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The moonshot mindset embraces the idea that audacious goals are the best way to bring revolutionary changes to health. Over the past several decades, the term “moonshot” has been used broadly to describe an ambitious approach to tackling society’s most intractable challenges, starting with the work that led to the first moon landing in 1969 and now encompassing research on the world’s biggest health issues, such as ending cancer, curing infectious disease, and extending healthy life.

Moonshot thinking has spawned powerful new initiatives in the past few years: from Calico, a Google moonshot company focused on extending life, to MD Anderson Cancer Center’s Moon Shots program, the White House’s Precision Medicine Initiative, and Vice President Joe Biden’s Cancer Moonshot. StartUp Health, where I serve as the chief medical officer, has a 25-year plan to build an army of digital health entrepreneurs and innovators that we call Health Transformers to achieve 10 of the world’s biggest health moonshots.


Although these massive and multifaceted efforts may have different names and goals, they operate under the shared ethos that the most effective way to bring real change to medicine is to move forward together, arm in arm, in giant leaps rather than incremental steps.

It’s inevitable that audacious plans sometimes fall short of their stated missions or don’t happen as fast as we’d like. I’ve been struck by the recent reports about Dr. Patrick Soon-Shiong’s Cancer Breakthroughs 2020, not because of the specific criticisms of his business tactics but because of the short-term lens that’s being used to judge a health transformer’s progress.

While success is important, so is trying: Trying to make a difference. Trying to make a change. Trying to speed up the progress of what we know will eventually come but is taking too long. Trying to spare another family from the horrific conversation that there’s nothing that can be done for their dying loved one.


Disruption is always uncomfortable, and it doesn’t happen overnight. But as a result of the bold visions of health transformers striving to do what many believe to be impossible, I believe we are on the cusp of a medical revolution akin to the discovery of antibiotics or mapping the genome. This quest will usher in treatments that haven’t yet been imagined. In order to achieve the next great leap, we need to dream big, keep innovation open and transparent, collaborate more, and embrace the moonshot mindset.

Over the past decade, the medical community has learned an enormous amount from the disruptive innovation approach of entrepreneurs, which often delivers game-changing new business models and solutions at a breakneck pace. Some ideas work, many don’t. The only way to make breakthroughs is by working passionately and around-the-clock to turn far-fetched visions into reality. With so much uncertainty for the future of science funding, and a culture of skepticism at the highest levels of government today, we will all be better off if we support those already in mid-leap, no matter how long it takes.

One well-known disruptor, Mark Zuckerberg, wrote a poignant blog post last month that reminded me of a core mantra of disruptive innovation: “We always overestimate what we can do in two years, and we underestimate what we can do in ten years.”

That mantra is especially fitting at a time when thousands of health entrepreneurs and “doctorpreneurs” are testing novel approaches to reinvent the future of medicine. I’m personally agnostic as to who announces the next breakthrough, as I want them all to succeed. As Joe Biden said at the National Cancer Moonshot Summit last June, these moonshots are “carrying the hopes and dreams of millions of people who want us to succeed, make a difference in their lives and their families. Not someday, but now.”

Every day in my clinical practice with cancer patients, I witness the real power of undaunted, uncompromising hope. I firmly believe that a moonshot approach to medicine is what we need to push us into the next epoch of human health and longevity.

Howard Krein, MD, is the chief medical officer of StartUp Health, as well as a head and neck cancer surgeon at Thomas Jefferson University Hospital and the senior director of health policy and innovation at Jefferson’s Sidney Kimmel Cancer Center.