E193: GLP-1s, AI & the End of Sick Care: The Next $10B Health Tech Giant

What if your healthcare wasn't about just treating sickness, but maximizing your potential? In today's episode on How I Invest, I spoke with Dr. Cameron Sepah, founder and CEO of Maximus, a performance medicine company pioneering a new paradigm in healthcare. Cameron previously helped build Omada Health, now a billion-dollar public company, and coined the term “digital therapeutics.” Now he's productized his unique medical expertise into a next-gen men's health platform. We talked about the evolution of performance medicine, why testosterone and GLP-1s are changing how Americans manage their health, and how AI is reshaping clinical decision-making. We also dug deep into the personal and systemic failures of the traditional healthcare model — and what the next 10 years will look like as proactive medicine goes mainstream.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00David Weisburd?

  So what is Maximus?

• 0:01Speaker 01

  It's a great question. So Maximus is a consumer healthcare technology startup that I started in 2020. We are basically an online clinic that is pioneering performance medicine, which is a whole new paradigm shift. As you know, we really don't have a healthcare system. We have a sick care system. So if you break a bone, you have an infection, you have cancer. We actually have a very high-quality healthcare system that helps sick people get better. But that is really not enabled to prevent illness and it's really not enabled to enhance quality of life and health span, which is the number of quality years that you have.

• 0:45Speaker 01

  And so performance medicine is really a new paradigm shift. A lot of people obviously know that athletes, for instance, use performance-enhancing drugs and substances in order to enhance their competitive performance in order to win. Increasingly, kind of the thesis of Maximus is that the average consumer also cares about how they perform, whether as an employee or founder of a company, whether as, you know, a father or spouse, or whether as an amateur athlete, just trying to get the most out of their gym gains. All of the protocols that we provide are not just for people who have an illness or a medical condition, but for people who can be completely healthy, essentially have no major diagnosable medical problem,

• 1:30Speaker 01

  but just want to look, feel, or perform their best.

• 1:32David Weisburd?

  And just full disclosure, I invested multiple times alongside ABC, Founders Fund, others. One of the reasons I invested in you is you're on the founding team of Omada, which has now gone public and is a billion-dollar public company. What lessons did you learn from Omada that you apply to Maximus every day?

• 1:50Speaker 01

  It's a really great question. I was privileged to be part of the founding team at Omada and I was the medical director and led clinical innovation at the company. And one of the first things that I did was to really establish Omada as a science-backed, science-based company. There's literally a video of me on Omada's website back in the day talking about how, you know, We hold ourselves to the highest gold standard of running clinical trials to prove that what we do works. And you have to remember, you know, I joined the company in like 2012. You know, online therapy was like not a thing, you know, people thought it was like this crazy concept. I come from the world of working in hospitals where I run in-person treatment programs. So Sean Duffy and I, the CEO of OMADA at the time, flew out to the CDC. We

• 2:35Speaker 01

  met the woman who ran that particular division named Dr. Anne Albright. And we said, hey, do we have to run a randomized clinical trial to prove that online therapy is as effective as in-person therapy? And she said, well, we know it's the same thing. Just prove that it's comparably efficacious, that you know, you can get the same weight loss results. And we said, all right, let's do that. So I actually published three papers for OMADA looking at, does basically an online weight loss program lead to clinically meaningful weight loss results at one year, two years, and three years, which we showed people lost about 5% of their body weight, reduced their A1C or blood sugar levels, and kept off the most of that weight for the course of three years. I was actually the first person

• 3:16Speaker 01

  to publish the term digital therapeutics in a pub peer-reviewed research paper. That became an entire field. There's literally conferences now that are dedicated to digital therapeutics, meaning using software as treatment. That really enabled OMADA to do a lot of its early enterprise sales, because I would go to my counterpart chief medical

• 3:37Speaker 01

  officers at large healthcare systems like Kaiser's or Carolinas, or to large self-insured employers like Home Depot and Lowe's. And they're like, well, how do I know this is going to help my employees or my patients? And I said, well, we have the research. We published it. Look at the data for yourself. It's as good as any other basically weight loss treatment out there, but it's incredibly convenient because you can do it all in the comfort and convenience of your own home. So that lesson was a very powerful one. And that's what really makes Maximus, I would say, different from the Hims and other telemedicine companies of the world. None of these companies publish research. They'll just put out products. You have no idea whether they work. And half the time, they don't. And I'll give you an example of this. So the GLP-

• 4:20Speaker 01

  Want medications, people probably know Ozempic or WeGubby, you've heard the brand names. There are companies out there that are selling oral versions of them. They do not work. They literally sell them as gummy bears. It's literally a crime that that it should be criminal, in my opinion, or certainly unethical or immoral. Because none of these companies are actually testing whether they work. Maximus, on the other hand, we actually run clinical trials. You can go to our website, for instance. Don't take my word on inclamiphine. There are a lot of pre-existing research studies on inclamiphine. As they were going through clinical trials, but we also published our own because we showed, for instance, the lower dosages that we pioneered and innovated on also work. Also, it works in a healthier population. So we had to do de novo or novel research to prove that.

• 5:05Speaker 01

  Same thing with the oral testosterone. We show that oral testosterone, counter to everyone's expectations, is not suppressive. It maintains fertility markers such as LH and FSH. And so you can kind of have your cake and eat it too, as I was mentioning. Obviously, the health and wellness world is full of snake oil, unfortunately, in this day and age. You have crazy people like Brian Johnson, literally scamming people as a con artist. You know, pretending that you can't die or you'll live forever, making completely unsubstantiated claims. But I think there are high integrity companies. Maximus is not the only one. But to me, if I was a consumer, I'd be like, you know, how do you, how do I know this is safe? How do I know this is effective? What is the research that has been published on this compound, this drug, this therapeutic paradigm?

• 5:47Speaker 01

  And how do you know your version of it works if you're using a different delivery system, such as an oral or topical form, a different dosage that's been done in the clinical trials? Show me the data.

• 5:58David Weisburd?

  So double click on that. Why is it that you're able to, as a startup, without hundreds of millions of dollars in funding, actually publish research? How does that work?

• 6:07Speaker 01

  It's a great question. Well, there's the publishing the research and why not go through FDA clinical trials? So testosterone is a great example. Testosterone as a, as a drug or a compound, it's been around for. Half a century, maybe a whole century. Pharmaceutical companies really can't patent something that's been around forever. It's a generic essentially. And so they're no longer kind of doing research on it unless they're developing a completely new sort of delivery system for it. And then they're trying to patent that and they're trying to protect it. Like for instance, there are companies that have been trying to do this with oral testosterone, coming up with their own special formulations. I believe there's three FDA approved forms of oral testosterone as well. But you know, from our perspective, if something has already been FDA approved, it's a known

• 6:52Speaker 01

  compound, like we understand, you know, the benefits and side effects of testosterone very well, because it's like probably close to a century of use. You know, our job is to just come up with better delivery systems or like I said, coming up with different dosage schemes or using it in healthier populations. And in that way, we can run very quick trials because the trials are not designed to go through a multi-stage FDA approval process. It's just to prove that something that we already know is safe, already know is FDA approved, can be used for a different sort of purpose. And in that way, you know, we can do this very, very lean to sort of startup speak. And in a way that's really catered to our target consumer, which is generally our younger, healthier folks who are not using it, like I said, for necessarily the treatment of

• 7:35Speaker 01

  a medical condition, but they just want to enhance themselves and they want to know that, does this work for me?

• 7:40David Weisburd?

  Last time we chatted, you told me that people are microdosing GLP-1s. I looked into this and now a very happy Maximus customer. In full disclosure, I pay full price. Tell me about GLP-1s. What is the purpose? What's the second order side effects of them? And also, why are people microdosing them?

• 7:58Speaker 01

  It's a really great parallel example to the testosterone story that I was telling you about, that back in the day, you'd only inject testosterone and you'd only inject it if you were drastically low in testosterone, because you have to be dependent on the rest of your, for the rest of your life. And so it's kind of a niche thing. Obviously with the fertility safe oral and topical forms, non-injectable forms, and also protocols that are lower dosed for healthier populations, basically.

• 8:27Speaker 01

  Any adult male that's otherwise healthy that wants to be better can take testosterone. I really think that there's going to be a similar paradigm shift with GLP-1s. If you understand the history of GLP-1s, they're originally medications that were prescribed for diabetes, which is, you know, the field that I come from at Omada. GLPs are basically glucagon-like peptide one receptor agonists, which is just a mouthful of way of saying they're medications that mimic a natural hormone to increase insulin secretion, it decreases appetite, it slows digestion, and by doing so, it promotes weight loss and better blood sugar control. So originally they were using diabetics. They noticed, hey, these guys are losing weight, we should probably use this for weight loss. And so they actually went through new FDA approvals,

• 9:12Speaker 01

  which is why literally the same drug is called Ozempic and Wegovy, which is the generic name is semaglutide or semaglutide, because it was approved for diabetes and then it was re-approved for weight loss. Now, under the sick care system that I was telling you about, it's very hard to get your insurance to cover it because these are very expensive drugs. It costs like $1,000 to $1,500 a month, which is crazy. If your insurance is not covering it fully, but if your insurance is covering it, you have to have a BMI over 30, so you have to be essentially obese. And there's some, you know, provisions if your BMI is over 27, but you have prediabetes or diabetes, they'll let you slide. You often have to go through a weight loss program like Omada to qualify for it

• 9:56Speaker 01

  because they want to prove that you've tried to lose it, you know, the old fashioned way, so to speak. Because, you know, insurance is basically in the business of denying care. They don't want to pay $1,500 a month, they can avoid it. So they're going to make you jump through a bunch of hurdles and they're going to limit it to the sickest portion of the population ever. Now, what's happened is because these drugs, the demand was so high and they weren't able to produce enough, these drugs are basically on shortage. And then the FDA basically allows compounding pharmacies to produce these drugs at lower costs, essentially as if they were generic, or if they're being used for personalized dosages. And so, let's say you're not grossly obese. You obviously, if you're half the body weight of someone who's obese,

• 10:40Speaker 01

  you may still have body fat to lose. You may have excess visceral fat that's surrounding your organs. You may have excess subcutaneous fat that you can see, obviously, if you have sort of the beer belly that guys have. And you benefit both from a health perspective and maybe even cosmetically from weight loss. And so a lot of people, obviously, in private, were going to private practices, medical spas, et cetera, who are not limited by insurance, paying cash out of pocket and using GLP-1s to lose weight. Now, these are typically people who are like overweight, but maybe not obese and wouldn't get, wouldn't qualify for their insurance. Interestingly, as a lot of these people were using GLP-1s, they noticed a lot of benefits in addition to weight loss. So for instance, a lot of people noticed improved impulse control.

• 11:24Speaker 01

  So it was improving their addictions, which is really interesting and I think emerging, but early research in terms of like psychiatric and addiction medicine. And a lot of people who had comorbid medical conditions noticed a really significant improvement in inflammation. So if they had arthritis, if they had PCOS, a lot of these inflammatory mediated conditions noticed, hey, my inflammation is lower, I have less pain, I'm a lot more mobile. And so a lot of people are using it for sort of these off-label use cases, meaning that the drugs are originally approved for diabetes and the treatment of obesity. But if you're using it to lose belly fat, you're using it to reduce inflammation, you're using it to reduce your blood sugar and improve your metabolic conditions.

• 12:05Speaker 01

  Those are sort of off-label indications, but a doctor can still, under their clinical discretion and judgment, prescribe it for those reasons. So what we did is we had a lot of, you know, clients coming to us and said, hey, I'm not, you know, overweight, but I still like to use, I still have some body fat to use, or I want to use it for these other reasons. And so we developed a microdosing protocol. So for instance, if you're BMI is at least over 22, so you're not necessarily overweight, but you still have some body fat that you'd like to use because of your, you know, central adiposity, et cetera. You can take a much lower dose. So for instance, the dose that we use of semaglutide is forty percent lower than the typical starting dose. And we're not titrating it up like you would on a typical obesity protocol.

• 12:49Speaker 01

  Because you know, those folks often get a little nauseous because the dose is so high and you have to ramp up basically every single month. If you're taking a microdose, you don't typically run into as many of the typical side effects that you do in GLP-1s, which often are nausea, as most people have heard about. Slowed gastric emptying, sometimes people get a little bit of gastrointestinal distress because obviously that's part of the way that it works. But on a very, very tiny microdose, it really helps control the food noise, as people call it, sort of those cravings for late night food and snacks. And it just helps people kind of fight the willpower battle, I would argue, in helping them make better choices. Obviously, lifestyle intervention, which is, you know, what I've done my whole career, including at Omada,

• 13:32Speaker 01

  in terms of getting people to eat right, exercise, sleep, and manage their stress, are always foundational and first line therapies. But you know, instead of this argument of, well, you should do behavior change or you should take a drug, what we find is that the combination is the most effective. The drugs help people make the necessary behavioral changes, whether with testosterone or GLP-1s. Because when you just have more energy, more drive, more motivation, better appetite control, you're not fighting this willpower battle, as I mentioned, that's just really hard, obviously, with the stressors of life. I have a very, you know, kind of radical perspective on kind of what the future of America will look like. And here it is. Number one, the majority of Americans in the next five to 10 years are going to be on a GLP-1. First of all, it's because America is so fat.

• 14:16Speaker 01

  Seventy percent of the country is overweight or obese. And so they, absolutely from a clinical perspective, that's justified. But a lot of, even the thirty percent of people who are not, I think increasingly are going to be on it. Because what's going to happen is I think GLPs are revolutionary in that people are going to take the just right personalized dose to get to their optimal state. So for instance, if you look at kind of the cross section of America now, right? You have thirty percent of people who are not overweight, about thirty-five percent of people who are overweight, about thirty-five percent of people who are obese. So about a third, a third, a third. And almost nobody's really at their optimal level of health or aesthetics.

• 14:57Speaker 01

  If you look at, if you include sort of metabolic dysregularities, including high blood sugar, high blood pressure, high cholesterol or dyslipidemia, eighty-eight percent of the country has some metabolic abnormality, meaning only twelve percent of the country is actually perfectly healthy from a metabolic perspective.

• 15:14David Weisburd?

  Are these comorbidities to being overweight, this eighty-eight percent, or are they unrelated?

• 15:19Speaker 01

  Yes, being fat makes everything else worse, as you've kind of common sense dictates. The major driver for why people, for instance, have high blood sugar is being overweight. That's why the treatment for prediabetes and diabetes, as we did at Omada, is to lose five to ten percent of your body weight. Now, obviously, there are genetic factors as well. Some people with certain racial categories and genetic predispositions can be kind of skinny fat. They're not overweight or obese, but they're still prone to diabetes. So there are multi-factors. But in America, if you look at the prevalence of, you know, diabetes hypertension, it's mostly lifestyle driven in terms of being overweight and obviously the sleep and stress that you sort of talked about. So if we start with the paradigm of like, basically only one in ten people are healthy,

• 16:03Speaker 01

  how do we get the other ninety percent of people on board? Obviously, I've spent my whole career trying to get people to change their behavior. I do think on an individual level, it's absolutely possible. All of us know people who have turned their lives around through pure willpower, coaching, therapy, and made changes. At a population-wide level of three hundred-plus million people, it has not worked. We have not made a dent. We have failed, essentially, as a medical system, as a society, public policy, et cetera. What I think is going to happen is if you offer these medications at personalized dosages, there's going to be a contingent of people who don't need them at all, right? They're the thin coastal elites, highly educated, high willpower people. Great, if you can do it without medications.

• 16:44Speaker 01

  Perfect ideal case scenario for the rest of the country, the ninety, you know, two percent of people who need some help. There, I think there's going to be some people who need it to kickstart a weight loss journey. They'll maybe take it for twelve to sixteen weeks. They'll lose the weight and they'll highly motivated. And then, once they're able to fit into their jeans or their high school dress, they won't need it for the rest of their lives. There'll be a contingent of people who they'll lose the weight. Life stress happens, you go through a divorce, you're starting to gain the weight back. You'll go back on it whenever you need it to just get back down to the ideal weight. And for the rest of the, the population, probably the majority of the population, they'll take a higher dose to get down to their ideal weight.

• 17:25Speaker 01

  And then they might need a microdose or a maintenance dose to maintain the weight loss forever. But no matter how much you need, which is zero occasional use or chronic use of the medication. I think the majority of the people who literally have at least the financial means and the psychological willingness can all get down to an ideal state of low body fat, metabolic health, um, and are looking and feeling their best. And it's really the medications that in combination with the behavior change that it's going to get us there.

• 17:55David Weisburd?

  What I observed in myself, the way that I kind of look at the GLP ones is essentially puts your body into cruise control. They kind of like take over your body and it shows to you that if you don't eat as much, you could lose weight, which sounds like the most obvious thing, except people kind of have this learned helplessness that they could never lose weight, almost like it's impossible for them specifically. But it kind of takes over your body, shows you that it's possible. And then you know, okay, if I eat once a day or I eat these types of foods, I'm going to lose weight. You reconnect yourself to cause and effect when it comes to foods and its effect on your body.

• 18:31Speaker 01

  Absolutely, and I'm, I'm really glad that you shared that sort of personal anecdote. I, I've spent my career working with people, um, and helping them lose weight. And the, the struggle is real because, you know, I actually, I, I take also kind of a little bit of a radical point of view that basically all obesity is psychologically driven. There's very few people, maybe a few percentage of people where there, there is some genetic serious medical condition that's, that's driving it. But if you look at how quickly, literally over. Two generations, the the rate of obesity has skyrocketed. You can't say that's genetic. That's an environmental illness essentially, uh, because we essentially sixty-six percent of the American diet comes from ultra-processed foods. That's really the the root cause. The problem is, we're not getting rid of it.

• 19:12Speaker 01

  People are not going to eat a hundred percent whole foods. People don't cook anymore. The lifestyles that we have, the convenience and the cost, um, you know, issues that are driving all this, you know, definitely should be addressed on a public health level. It's not gonna uh happen anytime soon in in any way that's sort of uh gonna save America. So if you're basically, you know, out in the world and you have these designer drugs, if you will, these ultra-processed foods that are constantly tempting us, you can't just sit there and shame people and say, well, just avoid avoid temptation, avoid uh addiction. Um, when essentially the majority of the country is to some degree addicted or reliant on packaged processed foods. Literally, the only time you can't be is you you can't you buy anything with a nutritional label, right?

• 19:53Speaker 01

  Anything that has a nutritional label is by definition processed, right? If you think about meats, fruits and vegetables are basically the only produce um that doesn't have a nutritional label because there's one ingredient, it's a banana, you know what it is. But uh I don't know anyone, even like the people who have a lot of um, you know, means, personal chefs that that eat nothing uh that's processed. Um, and obviously, there's there's some things that are minimally processed that can be healthy, yogurt, um, you know, et cetera, things that you theoretically could make at home. But that that world is gone, uh, except, like I said, on an individual level. But on a societal level, um, given that we have um these things that are not optimal, there has to be something that helps support choice and willpower so that we don't overeat, right?

• 20:35Speaker 01

  And fundamentally, weight loss is about a caloric balance issue. Um, you know, it's an excess calorie issue. Obviously, it's like easier said than done, though. When you have sort of emotional, psychological and environmental factors that are driving people to eat excess amounts, you know, if you can regulate your appetite, to me, that is in essentially in some way addressing the root cause. Not an environmental root cause, but individual root cause in that it helps just avoid that temptation and really help people make better choices.

• 21:02David Weisburd?

  Tell me about the research, what the research says in terms of people going on these GLP-1s and then they come off. How much of that weight do they regain? And in what cases do they regain more than they initially lost?

• 21:15Speaker 01

  Here's the fascinating thing, having been a published, you know, weight loss treatment, you know, author and researcher, if you look at any treatment for weight loss, including behavioral treatments, pharmacological treatments, the majority of the people regain the weight if they stop the treatment. But that kind of makes common sense. It's like if you ask, if you tell people, "Well, I'm going to put you on a 16-week exercise plan. Are you going to get in shape? Of course. And if you stop exercising, are you going to stay in shape? Of course not. Same thing with vitamin D. It's like if you're deficient and you get sunlight supplementation, your levels will go up. And then the last, "Well, do I need to be on this forever?" Of course you do. If you need to maintain everything in order to maintain the benefits.

• 21:57Speaker 01

  So for the majority of people, they will need to remain on medications to some degree or some dosage to maintain the weight loss gains that they have. Now, again, individual results always vary. There are lots of people that I know, even personally, that have lost the weight and have used that as a catalyst to make the behavioral changes. But I would argue they're not getting off of everything. What they've done is they've kind of used the weight loss medications to be the catalyst and then they're switching to another therapeutic, which is lifestyle slash behavioral medicine in that they've, for instance, significantly increased their protein intake, significantly decreased their refined carbohydrate intake, and that's what's maintaining them over time.

• 22:40Speaker 01

  So we should need to get out of this paradigm of, "Oh, I have to be reliant on these medications forever. It's a crutch and somehow it's a stigma or a problem to be on something forever." Like, the reality is most people should be on a vitamin D supplement for the rest of their lives. Why is that? Because we don't, we're not laborers who are outside in the sun all day. We actually did a research study where we looked at men in Los Angeles. It's sunny here. I literally go outside and tan on purpose. 66% of people were literally deficient in vitamin D. And a hundred percent were suboptimal. Our lifestyles and our modern environments are not conducive essentially to that. So yeah, you gotta take a vitamin D pill for the rest of your life if you wanna be optimal. But there's no issue with that unless you wanna radically like become, you know,

• 23:25Speaker 01

  an agrarian farmer like your ancestors. So I think the same thing with GLP ones. Like I said, if you can not take it because you've substituted it with behavioral medicine, more power to you and you should absolutely do that. But if you need to occasionally take a dose to get kinda back on the train, or you need to take a micro or maintenance dose to maintain it forever. To me, it doesn't matter. Whatever gets you to that end goal of looking, feeling your best, maintaining a six pack, maintaining optimal health, you should do that. And so to me, I leave it up to the individual patient. I'm like, hey, you wanna get off the medication? I fully support you. If you can do it, do it. And if you can't, there's nothing wrong with you. It's the same boat the majority of people in. Take the minimal effective dose, I call it the med, in order to get you to the optimal state.

• 24:08Speaker 01

  Rather than thinking about this black and white, like I'm gonna be on or off forever.

• 24:13David Weisburd?

  Most effective people that I know, they pick their battles. Some want to spend all their willpower on getting into good shape. Some wanna work, some want to spend time with their kids. In many ways, not choosing what to be bad at is a way to be bad at everything. So not choosing what to kind of outsource or what to put into autopilot hurts your ability to do other things to a high degree.

• 24:39Speaker 01

  But also, if you substitute medications for behavioral interventions, you realize how silly that logic is. It's like saying, oh, I gotta be dependent on exercise for the rest of my life in order to be healthy. Duh, and what's wrong with that? If you think about it, modern instantiations of exercise are a completely weird and foreign invention. Nobody was lifting weights at a gym. We used to just physically labor through our work. Like jogging was essentially invented by, I believe, a New Zealand coach named Arthur Litterd in the 1960s. He published a book called Jogging. And then like, nobody used to jog. Even in the 1990s, when I ran track and cross country and I was running through the neighborhood. People thought it was weird back then. Like, people thought you stole something if you were running. They're like, what are you doing, right? Like, this, people forget, we have very

• 25:24Speaker 01

  short-term memories as a society, that these, these interventions are essentially modern, you know, concoctions or inventions. But obviously, they're really healthy. There's nothing, there's nothing wrong with exercise. Probably the best health intervention, essentially, that you can do for, for anything, including the prevention of Alzheimer's and dementia in particular. But nobody thinks, oh, I'm, I'm dependent on it for the rest of my life. Of course you are. Everything needs maintenance, right? Our bodies need maintenance, whether it's through food, food supplementation, medication. I think it's a particularly male paradigm. I just want to actually point this out. This is kind of a downside of guys is, guys are obviously have this kind of rugged, American, Marlboro notion of self-reliance. I don't want to be reliant on anything, right? I should be a self-sustaining man is kind

• 26:09Speaker 01

  of the machismo paradigm. That comes from that sick care system, because back in the day, if you were on a medication, again, it means something's wrong with you. Under the maximist paradigm, where you're not taking medication because anything's wrong with you. It's because you just want to be better. You want to be more optimal. You want to be enhanced in terms of your performance. That's the great thing. A lot of our clients, literally, they go tell their friends, hey, I'm on testosterone. I, not because I particularly need it. It's because I want it, and I'm better for it, and you should look into this too. As opposed to, I think, a lot of companies out there, the traditional telemedicine companies that push a lot of erectile dysfunction and premature ejaculation medications, no one's going to want to tell their friends about that, because it means obviously there's something, there's nothing wrong with you in that particular case. As the, as the, the

• 26:53Speaker 01

  shift happens from sort of stigmatized sick care to, you know, pro-social performance medicine, I think people are going to get over the stigma of medications. And in fact, it'll, it'll be bragging rights. I'll tell you a funny anecdote. In certain Middle Eastern countries, getting a rhinoplasty or a nose job is, is not, is no longer stigmatized. In fact, people Fake getting surgeries by putting a Band-Aid on their nose to to pretend that they got the surgery because it basically means you have money, right? Or you so it's almost become a badge of honor or prestige that you have the the the, you know, the means essentially to get cosmetic surgery.

• 27:35Speaker 01

  And now you can argue whether that's a good or bad thing, but essentially it's been completely de-stigmatized and maybe even it's become prestigious. I think the same thing will happen essentially. It's happened with personal training. It doesn't just mean you're fat anymore. A lot of people are literally professional athletes that have a trainer or coach. It's a prestigious thing to have one because it also means you have the means to do so, but it also means that, you know, you're someone who prioritizes their health. I think that's happening with psychotherapy. It used to mean that you had a mental illness. Starting in the 1960s, a lot of people started doing psychotherapy for self-actualization, for personal growth. It's become a badge of honor. In fact, a lot of women on dating apps will say, I want a guy. Green flag if they're in therapy because it means that they've worked on themselves. I literally think it's the same thing with pharmacology. You're not going to be hiding it from your wife or girlfriend or your boyfriend or husband.

• 28:19Speaker 01

  You're going to be like, hey, help me inject my GLP-1s because, um, you know, I'm not going to have a dad bod or a mom bod for the rest of my life. In fact, I will maintain my weight forever. And I actually think it's going to help a lot of relationships in the long term. I do think we'll see it probably within this decade. So as I mentioned, nothing on the market right now is really efficacious orally. There is one version of semaglutide. There is an oral version actually on the market. It's not very popular. Um, I think like the benefit to side effect ratio is just not as good as the injection. And the other thing too, I just want to point out this, most people are afraid of injections who've never injected themselves. I even had this notion, I was like, I'm a healthcare practitioner. I'm not afraid of needles.

• 29:04Speaker 01

  I've got my blood drawn like literally like over a hundred times. Um, I don't have any problem with it, but I just didn't like the idea of injecting myself on a regular basis. The thing that people don't realize is unfortunately people's association with injections is getting vaccines. It's usually the only time that people get injections. It's an intramuscular injection. It's in the shoulder. It kind of goes deep. The paradigm shift is as opposed to using these big scary needles that do kind of hurt, you can use insulin needles. They're very thin, they're very small, and they're very painless. And the other thing is you don't inject it into your muscle for most of these things, including testosterone and GLP-1s, you can inject it into your subcutaneous fat. Literally, you just pinch your belly fat, you inject it right into there. I would say the pain is like a one to two out of 10.

• 29:49Speaker 01

  It really doesn't hurt. And most, most of the time when people do it, unless they literally have like a needle or blood phobia, which is rare, they get over it. It's literally exposure therapy. We know this is from psychotherapy. The idea is worse than the reality of it. And so I think most people, in fact, they don't mind it, actually. Oral GLP will be a game changer. And like I said, in the next maybe five years, probably a new one will come to the market. That's pretty efficacious and a lot of people will take it. But the injectables are really not as bad, and I think there's something for everyone. And we know this from testosterone. There's some people who just prefer the convenience of injecting once a week. That's great. We offer injectable testosterone. And there's a lot of people who are like, great, I just like the oral form. I don't like sticking myself. And I think the best paradigm is that if you offer both,

• 30:32Speaker 01

  there's going to be something for everyone, and you're going to address the largest population possible.

• 30:35David Weisburd?

  Obviously, AI is disrupting every industry. We just saw Grok 4 come out with their new LLM. For a company like Maximus in the healthcare space, how does AI change the projections and the future of your space?

• 30:52Speaker 01

  That's a great question. I'm very bullish on AI. If you kind of understand the history of AI, it was actually psychologists who pioneered artificial intelligence, you know, like 50 years ago. Because, you know, a lot of these concepts, like for instance, like a neural network is based on how the brain works. The concept of reinforcement learning is literally based on behavioral psychology. GPUs allow us to have sort of the computational horsepower to make a lot of the vision of sort of the early AI pioneers and psychologists come true. For instance, the Turing test of being able to have, you know, pass a test of, how do you tell if, you know, how you're having a conversation with a human being or a robot? And being indistinguishable essentially is passable now with chat GPT.

• 31:37Speaker 01

  So there's a couple of examples in which we use AI. So first of all, for internal research purposes, as I mentioned, like we're an R and D driven company. We repurposed essentially FDA approved drugs for novel optimization use cases. We'll we're it's very efficient as opposed to you to going into PubMed, finding research studies to to trawl the existing essentially research and very, very quickly come up with insights, pull data, help us write our research papers. Once we've collected the data, it makes the kind of the research and publication process a lot faster, which allows us to obviously innovate on a faster time scale. So that's a huge paradigm shift that's happened. The second thing is increasingly, I think AI will supplement and support doctors, not completely replace them.

• 32:23Speaker 01

  I think people still want a human being that's in charge of their health, especially when things go wrong. AIs are not perfect in handling sort of especially like emergencies, edge cases, et cetera. For instance, you know, we are the largest prescriber of inclomiphene in the United States. We have the largest database, so we know in fact what dosages tend to work. And so the doctors have kind of learned, for instance, through the art of medicine, that maybe if you're heavier to start with, you're lower testosterone to start with, you probably need a higher dose. So they're probably using maybe like a couple of different variables, looking at patients' charts and medical histories in order to decide what the initial dose is. We measure their baseline testosterone levels, we measure it again after thirty days,

• 33:07Speaker 01

  and then we look, okay, you doubled your levels, or maybe you got up to like one point five X, so you might need a little bit of a higher dose. Or maybe someone triples their levels, but they're starting to run into some side effects. Okay, maybe we need to decrease your dose. And so it usually will take two or three iterations to get people to the optimal dose through kind of trial and error, because you know, you're testing labs, you're listening to patients in terms of their symptomatic improvement, side effect response. But because we have all this data, you can train an AI model and say, okay, input all of the data that we have on this this patient, not just basic demographic variables like their weight and starting testosterone level, and then suggest the

• 33:49Speaker 01

  The dosage that is most likely to result in the optimal outcome. And they'll can suggest it to the doctor, the doctor can obviously choose to accept it or override it. So increasingly, we're gonna instantiate essentially like AI to help with dosing and dose titration. So that we can get it right, perhaps on the second iteration versus the third iteration. Right. And get people to an optimal state even faster. And then the third thing is I'm particularly excited about its use in coaching. So at Amata, I trained over one hundred and fifty health coaches, human beings, you know, nutritionists, nurses. That would provide individualized one-on-one coaching to patients. Because the social accountability, the social support are a big part. And it's obviously a lot of people, they know they need to eat last and eat better.

• 34:34Speaker 01

  But having that sort of social reinforcement is particularly effective in helping people get to those outcomes. Obviously, with, you know, GPT and conversational, you have a twenty-four seven health coach in your pocket. That is smarter, quite frankly, than most PhDs nowadays. Can anal, you know, I was talking to Google like ten years ago about can you take a picture of your food? And analyze the contents and the macronutrients and micronutrients. This is all reality nowadays, right? And so it can provide even more, more specific coaching than ever. So one example of this that we're working on right now is using visual AI to analyze people's body fat. So you can take front and side pictures or like a three dimensional scan, just literally using your phone and doing this.

• 35:17Speaker 01

  That is within two percent accuracy of a DEXA scan, which you have to go to a clinic, pay fifty to a hundred bucks. And now through AI, essentially, it can give you a very accurate assessment of your body composition, which is obviously useful if you're tracking. You know, are you gaining muscle on testosterone? Are you losing body fat on a GLP? So all of these are example use cases in which AI, I think, is going to really complement the pharmacological means. Because it'll help the coaching, it'll help the tracking, it'll help the dose titration. And just providing an ecosystem where it just makes the entire process better.

• 35:48David Weisburd?

  What diagnostic tests should a otherwise healthy male or somebody that's not obese or morbidly obese be doing? In order to optimize their health?

• 35:59Speaker 01

  It's a really great question. First of all, I actually encourage everyone to have a primary care physician. It's crazy like the percentage of people who don't have a doctor at all. I think you need a basic doctor and the the utility of I think a primary care physician that you can see in person is like literally when you're sick and you know you need to have someone like listen to your lungs, prescribe you an antibiotic if necessary, determine if an antibiotic is necessary. It's it's really important to have that. Unfortunately, a lot of people don't. I encourage people, you know, obviously use your health insurance. If not, you can kind of find people to have that. But you know, like they're not going to do performance medicine, right? They're going to just make sure that you're not sick. So take care of the foundation, take care of the fundamentals first. It's not a replacement for for basic sort of healthcare.

• 36:42Speaker 01

  Now, on top of that, the problem is like the traditional healthcare system doesn't do routine blood testing. They'll really only blood test you if you're sick. And then the crazy part is they don't test for routine things. Like I'll give you a personal example, you know, I have a family history of diabetes. My my doctor never asked to ever check my blood sugar levels, right? Even though they know they knew my family history, I had to literally ask them, I say, hey, like my dad has type two diabetes. I should know what my blood sugar levels are because I want to obviously avoid it. They're like, okay, sure. You know, but I had to literally convince them to do so. Same thing, unless you're like feel like you're dying, no one's going to check your testosterone levels, even though obviously hormonal health is fundamental to your health. So unfortunately, our sick care system and the reason for this honestly is because insurance companies don't want to pay for testing.

• 37:25Speaker 01

  They're like, unless you're falling over, you're you're, you know, deathly symptomatic, there's probably nothing wrong with you. That's obviously foolish, right? We know that like thirty seven percent of Americans are prediabetic and eighty nine percent of them don't know it because they've never tested their blood sugar levels. And similarly, a ton of people are low testosterone these days that nobody knows because nobody ever checks. And so what I tell people is like, look, get an annual physical exam from your primary care physician. You know, they should be checking your prostate, make sure you don't have testicular cancer. These are the in-person exam stuff that you need. But you can go to a company like Maximus, and there's other companies too, I don't want to just promote our own, and do an annual blood test. At the very least, every six to 12 months, you should get a blood test done.

• 38:10David Weisburd?

  We'll get right back to interview, but first, we're looking for the next great guest. If you or someone you know is a capital allocator and would make for a great guest, please reach out to me directly at [email protected].

• 38:21Speaker 01

  There's basic things. There's called a CBC, CMP, comprehensive, you know, blood count, comprehensive metabolic panel. And this measures the basic things, including your blood sugar levels, for instance. You should get that done. I do think it's helpful to get a hormone panel done. So you should be measuring your total testosterone, your SHBG. Use those things. You can calculate your free testosterone. You want to measure your LH and FSH, which are essentially your fertility markers. That's a signal from your brain to your testes to produce testosterone and sperm. Probably measure your thyroid and your lipids, so that you don't have, you know, high cholesterol and other kind of risk factors. Those are, I would say, like, a basic blood panel. A lot of times, people

• 39:06Speaker 01

  can do that through their primary care physician, but like I said, they usually won't measure all of those things. And so you can go pay out of pocket for a company like us, or there's a lot of lab testing companies. Get that done every six to 12 months and just make sure that you're obviously maintaining. And if there are problematic things, like for instance, your blood sugar is high, your testosterone is low, your vitamin D is low, that's another one, by the way, almost like I mentioned, most people aren't aware that they're vitamin D deficient or at least suboptimal. Get that measured, and then you can do an intervention. So for instance, we offer a prescription multivitamin called building blocks. It has a prescription dose of vitamin D, which is 10,000 IU's. So people are deficient, which is below 30, I believe it's nanograms per milliliter.

• 39:49Speaker 01

  Or suboptimal, which is below fifty, you know, we put people on the overwhelming majority of people get above fifty, which has been shown, by the way, to like, reduce the incidence of COVID-related death to basically zero. There's literally a paper came out that said if we gave everyone vitamin D supplementation, almost nobody would die from COVID, except for like, maybe this super, you know, immunocompromised, essentially. Yeah, that's basically the best thing to do, routine blood testing. I don't think you need to go crazy. I think there are some companies that are promoting these like, oh, you gotta test like, hundred-plus markers all the time. It's sometimes interesting to do once, maybe to see, for instance, do you have like, heavy metal toxicity if you're, I don't know, exposed to a lot of it. But most of the time, people are fine. You can test it once. I really am more of a fan of just kind of like, routine testing the basic

• 40:34Speaker 01

  things, the things that I mentioned before, and making sure that those are really dialed in, because those are the things that are most responsive to lifestyle intervention. Like, obviously, your lipids are influenced by what you eat. Your blood sugar levels are influenced by what you eat. Your hormone levels are influenced by this amount of sun exposure, your stress and your sleep. And so, these are modifiable things. The other things are a little bit exotic markers, and they're not very actionable. I've seen a lot of like, founder colleagues that pay five hundred bucks to get this humongous panel done. They're like, what do I do with this information? I don't even know what's a problem, what's not. I do think AI is helpful in helping people understand their biomarkers, but like I said, you want to really kind of measure the ones that are critical for health span and the ones that are really modifiable. One of the big paradigm shifts

• 41:16Speaker 01

  of Maximus is getting blood testing is a pain in the ass. You gotta go to a Questor LabCorp. They stick a giant needle in your arm. It's painful. It's hard to get an appointment. You gotta, or you gotta sit in the waiting room when you walk in. It is helpful to do when you do comprehensive testing, like you're measuring like, like fifty-plus markers. But if you're measuring a handful of markers, we've really innovated at-home blood testing. We use a little device, looks like a CGM. You stick it on your shoulders. It uses actually microneedle technology. It doesn't hurt, because it's not going into your veins. It's literally actually superficially, just, you know, going into your fat and drawing out capillary blood. And you can get about a half a pinkie's full of a

• 41:59Speaker 01

  Blood and obviously you can't measure a million things. We're not trying to be like Theranos here. Um, you can measure about up to about a dozen markers. So like I said, if you need to measure 50 plus, go get a traditional blood draw. But if you're just trying to measure your hormones, you can do that completely at home and you can literally mail it off. It's mailed off via next day air to a lab and it's 99% as accurate as uh being a puncture draw through Quest and LabCorp. So this has been validated. Um, it's way better than the finger test, but way better than the saliva tests that are out there in terms of its accuracy, reliability, validity. And so this is a huge paradigm shift for us as well in that.

• 42:35David Weisburd?

  Cam, I don't know if I ever told you, the reason I invested in you, because I was very excited when you started Maximus, that you essentially productized yourself. You were talking about all this and then you turned into a business. It's one of my favorite theses is. And I've seen a lot of success investing to people that productize themselves into a company. So it's uh, thank you for having me along the journey and I look forward to sitting down live soon.

• 42:57Speaker 01

  Thank you so much for your support. Uh, yeah, I mean, Maximus is is a labor of love. Like, you know, I've, I've been practicing as a clinical psychologist. Um, and as a psychiatry professor, you know, like working with CEOs and VCs, I kind of a concierge practice, like a half day a week where I have been optimizing their health and performance. It's never meant to be scalable, but Maximus essentially to your point is a scalable version of that. You know, as opposed to paying thousands of dollars to see a concierge doctor, um, how do you democratize essentially performance medicine? And that's really what we've done with Maximus. Um, and I really appreciate the support of great investors like yourself, um, in helping us realize that vision.

• 43:32David Weisburd?

  Thanks, Cam. Thanks for listening to my conversation. If you enjoyed this episode, please share with a friend. This helps us grow, also provides the very best feedback when we review the episode's analytics. Thank you for your support.