# AI could predict drug side effects without human trials

Markdown copy of https://realalpha.app/s/ai-could-predict-drug-side-effects-without-human-trials/ on Real Alpha, the best minutes from long interviews with the people building AI. Cite and link the page, not this copy.

- Speaker: [Bill Gates](https://realalpha.app/people/bill-gates/) · Bill Gates is co-founder and former CEO of Microsoft and chairman of the Gates Foundation. · Co-founded Microsoft in 1975; now chairs the Gates Foundation, which will close in 2045.
- Host: [Nilay Patel](https://realalpha.app/people/nilay-patel/) · Editor-in-chief, The Verge · Helped start The Verge in 2011 and has hosted Decoder since 2020.
- Show: Decoder
- Episode: [Bill Gates says to prepare for 20 years of tumultuous AI disruption](https://realalpha.app/v/A0kTUP7fWtk/), Oct 22, 2026
- Moment: 45:58 to 50:00 of the episode (4 min), playing on https://realalpha.app/s/ai-could-predict-drug-side-effects-without-human-trials/; the episode from there: https://realalpha.app/v/A0kTUP7fWtk/?t=2758

## Quote

> “in the next five to ten years, I think there's a **very good chance** these in-silicon models will give us that capability.”
> — [Bill Gates](https://realalpha.app/people/bill-gates/) at [48:31](https://realalpha.app/v/A0kTUP7fWtk/?t=2911) · Decoder

## Takeaways

1. AI is already being used in drug discovery and health delivery
2. In-silico models may predict drug side effects in five to ten years
3. Gates expects notable job and cyber effects within two to three years

## About this segment

Bill Gates describes the foundation's AI work in health and agriculture, and says drug models could predict side effects without human trials within five to ten years. He expects job and cyber harms sooner.

From “Bill Gates says to prepare for 20 years of tumultuous AI disruption”, Oct 22, 2026. [Watch the full episode](https://realalpha.app/v/A0kTUP7fWtk/)

## Transcript

Transcribed by machine (Whisper) from the episode’s audio, so a word may be off here and there.

[46:09](https://realalpha.app/v/A0kTUP7fWtk/?t=2769) The industry has largely stopped talking about how it's going to kill everyone and take the jobs away. They've pivoted to AI will cure all diseases. I hear this from various AI CEOs all the time. I actually asked Mustafa about that change in tone over the conversations we have had over the past year or so. The idea that there are huge positive benefits from AI at scale seems to have come back to the forefront rather than some of the doomer impulses that maybe a year or two ago were there.

[46:36](https://realalpha.app/v/A0kTUP7fWtk/?t=2796) It strikes me that AI curing all diseases is right in your strike zone. It's something that Gates Foundation has been working on in global health for years and years. It doesn't seem as easy as just telling the model to cure cancer, right? You have to do trials. You have to manufacture the drugs. You have to distribute the drugs. drugs, you have to make sure they work. How do you think that's going to go? Is that in the same 20-year time period as the robots building our houses? Is it faster? Is it slower?

[47:01](https://realalpha.app/v/A0kTUP7fWtk/?t=2821) In that time period, I mean, you know, this is my full-time job is as chairman of the Gates Foundation. In fact, this month, you know, we do two weeks of strategy reviews to decide how we'll spend our money next year on tuberculosis, HIV, malaria, you know, and it's fantastic how we're using AI not only on the drug discovery side, but also as we get the African languages to be properly understood by these models, which is a thing we announced initiative with 60 partners last month. So health care discovery and delivery will be incredibly accelerated by AI. And that's very exciting. You know, better seeds, better livestock genetics, weather forecasts for farmers in Africa who never had any of those things. So yes, that's good stuff that AI enables during the remaining 19 years of the Gates Foundation.

[48:10](https://realalpha.app/v/A0kTUP7fWtk/?t=2890) Do you think that that is enough to overcome people's skepticism or fear of the AI models they encounter today? No, absolutely. Because that is very much how the companies think about it. No, come on. I mean, I think it's unfair to say they were totally on a Doomer message and now they've switched to some other message. These two things are deeply entangled. The fact that AI eventually will be able to model human biology in such a way that you'll understand the side effects of a drug without having to do human trials.

[48:41](https://realalpha.app/v/A0kTUP7fWtk/?t=2921) We're not there, but in the next five to ten years, I think there's a very good chance these in-silicon models will give us that capability. Biology is very complex. AI is extremely good given enough data, which there's new tools to gather and feed. Very, very good at dealing with complex systems. It's almost perfect for biology. But no, that doesn't mean that people will feel good about the downsides.

[49:12](https://realalpha.app/v/A0kTUP7fWtk/?t=2952) And how quickly do the good things arrive? You know, how quickly do you look at your medical bill and go, wow, that's really low? Or you say, oh, I want to buy a new house. Wow, these houses are sure cheap. The good stuff does take time. And some of the things like cyber attacks and the job market thing, you know, even in the next two to three years, you'll see significant negative effects in those two areas.

[49:39](https://realalpha.app/v/A0kTUP7fWtk/?t=2979) You have a number of ideas for how you would stop those negative effects or prevent them or at least mitigate them in your letter. Moderate them, yes. It's somewhere. Ameliorate is what might be the right word. And they're not small.