Biology is booming, so why isn’t medicine keeping up?

We sit down with Ruxandra Tesloianu to unpack the real constraints slowing drug development. From clinical trial inefficiencies and regulatory opacity to risk-averse biotech culture, we explore why breakthrough discoveries so often stall before reaching patients, and why increasing the availability of clinical trials might be the answer.

We dig into:

•⁠ ⁠Why pharma R&D productivity keeps falling (Eroom’s Law)
•⁠ ⁠The clinical trial bottleneck and late human feedback loops
•⁠ ⁠How regulatory uncertainty quietly inflates costs
•⁠ ⁠Why investors avoid high-risk areas like aging
•⁠ ⁠The overlooked role of surrogate endpoints and biomarkers
•⁠ ⁠What China and Australia reveal about regulatory arbitrage
•⁠ ⁠Whether AI can actually fix the pipeline
•⁠ ⁠The expanding role of IRBs and procedural friction

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We dive into the hidden environmental cost of modern agriculture, from sprawling farmland covering 40% of the planet to the $300 billion global subsidy system that rewards scale over sustainability.

Author Michael Grunwald unpacks why food production, not cities, is the biggest driver of deforestation, water use, and carbon emissions, and what technology, policy, and smarter incentives could do to change course. From lab-grown meat and AI-engineered crops to the surprising truth about “natural” farming, he challenges how we think about food, land, and climate.

Key topics:
•⁠ ⁠Why agricultural sprawl dwarfs urban sprawl
•⁠ ⁠The real impact of meat production
•⁠ ⁠Subsidies and the politics of farming
•⁠ ⁠Tech solutions: alternative proteins, gene editing, AI agriculture
•⁠ ⁠Policy vs. innovation — what actually moves the needle?
•⁠ ⁠How consumers can make a difference without perfection
•⁠ ⁠If we need 50% more food by 2050, how do we grow more without destroying more?

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In this episode of Everybody Gets Pie, we are joined by Neera Tanden, President and CEO of the Center for American Progress and former Domestic Policy Advisor to President Joe Biden. Neera reflects candidly on her time in public service, the lessons of the Biden administration, and why Democrats must be ruthless about solving real problems, and especially on housing and affordability.

We cover:
•⁠ ⁠How housing location shapes life outcomes
•⁠ ⁠The tension between inclusionary zoning and housing supply
•⁠ ⁠Why renters didn’t feel relief fast enough
•⁠ ⁠Lessons from serving inside the Biden White House
•⁠ ⁠Why permitting reform stalled for housing and clean energy
•⁠ ⁠Supply vs. intervention—and why both matter
•⁠ ⁠Why “bad answers” often beat “no answers” in politics

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