Inside the GLP-1 Gold Rush: Eli Lilly CEO on New Breakthroughs, Addiction & Mental Health, Pricing

(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 Thanks to our partners for making this happen! Solana - Solana is the high performance network powering internet capital markets, payments, and crypto applications. Connect with investors, crypto founders, and entrepreneurs at Solana's global flagship event during Abu Dhabi Finance Week & F1: https://solana.com/breakpoint OKX - The new way to build your crypto portfolio and use it in daily life. We call it the new money app. https://www.okx.com/ Google Cloud - The next generation of unicorns is building on Google Cloud's industry-leading, fully integrated AI stack: infrastructure, platform, models, agents, and data. https://cloud.google.com/ IREN - IREN AI Cloud, powered by NVIDIA GPUs, provides the scale, performance, and reliability to accelerate your AI journey. https://iren.com/ Oracle - Step into the future of enterprise productivity at Oracle AI Experience Live. https://www.oracle.com/artificial-intelligence/data-ai-events/ Circle - The America-based company behind USDC — a fully-reserved, enterprise-grade stablecoin at the core of the emerging internet financial system. https://www.circle.com/ BVNK - Building stablecoin-powered financial infrastructure that helps businesses send, store, and spend value instantly, anywhere in the world. https://www.bvnk.com/ Polymarket: https://www.polymarket.com/ Follow the besties: https://x.com/chamath https://x.com/Jason https://x.com/DavidSacks https://x.com/friedberg Follow on X: https://x.com/theallinpod Follow on Instagram: https://www.instagram.com/theallinpod Follow on TikTok: https://www.tiktok.com/@theallinpod Follow on LinkedIn: https://www.linkedin.com/company/allinpod Intro Music Credit: https://rb.gy/tppkzl https://x.com/yung_spielburg

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

• 0:01Speaker 00

  GLP-1 drugs have become increasingly popular. Eli Lilly coming to save us here.

• 0:06Speaker 01

  Has had its market capitalization increase by about 860% since he became CEO. And the stock price is up a little bit more than 1,000%.

• 0:17Speaker 02

  No need for needles, Eli Lilly says it has a pill.

• 0:21Speaker 03

  Eli Lilly's experimental pill appears to work as well as the injected drug. It's everyone's job to move the science. We should always be pushing forward.

• 0:32Speaker 03

  Ladies and gentlemen, please welcome Eli Lilly's CEO, Dave Ricks.

• 0:52Jason Calacanis?

  Good to see you. How are you? How are you? Dave? All right.

• 0:56Speaker 05

  You want to say thank you?

• 0:57Jason Calacanis?

  What's happening?

• 0:57Speaker 05

  I just want to...

• 0:58Jason Calacanis?

  What's happening?

• 0:58Speaker 05

  Want to have a good hug?

• 0:59Jason Calacanis?

  Dave? Yes? I don't want to make it awkward. But we were sitting here three years ago on this pod and Chamath was calling me a fat bastard. He wasn't wrong. I was 213 pounds. I'm a schwelt, 172 right now.

• 1:14Chamath Palihapitiya?

  Hey!

• 1:14Speaker 05

  Awesome.

• 1:16Jason Calacanis?

  And it's because of what you've done. Thank you. Can I give you a hug? You can, yeah. Bring it in here. Bring it in here. I appreciate it. Congratulations. Also, Sacks lost 20 pounds, so together we've lost a Friedberg. Let Sacks give him a hug. Come on. Nice. Nice. How much money are you guys printing? My lord.

• 1:36Jason Calacanis?

  What do you do with it? You have wheelbarrows? What do you do with all of it?

• 1:39Chamath Palihapitiya?

  Can I please start?

• 1:40Jason Calacanis?

  Yes, go ahead.

• 1:40Chamath Palihapitiya?

  Okay.

• 1:41Jason Calacanis?

  I got four more jokes. I'll get them in the end.

• 1:44Chamath Palihapitiya?

  I mean, you really have built one of the most incredible businesses in America, but you've done it because you took an enormous bet a long time ago.

• 1:52Jason Calacanis?

  Yeah.

• 1:54Chamath Palihapitiya?

  Do you want to talk 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?

• 2:03Speaker 07

  Yeah, great, and thanks for having me here. I'm trying to up my cool factor. That's what they tell me in the Midwest I need to do. Did you get a Tomas Ford suit as well? No, I'm actually disappointed in the ties. Like, I don't know, that's not... No, you and I are similar. Former guy wears ties.

• 2:19Chamath Palihapitiya?

  Dave, Suit Supply does a great job. Just own it.

• 2:21Speaker 07

  Okay, there we go, just own it. Okay, so yeah, GLP-1 drugs, we all know about it. It feels like an overnight success, but what happened? You know, drug development is hard and long, and requires a fair amount of failure and discipline, a huge amount of capital. So, actually in 2006, we launched the first GLP-1 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 said, there's a quote, it says, "My diabetes is under control and I'm losing a little bit of weight." So that was 18 years ago. I mean, 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.

• 3:05Speaker 07

  Needed to get the dose up, and people tended to lose weight, more weight when you got the dose up. And then Terzepatide, which you ask how much money we're making, but actually in Q2, we reported global sales, which surpassed Keytruda to becoming the best-selling drug in the world, actually the best-selling drug in the world of all time. In Q2 this year...

• 3:24Chamath Palihapitiya?

  How much did it make in Q2?

• 3:25Speaker 07

  Eight point one billion dollars in revenue. And growing at 80%.

• 3:31Chamath Palihapitiya?

  And how many people are on a GLP-1 globally now?

• 3:35Speaker 07

  I'd estimate around 20 million take prescription GLP-1s. Some unknown amount of people take non-prescription. But anyway, so...

• 3:44Chamath Palihapitiya?

  That would be compounding?

• 3:45Speaker 07

  Compounded, or... Synthetic? Yeah, or just like not for human use. We can talk about all that, yeah. So anyway, 2014 comes along, four scientists at Lilly decided to combine GLP-1 with another peptide that your stomach produces when you eat that's appetite suppressing. They made the single molecule called Terzepatide. That's what's Monjaro now. But that happened in 2014. 2016, I was named the CEO and I got a call that fall and one of our chief scientists called me and said, hey, we have to stop an early phase study for Terzepatide. That's usually a bad call. So I'm like, oh, like this is the follow up to our second gen version of the GLP-1. He said, no, no, it's actually good, good news. We were running this study in Singapore with healthy male volunteers.

• 4:30Speaker 07

  You can imagine what a healthy male Singaporean looks like at baseline, right?

• 4:35Chamath Palihapitiya?

  Not takeout.

• 4:36Speaker 07

  They're not overweight. And we had to stop the study because they were losing too much weight too quickly. They were basically not eating. So scientists like, actually, it's good news. We can tune the dose down. We can work with this. And from there, it was kind of just, just execution. We knew it was going to be huge. And we started building out supply chain, building out factories, running a massive clinical program. We currently have over 100 clinical studies with the medicine going on for all kinds of other uses as well, not just slowing you down.

• 5:08Chamath Palihapitiya?

  We're going to go there in one sec, but I just want to go back to this. So the problem now, and maybe you can comment on this, is you have this enormous success.

• 5:17Speaker 07

  Yep.

• 5:18Chamath Palihapitiya?

  There is a very active gray market, particularly in China, peptide synthesis that are producing drugs that are basically the equivalent of your drug, working around copies.

• 5:30Speaker 07

  Yep.

• 5:31Chamath Palihapitiya?

  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?

• 5:37Speaker 07

  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. Most of you bought out of your own pocket, but most people have.

• 6:03Jason Calacanis?

  Did you pay out of pocket? Interestingly, when I first got it four years ago, I had this revelation when I was in Forte de Marme 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 want to 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 prediabetic." I said, "No, I want to do it for weight loss. It's off-market." He said, "I don't know if I can do that. I said, "I'm going to get a different doctor if you don't." And he said, "Let me try."

• 6:29Speaker 07

  Yep.

• 6:30Jason Calacanis?

  And he got it on prescription. After I lost 20 pounds and my BMI got below 30, which really, I mean, I don't want to get emotional, but I got three daughters. I want to stick around.

• 6:38Speaker 07

  Yeah, absolutely.

• 6:39Jason Calacanis?

  And it really changed my life incredibly. And in many ways, I was embarrassed that I couldn't have the discipline to do it. 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 do have to pay for it. But have you always bought Dave's branded drug? Yes. You've always bought his branded drug? Yeah. Yeah. And I think, you know, 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. This is going to be a pill format. I think you're...

• 7:19Speaker 07

  Yeah, that's ours. That's coming next year.

• 7:21Jason Calacanis?

  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, that all of the diseases we have are downstream of obesity. We know that."

• 7:33Speaker 07

  Yep.

• 7:34Jason Calacanis?

  "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 that must weigh on your conscience that it's too expensive and you're too profitable in a way, and there are shareholders who want you to print money, but there are lives at stake here, and there's longevity and there's health spend. So maybe unpack that.

• 7:54Speaker 07

  Yeah, we're committed to bringing the pricing down and I want to come back to the supply situation because that led to some of the compounding, but also affects pricing. You know, we've led in reducing the out-of-pocket costs, but from, it was originally a thousand dollars, now it's $4.99 from us. We'll push that down further with new medicines like orals.

• 8:11Jason Calacanis?

  What's the goal for orals?

• 8:13Speaker 07

  The main goal is to get it reimbursed. Why is it we pay for 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.

• 8:24Jason Calacanis?

  But what's the number?

• 8:24Speaker 07

  Why do we pay for surgeries that don't work, but we don't pay for these?

• 8:27Jason Calacanis?

  What's the number on the pill? What's the target? You can tell us.

• 8:29Speaker 07

  Yeah, I don't have a target in my mind, but lower is the direction.

• 8:33Jason Calacanis?

  Two, three hundred?

• 8:33Speaker 07

  We've told the street, expect single-digit deflation in this category over time.

• 8:38Jason Calacanis?

  Five percent a year it goes down?

• 8:40Speaker 07

  Or more, yeah.

• 8:41Jason Calacanis?

  Or more, 10 percent, so you get it down from 500 to 550?

• 8:44Speaker 07

  But here's the risk, Jason, is if we cut the price to, say, I don't know, a hundred dollars, there will be no more new medicines in this category.

• 8:51Jason Calacanis?

  Okay.

• 8:52Speaker 07

  Because we'll have snuffed out essentially the incentive to create the next thing.

• 8:56Jason Calacanis?

  R and D.

• 8:56Speaker 07

  So we have to balance it. We want to create the next better medicine. We spent 25 percent of sales on R and D. This year, that'll be 14.2 billion dollars.

• 9:04Jason Calacanis?

  Wow.

• 9:04Speaker 07

  That has to get paid for.

• 9:05Jason Calacanis?

  Of course.

• 9:06Speaker 07

  And we pay for it through revenue.

• 9:07David Friedberg?

  So with the cash flow that the business is generating, is that how you think about capital allocation? Some percent to R and D, some percent, I'm assuming, to CapEx and supply chain durability?

• 9:17Speaker 07

  Yeah.

• 9:17David Friedberg?

  Some percent maybe to buybacks? I mean, how do you think about where the capital should be allocated? And maybe on the R and D side, you can tell us a little bit about diversification and how else you think about deploying capital?

• 9:27Speaker 07

  Yeah, well, I think 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, we have no enduring franchise. Everything we make goes to zero because of the patent system. So in 2030-something, Manjaro will go to zero.

• 9:50Jason Calacanis?

  Yeah.

• 9:50Speaker 07

  And so should we think about our company as one that will just return to the previous baseline, send all that money back to our shareholders who took that risk over 15, 20 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?

• 10:05Jason Calacanis?

  Yeah.

• 10:05Speaker 07

  And that's viable, that's great for shareholders. And literally, we think about our job a little differently. We want to 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. 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, so we're, we're running this experiment now. We're betting a lot on organic R and D build out. We currently have about 4,200 PhD scientists at Lilly. By the way, it's about the same as MIT and Harvard combined. So the scale of the science enterprise is huge.

• 10:47Chamath Palihapitiya?

  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 like some emergent scientist in your organization who wants to take a long shot, but then just doesn't feel motivated because like, oh, it's just like, this is not going to do anything.

• 11:04Speaker 07

  Yeah.

• 11:05Chamath Palihapitiya?

  How do you get that person unlocked so that they go for the big moonshot?

• 11:08Speaker 07

  You mean that their idea isn't big enough to matter?

• 11:10Chamath Palihapitiya?

  They think that, but they may not know. They may stumble in a different path.

• 11:13Speaker 07

  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.

• 11:22Chamath Palihapitiya?

  Right.

• 11:23Speaker 07

  So I'm trying to work on that side, 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 and venture? We can talk about venture and biotech in a second because it's totally

• 11:35Chamath Palihapitiya?

  Totally broken.

• 11:35Speaker 07

  Broken right now. 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 Monjaro and the follow-on drugs is they're injectable drugs. These are very capital intensive, technically difficult things to scale. We've committed with President Trump to build all that in the US. We're currently constructing six plants. We're going to 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, this is creating 20,000 construction jobs in this period and ultimately five or 6,000 manufacturing jobs. And so we'll become a net exporter at scale for these. And unless some Chinese state-owned enterprise gets in this business,

• 12:20Speaker 07

  it'll be very hard for others to build that out and follow.

• 12:23Chamath Palihapitiya?

  Well, they're doing it in the car business, so.

• 12:24Speaker 07

  Yeah, they, 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 biotech markets.

• 12:34Chamath Palihapitiya?

  Verve, you just bought Verve, you bought that gene therapy, right?

• 12:36Speaker 07

  Yeah, we recently bought a gene therapy company in June, we can talk about that. But we're doing a deal about every two weeks. Most of them are smallish. Biotech funding right now is a dumpster fire. Peak got to about 20 billion in new checks a year into biotech. We're now around five.

• 12:54David Friedberg?

  Just walk the audience through the dynamics. Why is biotech cratered? Why is it so hard for capital to flow back in? What are the dynamics that are driving this market condition right now?

• 13:07Speaker 07

  I think it'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 your cycle time to return is just more visible or faster, biotech is hard and slow. Secondly, I think too many biotechs IPO'd in the last decade. And so 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. So investors look at that and say, what's my future here? Unless you can really analyze the technology and take a differentiated bet on the drugs

• 13:49Speaker 07

  they're working on, I think general investors don't want to 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. They have like a swarm model here where they'll subsidize many small things, really against follow-on ideas, betting they can execute faster than us. It's a national priority for a long time.

• 14:13David Friedberg?

  Can you talk about the patent issue there? The patent and IP issue? So in the US, you know, when we make a filing and what goes on with respect to China? They just don't respect any of our IP, do they?

• 14:22Speaker 07

  Well, I think right now, they are okay amongst... So 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 2011, I think, the American Events Act, where it's first to file. It used to be first to invent. And all the patent litigation we had was all about whose lab notebook said January 5th versus January 4th 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. As a consequence of that, our biotech companies, and big companies like Lilly, Pfizer, etc., we file as soon as we can because we don't get beat on first

• 15:07Speaker 07

  to file. What does that do? A patent exposes the invention to the world. China's 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 to find chemical structures that will behave similarly but are outside the patent scope, and they go fast. So they're really quite a derivative biotech market, but that is also hurting biotech valuations in a significant way.

• 15:32Jason Calacanis?

  Dave, how old are you?

• 15:33Speaker 07

  I'm 58.

• 15:34Jason Calacanis?

  You're 58. You look great.

• 15:35Speaker 07

  Thank you.

• 15:36Jason Calacanis?

  You look like 40. What do you want?

• 15:38Speaker 07

  Are you hitting on me?

• 15:39Jason Calacanis?

  What's off the menu?

• 15:40Speaker 07

  (laughing)

• 15:41Jason Calacanis?

  Dave, come on. You look great. You've got some off-the-menu stuff going on. What do you got? You're on the Wolverine?

• 15:48Speaker 07

  I think you...

• 15:49Jason Calacanis?

  Are you on BBC 157?

• 15:51David Friedberg?

  It's actually an interesting question. What is your lifestyle routine? Do you supplement? Is there anything else?

• 15:55Speaker 07

  I know you have Brian Johnson coming. Okay, I follow him on X. I'm not doing the Brian Johnson program.

• 16:00Jason Calacanis?

  He's the opposite of you. He looks like he's dying. You're handsome. That guy looks like he's turning into a stot.

• 16:06Speaker 07

  You know...

• 16:07Jason Calacanis?

  That's a vampire.

• 16:08Speaker 07

  There's another Brian Johnson, the Liver King. I don't know if you've ever followed him.

• 16:11Jason Calacanis?

  Yeah, both of these guys have taken it too far. But, seriously, BBC 157?

• 16:14Speaker 07

  I get up early, I work out, I read, try to go to bed early.

• 16:18Jason Calacanis?

  Sleep is important.

• 16:19Speaker 07

  Sleep, okay. There's like four things in life that I think really matter. There was evidence. Sleep, eating healthy foods, mostly plants, movement, and social relationships. I think those are the things that, over time...

• 16:30Jason Calacanis?

  You meditate? Because I got a meditation app. If you've got a B-nut, you can throw in.

• 16:34Speaker 07

  My wife tried to get me to do that. I... My wife tried to... I haven't tried yours.

• 16:38Jason Calacanis?

  Have you been motivated to try some of these drugs prophylactically?

• 16:41Speaker 07

  You know, people ask me if I've used the GLP-1 drugs. I haven't, but...

• 16:47Speaker 07

  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 Novo is going to read out a study in a few months on dementia risk. 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 broad-based positive things. I think we're going to get to a point where taking pretty low doses for most people, say

• 17:28Speaker 07

  over 60, 58, is not a terrible idea and may help you live longer.

• 17:33Chamath Palihapitiya?

  I just want to follow up on this one specifically. These peptides are becoming quite the rage in the biohacking space. Have you been tracking the Wolverine Protocol, BPC157, and the tremendous impact people are reporting from it?

• 17:48Speaker 07

  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 approvals.

• 17:55Chamath Palihapitiya?

  But you watch it.

• 17:56Speaker 07

  Of course, yeah.

• 17:57Chamath Palihapitiya?

  And what do you think of those specifically?

• 17:59Speaker 07

  I...

• 18:00Chamath Palihapitiya?

  Are you pursuing them?

• 18:01Speaker 07

  As I'm saying, 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 Monjaro and showed a 93% reduction in conversion from pre-diabetes to diabetes. That's kind of how we work, is like slicing the medical stack. These guys are coming at it 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.

• 18:33Chamath Palihapitiya?

  There's a handful of drugs that I would say are epidemiically prescribed in America. Probably at the top of the list would be SSRIs and antidepressants. 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?

• 19:01Speaker 07

  Yeah, so this is interesting. I mean, sometimes we engineer medicine to do something like we did GLP-GIP, tirzepatide, 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. When we started doing these studies at scale, it was immediately obvious, people stopped smoking. Like, a lot of people stopped smoking.

• 19:23Chamath Palihapitiya?

  Also gambling.

• 19:24Speaker 07

  Gambling and online shopping, all kinds of positive benefits.

• 19:27Chamath Palihapitiya?

  This is why Chamath's on it, because he was stuck in the game. Poker's not gambling, but go on.

• 19:33Speaker 07

  So anyway.

• 19:34Chamath Palihapitiya?

  I was talking about craps.

• 19:35Speaker 07

  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 that were using GLP-1s 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-medicating, with a new GLP-1, a different one, that probably, that has a little less weight loss, but a little more brain activity.

• 20:04Chamath Palihapitiya?

  Really?

• 20:05Speaker 07

  So dialed in for these uses. So we'll get that drug in three or four years if it works. And I think it could really change some of these terrible mental health conditions.

• 20:13Chamath Palihapitiya?

  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 Maha movement, you know, what Bobby and his team are now doing at HHS?

• 20:26Speaker 07

  Yeah, long overdue. I mean, I think the, the food system in particular, I'm, I'm working on this, but it could be changed in a much more positive way. I think we are the, the least healthy metabolic big country, and probably the reason for that is the food we feed ourselves.

• 20:43Chamath Palihapitiya?

  Processed food, chemicals.

• 20:44Speaker 07

  Highly processed food, chemicals, this whole carb thing that went on for 30 years, which was, has been totally debunked. And food companies have a lot of influence and they've... You're saying the anti-carb, the low carb or no carb thing? The anti-fat, high-carb diets, which we were feeding people for 30 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 kind of thing. So I'm all for all that. And I think we should reform that and find ways to make quality food cheaper and more accessible for as many people.

• 21:18Jason Calacanis?

  You're pro Bobby Kennedy. You like that he's shaking it up. It's a big controversy.

• 21:21Speaker 07

  Parts of Bobby Kennedy. I think that part, I think we have a lot of alignment on. I worry about, I'm all for skepticism of science. That's what scientific process is, is 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, asking these questions. 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.

• 21:51Jason Calacanis?

  Let me ask you a hard question.

• 21:52Speaker 07

  Yeah.

• 21:53Jason Calacanis?

  The mainstream media, in many cases, make 25, 50% of their revenue off of advertising from companies like yours.

• 22:03Speaker 07

  Yes.

• 22:03Jason Calacanis?

  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?

• 22:17Speaker 07

  Well, I would be for a system where we don't have nearly as much drug advertising.

• 22:23Jason Calacanis?

  So you would?

• 22:24Speaker 07

  Yeah, yeah.

• 22:25Jason Calacanis?

  That's paradoxical. How do you, then you just want to rise and fall based on your reputation?

• 22:30Speaker 07

  It's like mutually assured destruction, right? The ads annoy people. They're poorly constructed. Why? Because of a regulation built, believe it or not. If you read the regulation, 1992, FDA published a regulation on advertising, built for magazine print advertisements.

• 22:44Jason Calacanis?

  Yes.

• 22:45Speaker 07

  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. That's literally how we're here. So the ads are poor. They don't represent the patients we're serving, et cetera. By the way, more than half of our consumer spending to reach consumers is not on TV.

• 23:04Jason Calacanis?

  Does it even work for you? Does it move the needle when you do a big ad buy?

• 23:08Speaker 07

  There it does, unfortunately. And that's why people keep doing it. Of course, the productivity that is debased when your competitor does it. But then you're then everyone wants to go up above the next one.

• 23:19Jason Calacanis?

  Prisoner's dilemma, yeah.

• 23:20Speaker 07

  A little bit. So I would be for a system where that got reduced.

• 23:24Jason Calacanis?

  Okay.

• 23:24Speaker 07

  There's been a lot of legal actions that said 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.

• 23:36Jason Calacanis?

  Yeah.

• 23:36Speaker 07

  It doesn't move my needle a ton.

• 23:38Jason Calacanis?

  You'd rather see that money go into R and D, I would suspect.

• 23:40Speaker 07

  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

• 23:47Jason Calacanis?

  Yeah.

• 23:47Speaker 07

  the system hasn't served me. The experts haven't served me. So I think people need better information. It could come from us. That's great. I just think on TV probably.

• 23:57David Friedberg?

  Yeah, you're not gonna know what what's available off the shelf, you know, on the doctor's shelf of to you without any sort of knowledge or information.

• 24:03Speaker 07

  And the truth is, most primary care doctors are way too busy.

• 24:06Jason Calacanis?

  Right.

• 24:06Speaker 07

  to even attend a continuing education, even know what's happening.

• 24:10Jason Calacanis?

  What do you think of people? What do you think of people using ChatGPT and large language models to do their research? And then they come to their doctors, sometimes with much deeper research than the doctor's aware of. Is this a plus or a minus? Do you trust it? Do you do it yourself?

• 24:26Speaker 07

  I think it's a huge plus, I would say. And I do do it myself. I also do it just to see what the different models are producing about our drugs.

• 24:34Jason Calacanis?

  Yeah.

• 24:34Speaker 07

  It's like an audit. But mostly it's accurate. And they've it's gotten better over the last two years. I'd say substantially better. And many, including Google to their credit, 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.

• 24:52Jason Calacanis?

  Do you work directly with them?

• 24:53Speaker 07

  I'm for consumers owning their health and for more information.

• 24:56Jason Calacanis?

  Do you work directly with them? Do you have an arm that will go to Grok, go to Gemini and say, hey, we did these searches. Here's some things you need to improve.

• 25:04Speaker 07

  So we've pointed things out when there are mistakes. It does feel a little bit like we're lobbying into a black hole. And maybe that's a capacity issue on their end, or maybe it's a, they're taking the point of view that our model's just trained on

• 25:17Chamath Palihapitiya?

  The internet.

• 25:18Speaker 07

  The corpus of information.

• 25:19Chamath Palihapitiya?

  On Reddit.

• 25:20Speaker 07

  Yeah, right. And it is what it is. We don't want to

• 25:23Chamath Palihapitiya?

  The bastion of intellectual

• 25:24Speaker 07

  That's right.

• 25:25Chamath Palihapitiya?

  Thought.

• 25:26Speaker 07

  Yeah. We don't want to own the outcome of it.

• 25:27David Friedberg?

  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 proposed. 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 into improving lives? 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?

• 25:59Speaker 07

  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. Mapping the human genome, a mega project that could only be done by government and undoubtedly produced a ton of good and economic value for the country. I think if you look at the, first of all, NIH total budget's a little over $40 billion. Most of that is extramural. They're granting that to institutions in smaller checks, sometimes very small checks. I personally

• 26:39Speaker 07

  kind of 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? I think that's a question that should be asked, and maybe Jay's asking that. I think the other problem with the NIH 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. So, there was a little bit of a back scratching issue here. And I think exposing some sunshine onto that to, you know, sort of say, what is that process? Yeah. Is it truly competitive?

• 27:21Speaker 07

  And is it truly pursuing ideas that the market can't solve itself?

• 27:25David Friedberg?

  And should it be done at 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 going to 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 model? Is this the right model?

• 27:47Speaker 07

  Probably too much that way. I'm on the board of an R1 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. I think there could be a place for other participants.

• 28:02Chamath Palihapitiya?

  Dave, tomorrow, we're going to have Mark Cuban.

• 28:05Speaker 07

  Yeah, great.

• 28:06Chamath Palihapitiya?

  And we're going to talk about PBMs.

• 28:07Speaker 07

  Yeah.

• 28:08Chamath Palihapitiya?

  And one of the big...

• 28:09Speaker 07

  He's on fire.

• 28:10Chamath Palihapitiya?

  Well, one of the big boogeymen in healthcare are these PBMs.

• 28:13Speaker 07

  Yeah.

• 28:13Chamath Palihapitiya?

  Can you just explain, you know, quickly 30 seconds? What do they do? And what's your view on whether they should even exist in American healthcare?

• 28:21Speaker 07

  Probably we're at the end of that S cycle and we should get to something else. We actually owned a PBM in the 90s. Why do 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. 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. Off of one of the mainline ones because it's in our business interest, but also their service is better. The other thing is negotiate like 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...

• 29:02Speaker 07

  You know, the, like any consolidated terminal state of an industry, what's the term? The in-ification of their service 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.

• 29:18Speaker 09

  Yep.

• 29:19Speaker 07

  Sacks.

• 29:20Speaker 09

  GLP's kind of came out of nowhere as this big category. If you had to guess, what do you think the next big surprise category would be that we're not thinking about?

• 29:29Speaker 07

  It's hard to predict that, but I would say probably a brain disease. I think if you look at human suffering globally, 40% is brain diseases and it's so broad, 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? 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 brain, you know, these. So I'd bet there, part of what we try to do is allocate capital into spaces where there

• 30:09Speaker 07

  are no drugs, hoping, you know, to hit, hit the dartboard where there isn't a competitor. That's how we got obesity drugs. We're working on that, but it'll be hard to, it's hard to predict. Ladies and gentlemen, please. Yeah, thank you. David Reis. David Reis. Thanks, bro. Great to see you. Yeah. I'll be right back. Thanks, David. Yeah. Thanks, David. Yeah. Congratulations, my man. I appreciate you. I appreciate you.