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Inside the GLP-1 Gold Rush: Eli Lilly CEO on New Breakthroughs, Addiction & Mental Health, Pricing Podcast Episode Description
(0:00) Introducing Eli Lilly CEO Dave Ricks
(1:43) How Eli Lilly discovered the GLP-1 impact on weight loss, counterfeit products from China
(7:08) GLP-1 pricing and capital allocation after a breakout pharma product
(12:56) Why Biotech VC has plummeted, “patent hacking” in China
(15:32) Dave’s health regimen: good sleep, movement, healthy diet, social relationships, reading
(18:32) Unexpected impacts of GLP-1s, helping with addictions, potential mental health use cases
(21:16) Thoughts on RFK Jr, Big Pharma’s influence on the media, how AI empowers patients
(25:27) Impact of proposed NIH cuts, explaining the “PBM boogeyman”, next major pharma breakthrough
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Inside the GLP-1 Gold Rush: Eli Lilly CEO on New Breakthroughs, Addiction & Mental Health, Pricing Podcast Episode Transcript (Unedited)
Speaker: 0
00:01
GLP one drugs have become increasingly popular. Eli Lilly coming to save us here.
Speaker: 1
00:06
Has had its market capitalization increase by about 860% since he became Meh, and the stock price is up a little bit more than a thousand percent.
Speaker: 0
00:18
No need for needles. Eli Lilly says it has a pill.
Speaker: 2
00:21
Eli Lilly’s experimental pill appears to work as well as the injected drug. It’s everyone’s job to move the science.
Speaker: 3
00:28
We should always be pushing ai
Speaker: 4
00:45
How are you? Hi, David. This is Dave.
Speaker: 3
00:51
Good to see you. How are you? Dave. Alright.
Speaker: 4
00:56
You wanna say thank you?
Speaker: 5
00:56
What’s happening?
Speaker: 4
00:57
What’s happening? What’s happening? What’s happening? Bob?
Speaker: 0
00:59
Dave? Ai. I don’t wanna make it awkward.
Speaker: 4
01:02
Well, we were sitting here
Speaker: 0
01:03
three years ago on this pod and Chamath was calling me a fat bastard. He wasn’t wrong. I was two hundred thirteen pounds. I’m a schwelt one hundred and seventy two ai.
Speaker: 3
01:14
Hey. Awesome.
Speaker: 0
01:16
And it’s because of what you’ve done.
Speaker: 3
01:18
Thank you.
Speaker: 0
01:19
Can I give you a hug?
Speaker: 3
01:20
You can. Yeah. Bring it in here. Bring it in here.
Speaker: 0
01:22
I ai it. Congratulations.
Speaker: 3
01:23
That’s it.
Speaker: 0
01:23
Also, Sai lost 20 pounds. So together, we’ve lost a Friedberg. Good, Sachs. Give him
Speaker: 3
01:28
a hug. Nice. Nice.
Speaker: 0
01:32
How much money are you guys printing? My lord. What do you do with it? You have bill barrels. What are you doing? Can I
Speaker: 4
01:39
ai start? Yes. Go ahead. Okay. Sorry.
Speaker: 0
01:41
I got four more jokes. I’ll get them in in the end.
Speaker: 4
01:44
I mean, you really have built one of the most incredible business in America, but you’ve done it because you took an enormous bet long time ago. Yeah.
Speaker: 3
01:53
Do you wanna talk
Speaker: 4
01:54
us through the journey and the process you had to go through and what you saw early on and, how you made the bet on this class of drug?
Speaker: 3
02:03
Yeah. Great. And thanks for having me here. I’m trying to up my cool factor. That’s what they tell me in Mid Midwest I need
Speaker: 4
02:09
to do.
Speaker: 3
02:09
Did you
Speaker: 5
02:10
get a Thomas Ford, suit as well? No.
Speaker: 3
02:12
I’m actually disappointed in the in the ai. Like, that’s I don’t know. That’s not that’s
Speaker: 4
02:17
No. You and I are
Speaker: 3
02:17
you and I are a guy wears ties.
Speaker: 0
02:19
Dave, Suitsupply does a great job. Okay. Just donate.
Speaker: 3
02:21
Okay. There we go. Just donate. Suitsupply. Okay. So, yeah. GLP one drugs, we all know about it. It feels like an overnight success, but what what happened? You know, drug development is hard and long and requires a fair amount of failure and discipline, a huge amount of capital.
Speaker: 3
02:37
Sai, actually in 02/2006, we launched the first GLP one drug. Nobody really knew the name of it. It was a twice a day injection for diabetes, but the cover of our annual report, in 2007 had a lady on it and she sai, there’s a quote. It sai, ai diabetes is under control and I’m losing a little bit of weight. So that was eighteen years ago.
Speaker: 3
02:56
I meh, and since that time, we’re now, we’ve been inventing new versions of that, solving various problems with that twice a day. We wanted to make it more convenient. We need to get the dose up and people tended to lose weight, more weight when you when you got the dose up.
Speaker: 3
03:10
And then Tirzepatide, which, you asked how much money we’re making, but in actually in q two, we reported, global saloni, which surpassed Keytruda to becoming the best selling drug in the world. Actually, the best selling drug in the world of all time in q two this year.
Speaker: 0
03:24
How much did it make in q two?
Speaker: 3
03:25
We $8,100,000,000 in revenue.
Speaker: 4
03:29
And Just a quarter?
Speaker: 3
03:30
Growing at 80%. Yeah.
Speaker: 0
03:32
And and how many people are on a GLP one globally now?
Speaker: 3
03:35
I’d estimate around 20,000,000 take prescription GLP ones. Some unknown people take non prescription. But anyway, so
Speaker: 0
03:44
That would be compounding?
Speaker: 3
03:45
Compounded or Synthetic. Yeah. Or just ai not for human use. We can talk about all that. Yeah. So anyway, 2014 comes saloni, four scientists at Lilly decided to combine GLP one with another peptide that your stomach produces when you eat that’s appetite suppressing. They made the single molecule called Tirzepatide. That’s what’s Manjaro now. But, that happened in 2014.
Speaker: 3
04:07
2016, I was named as CEO and I got a call that fall and one of our chief ai called me and said, hey, we’re we have to stop an early phase study for Tirzepatide. That’s usually a bad call. Sai, I’m ai, oh, this is the follow-up to our second gen version of the GLP one. He said, no. No.
Speaker: 3
04:25
It’s actually good good news. We were running the study in Singapore with healthy male volunteers. You can imagine what a healthy male Singaporean looks like at baseline. Yeah. Not too cut. They’re not overweight and we had to stop the study because they were losing too much weight too quickly. They’re basically not eating.
Speaker: 3
04:43
So, ai like, actually it’s good news. We can tune the dose down. We can work with this. And from there, it was kinda just just execution. We knew it was gonna be huge and we started building out supply chain, building out factories, running a massive clinical program.
Speaker: 3
05:01
We currently have over a 100 clinical studies with the medicine going on for all kinds of other uses as well, not just slowing you down.
Speaker: 4
05:08
We’re gonna go there in one sec, but I just sana go back to this. So the problem now, and maybe you can comment on this, is you have this enormous success. Yep. There is a very active gray market, particularly in China, peptide synthesis that are producing drugs that are basically the equivalent of your drug Copies. Working around copies.
Speaker: 3
05:30
Yep.
Speaker: 4
05:31
Talk to us about that. How do you deal with that? And what do you do about that? And what should people do about that? And when they encounter it?
Speaker: 3
05:38
Yeah. It’s an unusual situation. I think there’s always been counterfeit medicines. We’re not used to it in The United States because we, one, have a for most people, a pretty good system to subsidize some of the benefit via the insurance markets. So there’s not a lot of incentive to go outside the system. That’s different for these drugs because insurance quality is poor.
Speaker: 3
05:59
Most I don’t know if you bought out of your own pocket, but most people have.
Speaker: 4
06:03
And so Did you pay out of pocket?
Speaker: 0
06:04
Interestingly, when I first got it four years ago, I had this revelation when I was in Fuerte De Marmee and, I had heard Tim Ferriss talk about it on his podcast with a friend of mine, Kevin Rose, and I went to my doctor and I said, hey, I wanna get on this. He said, what is that? He said, oh, no, you don’t need that. That’s for people who are diabetic. You’re not even pre diabetic.
Speaker: 0
06:22
I said, oh, I wanna do it for
Speaker: 4
06:23
weight loss.
Speaker: 0
06:23
It’s off market. He said, I don’t know if I can do that. I said, I’m gonna get a different doctor if you don’t. And he said, let me try.
Speaker: 3
06:29
Yep.
Speaker: 0
06:30
And he got it on prescription. After I lost 20 pounds and my BMI got below 30, which ai, I mean, I don’t wanna get emotional, but I got three daughters. I wanna stick around. Yeah. And ai really changed my life incredibly. And in in many ways, I was embarrassed that I couldn’t have the discipline to do it.
Speaker: 0
06:46
And then I realized there was a food noise that I had that was constantly screaming. And once I cycled off of it for many months and now I’m on extremely low dose, the food noise and my discipline has come back. There’s something about a certain moment where you get too far over it. So now I I do have to pay. Okay.
Speaker: 0
07:02
You’ve always bought
Speaker: 3
07:03
this brand of brand of it.
Speaker: 4
07:04
Meh. You’ve always bought this brand ram
Speaker: 3
07:06
it. Yeah. Yeah.
Speaker: 0
07:06
Yeah. Ai Sai I think, you know, the the question I have for you about this big picture is there’s a lot of demand for it. It is still a bit too expensive. You’re wildly profitable. There’s gonna be a pill format. I think you’re
Speaker: 3
07:19
Yeah. That’s ours. That’s coming next year.
Speaker: 0
07:21
So is there some thinking when your, you know, head hits the pillow, hey, I’m having such a profound impact on so many people’s lives All of the diseases we have are downstream of obesity. We know that.
Speaker: 3
07:33
Yep.
Speaker: 0
07:34
This thing is helping with many other things. Do you have a moral imperative to bring this down, you know, 50% in price? I would think you that must weigh on your
Speaker: 3
07:44
conscience Yeah.
Speaker: 0
07:45
That it’s too expensive and you’re too profitable in a way, and there’s shareholders who want you to print money, but there are lives at stake here. And there’s longevity and there’s health speak. So maybe unpack that.
Speaker: 3
07:54
Yeah. We’re committed to bringing the pricing down, and I sana come back to the supply situation because that led to some of the compounding, but also affects pricing. You know, we’ve we’ve led in reducing the out of pocket cost, but from it was originally a thousand dollars. Now, it’s $4.99 from us.
Speaker: 3
08:08
We’ll push that down further with new medicines like orals.
Speaker: 0
08:11
That’s the goal for orals. Two of them.
Speaker: 3
08:13
The main goal is to get it reimbursed. Why is it we pay for ram antihypertensive drugs that the moment you stop taking them you have the same exact risk as before, but we don’t pay for anti obesity drugs. That makes no sense to me.
Speaker: 0
08:24
But what’s the number? Why do we
Speaker: 3
08:25
pay for surgeries that don’t work, but we don’t pay for these?
Speaker: 0
08:27
What’s the number on the pill? What’s the target? You can tell us.
Speaker: 3
08:30
Yeah. I don’t have a target in my mind, but lowers the direction.
Speaker: 0
08:33
Two, three hundred.
Speaker: 3
08:34
We’ve told the street speak single digit deflation in this category over time.
Speaker: 0
08:38
5% a year it goes down?
Speaker: 3
08:41
Or more. Yeah.
Speaker: 0
08:41
Or more. 10%. So you get it down for ai.
Speaker: 3
08:43
But here’s the here’s the risk, Jason. Is if if we cut the price to sai, I don’t know, a $100, there will be no more new medicines in this category.
Speaker: 0
08:51
Okay.
Speaker: 3
08:52
Because we’ll have snuffed out essentially the incentive to create the next thing.
Speaker: 0
08:56
R and D. Yeah.
Speaker: 3
08:56
So, we have to balance that. We sana create the next better medicine. We speak 25% of sales on R and D. This year, that’ll be $14,200,000,000. Wow. That has to get paid for. Of course. And we pay for it through revenue.
Speaker: 5
09:07
So so with the cash flow that the business is generating, is that how you think about capital allocation? Some percent R and D, some percent Ai assuming to CapEx and supply chain durability. Yeah. Some percent maybe to buybacks. I meh, how do you think about where the capital should be allocated?
Speaker: 5
09:21
And maybe on the R and D ai, you can tell us a little bit about diversification and and how else you think about deploying capital.
Speaker: 3
09:28
Yeah. Well, I think we’re we’ve had this totally asymmetric, success. So what do we do with it? I think one version of it is to sort of play out the cash flow game, return it to shareholders and return at some future date, remembering that in pharma, all our We have no enduring franchise.
Speaker: 3
09:43
Everything we make goes to zero because of the patent system. So, in February, Manjaro will go to zero.
Speaker: 0
09:50
Yeah.
Speaker: 3
09:50
And so, should we think about our company as one that will just return to the previous ai, send all that money back to our shareholders who took that risk over fifteen, twenty years with us and pay them back? That’s a little bit like, I don’t know how kind of Apple is running their company. Right?
Speaker: 4
10:05
Yeah.
Speaker: 3
10:05
And, that’s viable. That’s great for shareholders. Ai, at Lillie, we think about our job a little differently. We sana create a solution to some other problem people have. And, we think we’re good at that and can uniquely do it. So, we should try. We should not try to no end. That’s wasteful.
Speaker: 3
10:21
You can just bury all that money and that’s sort of the history of the industry is people have found success, wasted money. They go back to the baseline anyway, but the shareholders don’t get rewarded. That’s the Sai, we’re we’re running this experiment now. We’re betting a lot on organic arya d build out. We currently have about 4,200 PhD scientists at Lilly.
Speaker: 3
10:40
By the way, it’s about the same as MIT and Harvard combined. So the scale of the science enterprises
Speaker: 4
10:46
is huge. How ai, Dave? How do you push people on the risk spectrum? There’s a tragedy of riches that can happen because you’re so successful there’s this one drug. There could be ai some emergent scientist in your organization who wants to take a long shah, but then just doesn’t feel motivated because like, ai, it’s just like this is not gonna do anything.
Speaker: 4
11:05
Yeah. How do you get that person unlocked so that they go for the big moon shots?
Speaker: 3
11:08
You mean that their idea isn’t big enough to matter?
Speaker: 4
11:10
They think that, but they may not know. They may stumble in a different path.
Speaker: 3
11:13
I don’t think that’s our bigger problem. I think in big companies in general, and pharma companies maybe in particular, the bigger problem is people thinking they have a big idea, but having no way to advance it. Right. So I’m trying to work on that ai, which is if you think you have something that could be big, how does it become easier to advance your idea in our company versus leaving us and raising money in venture?
Speaker: 3
11:32
We can talk about venture and biotech in a second because it’s totally
Speaker: 4
11:34
Totally broken. Broken
Speaker: 3
11:35
right now. Totally broken. But, anyway, back to David’s question. So first priority, invest in organic R and D. Secondly, build out the supply chain. What’s different about, Manjaro and the follow on drugs is they’re injectable drugs. These are very capital intensive, technically difficult things to scale.
Speaker: 3
11:51
We’ve committed with President Trump, to build all that in The US. We’re currently constructing six plants. We’re gonna announce four more in the next six months. We’re hoping to be able to announce one today, but that’ll come in a few weeks. So yeah.
Speaker: 3
12:04
This is creating, 20,000 construction jobs in this period and, ultimately, five or 6,000 manufacturing jobs. And sai, we’ll become a net exporter at scale for these. And unless some Chinese state owned enterprise gets in this business, it’ll be very hard for others to build that out and follow.
Speaker: 0
12:23
Well, they’re doing it in the car business. So
Speaker: 3
12:25
Yeah. They Yeah. If they’re determined, they might. But then the final is is actually to buy external innovation where it makes sense to tuck it in. And maybe that leads us to the
Speaker: 4
12:33
ai market.
Speaker: 0
12:34
You bought
Speaker: 4
12:34
that gene therapy. Right?
Speaker: 3
12:36
Yeah. We recently bought a gene therapy company in in June. We can talk about that. But, we’re doing a bit of a deal about every two weeks. Most of them are smallish. Ai funding right now is a is a dumpster fire. Speak got to about 20,000,000,000 in new checks a year into biotech.
Speaker: 3
12:52
We’re now about 5. And Right. Just just walk
Speaker: 5
12:57
walk the audience through the dynamics. Yeah. Yeah. Ai is biotech cratered? Why is it so hard for capital to flow back in? What’s what are the dynamics that are that are that are driving this market condition right now?
Speaker: 3
13:07
There’s many factors, but the first one is competition for other venture ideas driven by the industry you guys are in. Right? So there’s just a crowd out going on with AI and other things that if it your cycle time to return is just more visible or faster Mhmm. Biotech is hard and slow. Secondly, I think too many biotechs Ai in the last decade.
Speaker: 3
13:29
And sai, the liquidity market has sort of collapsed because there’s a lot of investors deeply underwater. Half of biotech that’s publicly traded is trading at or below cash. Right. So investors look at that and sai, what’s my future here? Yeah.
Speaker: 3
13:44
Unless you can really analyze the technology and take a differentiated bet on the drugs they’re working on, I think general investors don’t sana participate in that. And then you have China, which is the other factor. Right? So China is investing heavily like they do every other state owned thing. They’re subsidizing their own companies.
Speaker: 3
14:01
They have, like, a swarm model here where they’ll subsidize many small things, really against follow on ai, betting they can execute faster than us. It’s a national priority for a long time.
Speaker: 5
14:13
Can you talk about the patent issue there? The patent and IP issue? So in The US Yeah. You know, when we make a filing and what goes on with
Speaker: 0
14:19
the fact that China
Speaker: 3
14:20
They just
Speaker: 0
14:20
don’t respect any of our IP, do they?
Speaker: 3
14:22
Well, I think right now they they are okay amongst Sai if I have a patent and I file and launch a product, I don’t see immediate copies because it’s in their interest to have a patent system right now for the reason you’re raising. So, we, changed the patent laws in The US in 02/2011, I ai, the American Invents Act, where it’s first to file. It used to be first to invent.
Speaker: 3
14:43
And all the patent litigation we had was all about whose lab notebook said January 5 versus January 4 on this invention. That was the case. Not did you file it in a reasonable time, but did you invent it first? Now, it’s first to file. So, there’s no question about who We don’t care who invented it first. It’s just who got into the patent office.
Speaker: 3
15:00
As a consequence of that, our biotech companies and big companies ai Lilly, Pfizer, etcetera, we file as soon as we can because we don’t get beat on first to file. What does that do? Sai patent exposes the invention to the world. Ai getting very good at patent hacking. So, what they do is they look at that chemical structure, they work backwards, sometimes driven by Ai, Algorithms define chemical structures that will behave similarly, but are outside the patent scope and they go fast.
Speaker: 3
15:26
Sai, they’re really quite a derivative biotech market, but that is also hurting biotech valuations in a significant way.
Speaker: 0
15:32
How old are you?
Speaker: 4
15:33
I’m 58.
Speaker: 0
15:34
You’re 58. You look great.
Speaker: 3
15:35
Thank you.
Speaker: 0
15:36
You look like 40. What do you want? What’s off the menu? You know come on. You look great.
Speaker: 4
15:44
Yep.
Speaker: 0
15:45
This you got some off the menu stuff going on. What do you got? You’re on the Wolverine.
Speaker: 4
15:48
You You want me to see one?
Speaker: 5
15:50
It’s actually it’s actually an interesting question. What is your lifestyle routine? Like, do you supplement? Is there anything
Speaker: 3
15:54
else you need to be ai? You’re Brian Johnson. Let me okay. I I follow him on on ai I’m not doing the
Speaker: 0
16:00
Brian Johnson burger. He’s the opposite of you. He looks
Speaker: 3
16:02
like he’s dying. Hey, look.
Speaker: 0
16:03
Right. You’re handsome. That guy looks like he’s turning into a stop. You know That’s a vampire.
Speaker: 3
16:08
There’s another Brian Johnson, the liver king. I don’t
Speaker: 0
16:10
know if
Speaker: 3
16:10
you ever follow me.
Speaker: 0
16:10
Yeah. Both of these guys are taking it too far, but but seriously, speak
Speaker: 3
16:14
I meh up early. I Ai work out. I read. Okay. Ai to go to bed early.
Speaker: 0
16:18
Speak is important.
Speaker: 3
16:19
Sleep. Okay. There’s like four things in life that I think really matter where there’s evidence. Sleep, eating healthy foods, mostly plants, movement and social relationships. Sai think Gotcha. Those are the things that over time get that out. You bet, too.
Speaker: 0
16:31
Ai I got a meditation app if you got a feed. I’ve tried to get me
Speaker: 3
16:34
to do that. My wife tried Have you I’ve tried yours.
Speaker: 4
16:38
Have you been motivated to try some of these drugs prophylactically?
Speaker: 3
16:41
You know, people ask me if I’ve used the GLP one drugs, used it. I haven’t, but, yet is my answer. Because what’s happening, as with all medicine technologies, you start with the sickest, the most extreme cases and you work your way as you prove safety to general use. I think what we’re seeing now with the broad benefits, everything from metabolic disease, less drinking, lower inflammation, our competitor, Nova, is gonna read out a study in a few months on dementia risk.
Speaker: 3
17:12
It probably won’t be positive. That’s my guess, but it will probably be in the right direction. So you have these sort of general, what scientists would say, pleiotropic effect, like bryden based positive things. I think we’re gonna get to a point where taking pretty low doses for most people, say over sixty, fifty eight.
Speaker: 4
17:30
Do you have
Speaker: 3
17:31
It’s not a terrible ai. It may meh help you live longer.
Speaker: 0
17:33
I just sana follow-up on this one specifically. These peptides are becoming quite the rage in the biohacking space. Have you been tracking the Wolverine protocol BPC one fifty seven and the tremendous impact people are reporting from it?
Speaker: 3
17:47
There’s lots of communities like this trying different things. We don’t ever recommend that because we live in a world of clinical studies and FDA approved.
Speaker: 0
17:55
But you watch it.
Speaker: 3
17:56
Of course. Yeah.
Speaker: 0
17:57
And what do you think of those specifically? I Are you pursuing them?
Speaker: 3
18:01
There are broad well, we’re pursuing them in the path we do, which is taking those disease states or people with the pre disease state, like pre diabetes, and then we study it and we prove an outcome. So, we did that with Manjaro and showed a ninety three percent reduction in conversion from pre diabetes to diabetes. That’s kinda how we work is like Got it.
Speaker: 3
18:19
Slicing the medical stack. These guys are coming out at the other way, which is sort of saying, I’m already healthy. Can I generally stay healthier, with small doses or other regimens, supplements? That’s not our game, but we watch it.
Speaker: 4
18:33
There’s a handful of drugs that I would say are epidemically prescribed in America. Probably at the top of the list would be SSRIs and antidepressants.
Speaker: 3
18:41
Yep.
Speaker: 4
18:42
And there’s a lot of anecdotal evidence that GLPs and this class of drug actually is quite helpful with just the psychological health of an individual. Can you talk to us about that? Like what’s ongoing? What is a readout that you think could be transformational in that space?
Speaker: 3
19:01
Yeah. Sai this is interesting. I meh, sometimes we engineer a medicine to do something like we did GLP, GIP, heaters, appetite to reduce body weight, lower blood sugar and lipids. And then, sometimes along the way, you discover an effect you didn’t predict. So, one of those is like smoking cessation.
Speaker: 3
19:17
When we started doing these studies at scale, it was immediately obvious people stopped smoking. Ai, a lot of people stopped smoking.
Speaker: 0
19:23
Also, gambling and gaming.
Speaker: 3
19:24
Gambling and online shah. All kinds of possibilities.
Speaker: 0
19:27
This is why Smot’s on it because he was stuck in the game.
Speaker: 4
19:31
Poker’s not gambling, but go on.
Speaker: 3
19:32
So anyway anyway
Speaker: 0
19:33
I was talking about craps.
Speaker: 3
19:35
So then, there have been reports and there’s a big VA study that read out and we know our veterans suffer from a lot of mental health. Yeah. And there were pretty dramatic reductions for those shah were using GLP ones who had diabetes. So, we are now, right now, starting studies in bipolar disorder and major depressive disorder along with these addictive hedonic pathways where you’re sort of self meh.
Speaker: 3
19:56
With a new GLP one, a different one that probably has a little less weight loss, but a little more brain activity. Really? So ai in for these uses. Sai, we’ll get that drug in three or four years if it works ai I think it could really change some of these terrible mental health conditions.
Speaker: 4
20:13
Well, can you take a step back maybe and jump off from SSRIs? Give us a description of the landscape of the American human health, the the Sana movement, you know, what Bobby and his team are now doing at HHS.
Speaker: 3
20:26
Yeah. Long overdue. I mean, I think the the food system in particular, Ai Sai won’t be working on this, but could be changed in a much more positive way. I think we are the least healthy metabolic big country and probably the reason for that is the food we feed ourselves.
Speaker: 0
20:43
Processed food. Chemicals.
Speaker: 3
20:44
Ai processed food, chemicals. This whole carb thing that went on for thirty years, which was has been totally debunked. And, food companies have a lot of influence and they’ve
Speaker: 5
20:55
You’re saying the anti carb?
Speaker: 3
20:56
The low carb or no carb thing? The the anti fat, high carb diets, which we were feeding people for thirty years, and I think most people don’t believe in that anymore, but it led to a big part of the obesity curve, glycemic index ai of thing. So, Ai all for all that and I think we should reform that and find ways to make quality food cheaper and more accessible for
Speaker: 0
21:18
as many people. You’re both Bobby Kennedy. You like that he’s shaking it up? It’s a big controversy.
Speaker: 3
21:21
Parts of Bobby Kennedy. I think that part, I think we we have a lot of alignment on. I worry about, I’m all for skepticism of science. That’s what scientific process is. It’s questioning and challenging. I worry about some of the stuff going on with vaccines right now, because I don’t see why we’re making the asking these questions.
Speaker: 3
21:40
But, it’s okay to ask them, but if we restrict access while we’re asking them, I worry about that. That hasn’t really affected the medicine world. We don’t make vaccines, but, at least recently we have. Let me
Speaker: 0
21:51
ask you a hard question.
Speaker: 4
21:52
Meh.
Speaker: 0
21:53
The mainstream media, in many cases, make 25, 50% of their revenue off of advertising from companies like yours.
Speaker: 3
22:03
Yes.
Speaker: 0
22:03
We allow you to advertise. Should we allow you to advertise? And have you captured that mainstream media? Is that the intent when Anderson Cooper makes double digits of his money from your firms?
Speaker: 3
22:18
Well, I would be for a system where we don’t have nearly as much drug advertising So you do. To be clear. Yeah. Yeah.
Speaker: 0
22:25
What the That’s paradoxical. How do you Then you just sana rise in full based on your reputation.
Speaker: 3
22:30
It’s like mutually assured destruction. Right? The ads annoy people. They’re poorly constructed. Why? Because of regulation built, believe it or not. If you read the regulation, 1992, FDA published a regulation on advertising built for magazine print ai. Yes. And, now we have to follow that regulation for TV advertisements, which is why you have the scrolling side effects as if they were printed on the back of the ad.
Speaker: 3
22:52
That’s literally how we’re here. So, the ads are poor. They don’t represent the patients we’re serving, etcetera. By the way, more than half of our consumer spending to reach consumers is not on TV. Does it does it work for you?
Speaker: 4
23:06
Does it move
Speaker: 0
23:06
the needle when you do a big ad buy?
Speaker: 3
23:08
There It does, unfortunately. Yeah. That’s why people keep doing it. Of course, the the productivity that is debased when your competitor does it, but then you’re Then everyone wants to go up above the
Speaker: 0
23:18
next door. President’s dilemma. Yeah.
Speaker: 3
23:20
A little bit. So, I would be for a system where that got reduced. Okay. There’s been a lot of legal actions that sai, that were fought over this through the years and it’s pretty clear under First Amendment we can do it. It’s hard to regulate. There’s been some efforts in Congress to tax it differently. I’m okay with that.
Speaker: 5
23:36
Yeah.
Speaker: 3
23:36
It doesn’t move my needle at times.
Speaker: 0
23:38
You’d rather see that money go into R and D, I would suspect.
Speaker: 3
23:40
R and D or legitimate ways to reach patients. I think consumers need to play a bigger role in their healthcare. I think that’s part of what Maha is about is a reaction to Yeah. The system hasn’t served meh. The experts haven’t served me. So, I think people need better information. It could come from us. That’s great.
Speaker: 3
23:55
I just think on TV
Speaker: 5
23:57
Shah. You’re not gonna know what what’s available off the shelf, you know, on the doctor’s shelf to you without any sort of knowledge or information.
Speaker: 3
24:03
Truth is most primary care doctors are way too busy Right. To even attend a continuing education, even know what’s happening.
Speaker: 0
24:09
So, people
Speaker: 3
24:10
need to self advocate. What do you think
Speaker: 0
24:11
people What what do you think of people using chat GPT and large language models to do their research and then they come to their doctors, sometimes with much deeper research than the doctors are aware of? Is this a plus or a minus? Do you trust it? Do you do it yourself?
Speaker: 3
24:26
I think it’s a huge plus, I would sana, and I do do it myself. I also do it just to see what the different models are producing about hard
Speaker: 4
24:33
drugs. Yeah.
Speaker: 3
24:34
It’s like an audit. But mostly it’s accurate and
Speaker: 0
24:37
Okay.
Speaker: 3
24:38
They’ve it’s gotten better over the last two years. I’d say substantially better And meh, including Google to their bryden, have a, like a way to sort of, click through and check the facts directly, which is a useful thing. They’ve served that up a little more proactively. That’s good.
Speaker: 0
24:52
Do you work directly with them?
Speaker: 3
24:53
Consumers owning their health and then for more information.
Speaker: 0
24:55
Do you work directly with them? Do you have an arm that will go to GROC, go to Gemini and sai, hey, we did these searches. Here’s some things you need to improve?
Speaker: 3
25:04
So we’ve pointed things out when there are mistakes. It does feel a little bit like we’re lobbing into a black hole, and maybe that’s a capacity issue on their end or maybe it’s sai they’re taking the point of view that our model is just trained on
Speaker: 4
25:17
The Internet.
Speaker: 3
25:18
The corpus of information. On Reddit. Yeah. Yeah. Right. And it is what it is. We don’t sana
Speaker: 4
25:23
the of intellectual Yeah.
Speaker: 3
25:26
We don’t want to own the outcome of it.
Speaker: 5
25:28
Before we run out of time, I just want to get your view on research funding in this country. The NIH budget cuts have been have been proposed. How what will the follow on effect be? Are these cuts going to be to low ROI research programs that ultimately wouldn’t have translated into the clinic and and into improving lives?
Speaker: 5
25:50
Or are you worried about NIH funding cuts and what they’re going to do to the pipeline of therapeutics in America? When will we realize the effects of that?
Speaker: 3
25:59
Yeah. Great question. I don’t think anyone knows the answers to those. It’s not obvious. Let me put it that way. No doubt that the NIH over its history has done some landmark things that no market could do, and I’m for more of that. So in mapping the human genome, a a meh project that could only be done by government and undoubtedly produced a ton of good and economic value for the country.
Speaker: 3
26:24
I think if you look at the first of all, NIH total budget is a little over $40,000,000,000. Most of that is extramural. They’re granting that to institutions in smaller checks, sometimes very small checks. I personally kinda wonder what the impact of that is it sort of a VC model where we spread a ton of bets and a few of those will bloom into giant successes, or is it just sort of filtered out without a strategy?
Speaker: 3
26:51
I I think that’s a question that should be asked, and maybe Jay is asking that. I think the other problem with the NH granting is as you do that, like any government mechanism, it gets influenced by the people who are making the grants. Who are those people? People receiving grants. Mhmm. Sai, there was a little bit of a back scratching, issue here.
Speaker: 3
27:14
And I think exposing some sunshine onto that to, you know, sort of say, what is that process? Yeah. Is it truly competitive? And is it truly pursuing ideas that the market can’t solve itself?
Speaker: 5
27:25
And should it be done bryden universities? Let me just ask you this. Are universities the right research institutions today and going forward? We’ve got two university leads tomorrow that we’re gonna have a conversation with about this topic amongst others, but what’s your view when you look around the world at how research is done, ex US, what’s the right what’s the what’s the what’s the right model?
Speaker: 5
27:45
Is this the right model?
Speaker: 3
27:46
I think probably too much that way. I’m on the board of an r one university, so I have to I’m a little biased maybe myself, but I think a lot of good things have happened in universities, but we should not exclude that to other applicants. Ai I think there could be a place for, other participants.
Speaker: 4
28:02
Dave, tomorrow we’re gonna have Mark Cuban.
Speaker: 3
28:05
Yeah. Great. And
Speaker: 4
28:06
we’re gonna talk about PBMs.
Speaker: 3
28:07
Yeah. He’s on fire.
Speaker: 4
28:09
Well one of the big boogeymen in healthcare are these PBMs.
Speaker: 0
28:13
Yeah.
Speaker: 3
28:13
Can
Speaker: 4
28:13
you just explain, you know, quickly thirty seconds, what do they do and what’s your view on whether they should even exist in American healthcare?
Speaker: 3
28:21
Probably we’re at the end of that s cycle and we should get to something else. We actually owned a PBM in the nineties. Why did they exist? Two reasons. To match up claims, so you can go into any pharmacy in the country with a card that says here’s my benefit and that benefit can be adjudicated to you.
Speaker: 3
28:36
That was a big IT problem in 1993. It’s not really a big IT problem now and there’s dozens of these so called transparent or light PBMs. Actually, our company is moving to one, often one of the ai ones because it’s in our business interest, but also their service is better.
Speaker: 3
28:51
The other thing is negotiate ai bulk discounts. So, gather up a bunch of employers or plans, go to the drug companies, get a lower deal. I think that’s fine. I’m for that too. What happened is, you know, the like any, consolidated terminal state of an industry, what’s the term, the of their service Yeah.
Speaker: 3
29:09
Is they just they just become so every every action they make is about their benefit, not the customer. And that’s what’s happened. That’s why everybody hates them. Meh.
Speaker: 0
29:19
Sacks.
Speaker: 6
29:20
GLPs ai of came out of nowhere as this big category. What if you had to guess, what do you think the next big surprise category would be that we’re not thinking about?
Speaker: 3
29:29
It’s hard to predict that, but I would say probably a brain disease. I think if you look at human suffering globally, forty percent is brain diseases, and it’s so broad we we could spend a whole panel talking about them. And what we’ve had so far has not worked, You know? When Bobby’s raising the question, why do we have so much autism? That’s a great question. What’s causing it?
Speaker: 3
29:49
Depression rates, despite the advent of and we invented Prozac, so many drugs. People are aided, but it’s not solved. We still have lots of depression in this country, and maybe it’s growing in youth. So these are huge problems as our population ages, dementia and bryden, you know, these sai I meh there, part of what we try to do is allocate capital into spaces where there are no drugs, hoping, you know, to hit hit the dartboard where there isn’t a competitor.
Speaker: 3
30:15
That’s how we got obesity drugs. We’re working on that. But it’ll be hard to it’s hard to predict.
Speaker: 4
30:20
Ladies and gentlemen, please Yeah.
Speaker: 3
30:21
Thank you. Yeah.
Speaker: 4
30:21
Take it a speak. Thanks, bro. Meh.
Speaker: 0
30:24
Great to see you.
Speaker: 4
30:24
Good. Yeah. Okay. Great.