.

We've also introduced a refinance program when you come out of school, which uh most folks surprisingly don't even know about yet, um and spending the market for five or six years. When you get out of school, if you get a job, the first thing you should do is look to trade in your old student loans because you got underwritten when you're eighteen, living with your parents with no credit score, and now you're gainfully employed, you've built some credit and hopefully you're on the way to moving

out for mom and dad. Right, your profile could not be more different than when you got that loan, and we've been saving students about two and fifty dollars a month on their student loan debt, which gets back to your question around accelerating your ability to buy a home, household, formation, getting married, having kids. Now, that refinancing that you just spoke about, and I give you about twenty seconds here, that refinancing could be for private student debt, but it

can also be for public for federal student debt. Right. That's that's exactly correct. Consumers make no distinction between the two, and um, we we will refinance either one of them is in most of the industry that's in this business will as well. You know, one of the stats the survey put out was about sixty percent of students have buyer's remorse on their decisions. So either they wish they went to a less expensive school or in some cases

they wish they didn't go to school at all. So once you've made that decision, it is what it is, but you can take control of your finances, refinance it and make it more affordable for you. Brendan Coughlin, thank you so much for being here. Brendan Coughland is President of Consumer deposits and lending for Citizens Bank in Providence,

Rode Island. The leader of Italy's Five Star movement, Luigi de Mayo, has warned that Italy's government will not retreat quote a millimeter from its spending plans amid pressures from the European Union. Here to tell us more is Alberto Gallo, partner portfolio manager for Algebras Macro Credit fund at Algebras, and he's also a Bloomberg opinion column this and he joins us, Now, Alberto, what if you make of Mr

Demio's statement? It looks a lot like the altitude the type of posture that the former finance minister in Greece, you know, Mr Barro Farkas had versus Europe, so very confrontational. Um. And it is the opposite to his coalition partner Saldini from the Northern League. So you have a government with two parties. One has been voted in the south of the country. Um. The other one has been voted in the north, which is reached sure and more industrial. Um.

You know. Mr Demira has been falling behind in contensus since the coalition started in Italy, while Mr Sylvenia has been gaining, so I think this is a competition to raise the voice against Europe, to try to gain back some votes. There is an internal dynamic between Mr. Demia Mr. Slvina are trying to raise for more consensus. However, the you know, some of the business components of the country are feeling the pain. As you know, yield go up

and investment drives up. So we you know, we think that Indian Mrs Slvinia will win more consensus and this could bring a more rational stand to the government to the debate with Europe. So I guess you know, there's the internal the deliberations about the votes that the Five Star Party could pick up. These are there's the external factor here, which is exactly as you're mentioning Albert Alberto, the yields rising and if you look at ten year

Italian yields now rising to the highest since March. I'm wondering, from your vantage point, are yields poised to go much higher? In part because the European Union is fed up with the Italian drama and it's withdrawing from its stimulus program. Anyway, this is it's hard to understand and predict the dynamic of every tweet. You know, of every statement generally the consensus and you know very well this from the US administration as well. I have no idea what you're talking about.

Other too, the consensus is very very short. You know, US investors have gone into emerging market, but no one, no one likes Europe. So there is a contents tous saying that Yales would go to for four or five percent. Having said that, the two point four percent number for the budget deficitit is just point one percent higher than last year. So you know last year we have two point three percent def that Italy has a current account surplus, which means that you know, the dest it comes from

interest costs UM. There's there's more experts than imports UM. And there's eight trillion of savings that Italians have and around seventy percent of bonds are held either by the bank compitily through easyb purchases or by tellent institutions. So really here the government is making an effort at creating financial volatility, trying to gain contensus from public opinion, trying to portray the EU as a as an enemy, and

we've seen this before in other countries. Having said that the coalition is fragile um, it's not stable, and you could see a point where the Northern supporters of Mr Slbini say this is enough. You know, you're damaging our business. You need to break up from Mr Demand who has been promising effectively free income to uh to be unemployed and very high spending which are unrealizable. And you can

see that from the latest declaration of success. You know Mr Slovini is absent, so he's not taking a position in favor of uh in in in extreme favor of the budget is taking a much more moderate position. So there's gonna be clearly stumble latility. But if you look through that, there's potentially attractive opportunities also in other parts of Europe, not necessarily in equally, but other parts that are widening, that are falling in sympathy with with Italy.

You look at Spain, for example, or the UK, well you have you have bond yield adjusted for currency in the UK or in Spain, which are wider than many emerging markets. You know, if you look at the Barclays bonds, subbortinated bonds are wider than Ecuador. If you look at the Spanish banks, you know they're wider than uh stub story and African sovereigns. So there is a structural short

in Europe. Um, you don't need Europe to have extremely high growth, you just need Europe not to break up too and you get paid very well for that for that. Alberto Guello, thank you so much for being with us, and really interesting to think that even if Italy perhaps is not a buy right now given the political uncertainty, the relative widening of other areas in Europe do offer some opportunities. Alberto Gaello, Partner and portfolio manager for the

Algebras Macro Credit Fund at Algebras Investments. Thanks for listening to the Bloomberg P and L podcast. You can subscribe and listen to interviews at Apple Podcasts, SoundCloud or whatever podcast platform you prefer. I'm pim Fox. I'm on Twitter at pim Fox. I'm on Twitter at Lisa Abramo. It's one before the podcast. You can always catch us worldwide on Bloomberg Radio.