All-In with Chamath, Jason, Sacks & Friedberg - Inside the GLP-1 Gold Rush: Eli Lilly CEO on New Breakthroughs, Addiction & Mental Health, Pricing

Episode Date: September 29, 2025

(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

GLP-1 drugs have become increasingly popular. Eli Lilly coming to save us here. It has had its market capitalization increase by about 860% since he became CEO. And the stock price is up a little bit more than a thousand percent. No need for needles, Eli Lilly says it has a pill. 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.

Ladies and gentlemen, please welcome. Eli Lilly's CEO Dave Ricks. How are you? Hi, David. Good to you. How are you? What do you want to do you want to make it awkward? We were sitting here three years ago on this pod,

and Chimoth was calling me a fat bastard. He wasn't wrong. I was 213 pounds. I'm a Schfeldt 172. Hey. Awesome. And it's because of what you've done. Thank you.

Can I give you a hug? You can, yeah. Bring it in here. I appreciate it. Congratulations. Also, Sacks lost 20 pounds, so together we've lost a Friedberg. That's a hug. Come on.

Nice. Nice. How much money are you guys printing? My lord. What do you do with it? You have real barrels? What are you doing with all of this? Can I please start?

Yes, go ahead. I got four more jokes. I'll get him in the end. I mean, you really have Bill one of the most incredible business in America, but you've done it because you took an enormous bet a long time ago. Yeah. Do you want to talk us through the journey and the process?

process you had to go through and what you saw early on and how you made the bet on this class of drug. 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 tie. I don't know. That's not, you and I are you and I are a guy wears Thai. Dave, suit supply does a great job. Okay. Just donate. Okay. So yeah, GLP1 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 GLP1 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, I had a lady on it. She said, there's a quote, it says, oh, 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, needed to get the dose up, and people tended to lose weight, more weight when you got the dose up. And then terseptide, which you asked how much money we're making, but actually in Q2 we reported global sales, which surpassed Ketruda to becoming the best-selling drug in the world,

actually the best-selling drug in the world of all time in Q2 this year. How much did it make in Q2? $8.1 billion in revenue, and growing at 80%. And how many people are on a GLP1 globally now? I'd estimate around 20 million take prescription GLP1s. Some unknown amount of people take non-prescription. But anyway, so. That would be compounding?

Compounded or synthetic. Yeah, or just like not for human use. We can talk about all that. So anyway, 2014 comes along. four scientists that Lilly decided to combine GLP1 with another peptide that your stomach produces when you eat that's appetite suppressing.

They made the single molecule called terseptide. That's what's Monjaro now. But that happened in 2014. 2016, I was named a 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-faced study for tersepetide. That's usually a bad call. So I'm like, oh, shit. This is the follow-up to our second-gen version of the GOP-1. He said, no, no, it's actually good news. We were running the study in Singapore with healthy male volunteers. You can imagine what a healthy male Singaporean looks like at baseline. Yeah, not Jacob. 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 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 a hundred clinical studies with the medicine going on for all kinds of other uses as well, not just slimming you down. 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. Yeah.

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. Talk to us about that. How do you deal with that? And what do you do about that? And what do you do about that? And when they encounter it. 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 of the 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 I don't if you bought out of your own pocket but most people have and so did you pay out of pocket there's 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 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 pre-diabetic. 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. Yeah. 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. Yeah, absolutely. And I 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 kind of a reset for you. Yes. You've always bought his brand of drug. Yeah. Yeah. And I think you know the the question I have for you about this big picture is there's a lot of demand for it. It is still a bit too expensive. You're a lot of money. It's still a bit too expensive. wildly profitable. This is going to be a pill format. I think you're... Yeah, that's ours. That's your coming next year. So is there some thinking when your, you know, head hits the pillow, hey, I'm having such a profound impact on so many people's

lives. All of the diseases we have are downstream of obesity. We know that. This thing is helping with many other things. Do you have a moral imperative to bring this down, you know, 50% in price? I would think you, that must weigh on your conscience that it's too expensive. and you're too profitable in a way, and there's shareholders who want you to print money, but there are lives at stake here, and there's longevity, and there's health spend. So maybe unpack that.

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 cost from it was originally $1,000, now it's $4.99 from us. We'll push that down further with new medicines like oral. What's the goal for orals?

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-obicity drugs? That makes no sense to me. But what's the number? Why do we pay for surgeries that don't work, but we don't pay for these? What's the number on the pill? What's the target?

You can tell us. Yeah, I don't have a target in my mind, but lowers the direction. Two, 300? We've told the street expect single-digit deflation in this category over time. 5% a year it goes down? Or more, yeah. Or more, 10%, so you get it down from 500, 450. But here's the risk, Jason, is if we cut the price to, say, I don't know, $100,

there will be no more new medicines in this category. Okay. Because we'll have snuffed out, essentially, the incentive to create the next thing. R&D, yeah. So we have to balance that. We want to create the next better medicine. We spend 25% of sales on R&D. This year, that'll be $14.2 billion.

Wow. That has to get paid for. Of course. And we pay for it through revenue. So with the cash flow that the business is generating, is that how you think about capital allocation, some percent R&D, some percent, I'm assuming to CAP-X and supply chain durability. Some percent, maybe to buybacks.

I mean, how do you think about where the capital should be allocated? And maybe on the R&D side, you can tell us a little bit about diversification and how else you think about deploying capital. 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 to shareholders, and return at some future date, remembering that in pharma, we have no enduring,

Everything we make goes to zero because of the patent system. So in 20-30 something, Manjaro will go to zero. Yeah. 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? Yeah. And that's viable.

That's great for shareholders. And literally, we think about our job a little differently. 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, as people have found success. Wasted money. They go back to the baseline anyway, but the shareholders don't get rewarded. So we're running this experiment now. We're betting a lot on organic R&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 enterprises is huge.

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 it's just like, this is not going to do anything. How do you get that person unlocked so that they go for the big moonshots?

You mean that their idea isn't big enough to matter? They think that, but they're not. But they may not know, they may stumble in a different path. 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. 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 in venture? We can talk about venture and biotech in a second because it's totally broken. Broken right now. But anyway, back to David's question. So first priority, invest in organic R&D. Secondly, build out the supply chain. What's different about Manjaro and the follow-on drugs is they're injectable drugs.

These are very capital-intensive, technically difficult things to scale. We've committed with President Trump to build all that in the U.S. We're currently constructing six plants. We're going to announce four more in the next six months. I was hoping to be able to announce one today, but they'll come in a few weeks. So, yeah, this is creating 20,000 construction jobs in this period, and ultimately five or six thousand 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, it'll be very hard for others to build that out and follow. Well, they're doing it in the car business, so. Yeah, if they're determined, they might. But then the final is actually to buy external innovation where it makes sense to tuck it in. And maybe that leads us to market. Verve, you bought that gene therapy, right?

Yeah, we recently bought a gene therapy company in June. 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 about five and half just just walk the audience through the dynamics yeah yeah why is biotech cratered why is it so hard for capital to flow back in what's what are the dynamics that are that are that are driving this market condition right now 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. Your cycle time to return is just more visible or faster, biotech is hard and slow. Secondly, I think too many biotech's IPOed 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. Right. 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 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. Can you talk about the patent issue there? The patent and IP issue, so in the U.S., 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? 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 change the patent laws in the U.S. 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, et cetera, we file as soon as we can because we don't get beat on first 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. How old are you? I'm 58. You're 58. You look great.

Thank you. You look like 40. What do you want? Are you hitting on me? What's off the menu? You know. Come on. You look great.

You got some off the menu stuff going on. What do you got? You're on the Wolverine? I think you're on BPC 157. It's actually an interesting question. What is your lifestyle routine? Do you supplement? Is there anything else?

I know you have Brian. You have Brian Johnson coming. Okay. I follow him on X. I'm not doing the Brian Johnson program. He's the opposite of you. He looks like he's dying. You look for handsome.

That guy looks like he's turning until a stuff. You know, that's a vampire. There's another Brian Johnson, the liver king. I don't know if you ever followed him. Yeah, both of these guys are taking it too far, but seriously, I get up early, I work out, I read, try to go to bed early. Sleep is important. Sleep, okay.

There's like four things in life that I think really matter. There's evidence. Sleep, eating healthy foods mostly plants, movement, and social relationships. I think those are the things that over time, because that's how we were. You meditate? Because I got a meditation app. My wife tried to get me to do that. My wife tried, I haven't tried yours.

Have you been motivated to try some of these drugs prophylactically? You know, people ask me if I've used the GOP-1 drugs. I haven't, but yet is my answer. Because what's happening, as with all medicine technologies, you start with the sickest, the most extreme cases, and you work your way as you prove safety to general use. I think what we're seeing now with the broad benefits, Everything from metabolic disease, less drinking, lower inflammation.

Our competitor, Nova is 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. We're taking pretty low doses for most people, say, over 60, 58. Is not a terrible idea. And they may help you live longer. 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 BPC 157 and the tremendous impact people are reporting from it? 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. But you watch it? Of course, yeah. And what do you think of those specifically? Are you pursuing them?

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 Mangaro 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 out of the other way, which is sort of saying, I'm already healthy. Can I generally stay healthier with small doses or other regimens, supplement? That's not our game, but we watch it. There's a handful of drugs that I would say are Epidemically prescribed in America. Probably at the top of the list would be SSRIs and antidepressants. And there's a lot of anecdotal evidence that GLP's in this class of drug actually is quite helpful with just the psychological

health of an individual. Can you talk to us about that? What's ongoing? What is a readout that you think could be transformational in that space? in that space. Yeah, so this is interesting. I mean, sometimes we engineer medicine to do something

like we did, GLP, GIP, Eter's appetite, to reduce body weight, lower blood sugar, and lipids. And then sometimes along the way you discover an effect, you didn't predict. So one of those is like smoking cessation. When we started doing these studies

at scale, it was immediately obvious. People stopped smoking. Like a lot of people stop smoking. Also gambling. Gambling and online shopping, all kinds of positive benefits. This is why Schmats on it because he was stuck in the game

Poker's not gambling, but go on. So anyway. I was talking about craps. 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 GOP-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 GOP-1, a different one. that probably has a little less weight loss, but a little more brain activity. Really? 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. 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 it, HHS? Yeah, long overdue. I mean, I think the food system in particular, I think, well, you're working on this, but it could be changed in a much more positive way. I think we are the least healthy metabolic, big country, and probably the reason for that is the food we feed ourselves.

Process food, chemicals. Highly processed food, chemicals. This whole carb thing that went on for 30 years, which has been totally debunked. And food companies have a lot of influence, and they've... You're seeing the anti-carp, 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 of that, and I think we should reform that and find ways to make quality food cheaper and more accessible for as many people. You're pro-Bobby Kennedy. You like that he's shaking it up. It's a big controversy. Parts of Bobby Kennedy. I think that part, I think we have a lot of alignment on. I worry about all for skepticism, but 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... Let me ask you a hard question. Yeah. The mainstream media, in many cases, make 25, 50% of their revenue off of advertising from companies like yours. Yes. 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?

Well, I would be for a system where we don't have nearly as much drug advertising. So you would. Yeah. Yeah. That's paradoxical. How do you, then you just want to rise and fall based on your reputation? 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. Yes. And now we have to follow that regulation for TV advertisements, which is why you have the scrolling side effects, as if they were printed on the back of the ad. That's literally how we're here.

So the ads are poor. They don't represent. the patients were serving, et cetera. By the way, more than half of our consumer spending to reach consumers is not on TV. Does it work? Does it even work for you? Does it move the needle when you do a big ad buy? It does, unfortunately. That's why people keep doing it.

Of course, the productivity of that is debased when your competitor does it, but then everyone wants to go up above the next one. Prisoner's dilemma, yeah. A little bit. So I would be for a system where that got reduced. There's been a lot of legal actions. that said that they 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. It doesn't move my needle at a time. You'd rather see that money going to R&D, I would suspect. R&D or legitimate ways to reach patients. I think consumers need to play a bigger role in their health care. I think that's part of what Maha is about is a reaction to. 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, yeah, you're not going to know what's available off the shelf, you know, on the doctor's shelf to you without any sort of knowledge or information. And the truth is most primary care doctors are way too busy. Right.

To even attend a continuing education, even know what's happening. So people need to self-activate. What do you think of people using chat GPT and large language models to do their research and then they come to their doctors sometimes with much deeper research than the doctor's aware of? Is this a plus or a minus? Do you trust it? do you do it yourself? I think it's a huge plus, I would say.

And I do it myself. I also do it just to see what the different models are producing about our drugs. Yeah. It's like an audit. But mostly it's accurate, and it's gotten better over the last two years. I'd say substantially better. And many, including Google to their credit, have 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. Do you work directly with that? consumers owning their health and for more information. Do you work directly with them? Do you have an arm that will go to GROC, go to Gemini, and say, hey, we did these searches. Here are some things you need to improve.

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 the corpus of information. On Reddit. Yeah, right. And it is what it is. we don't want to own the bastion of intellectual thought yeah we don't want to own the outcome

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 how what will the follow-on effect be are these cuts going to be to low ROI research programs that ultimately wouldn't have translated into the clinic and and into improving lives 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? 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 is 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 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 is asking that. I think the other problem with the NH granting is, as you do that, like any government mechanism, it gets influenced by the people who are making the grants. Who are those people? People receiving grants.

So there was a little bit of a backscratching issue here, and I think exposing some sunshine onto that to, you know, sort of say, what is that process? Is it truly competitive? and is it truly pursuing ideas that the market can't solve itself? 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 has done XUS, what's the right model? Is this the right model? Probably too much that way. I'm on the board of an R1 university. so 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.

Dave, tomorrow we're going to have Mark Cuban. Yeah, great. And we're going to talk about PBMs. Yeah. And one of the big... He's on fire. Well, one of the big boogeymen in health care are these PBMs. 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 health care? 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 did they exist? Two reasons. To match up claims so you can go into any pharmacy in the country with a card that says, here's my benefit, and that benefit can be adjudicated to you. 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 interests, 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 drunk companies, get a lower deal. I think that's fine. I'm for that, too.

What happened is, you know, like any consolidated terminal state of an industry, what's the term, the inshittification of their service, is they just become so, every action they make is about their benefit, not the customer. And that's what's happened. and that's why everybody hates them. Yeah. Sacks. GLP 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? It's hard to predict that, but I would say probably a brain disease. I think if you look at humans 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 is not worked.

You know, when Bobby's raising the question, why do we have so much autism? great question. What's causing it? Depression rates, despite the advent of, I mean, we invent of Prozac, so many drugs, people are aided, but it's not solved it. 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 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 Ricks. Dave Rick. Thanks, bro. Great to see you. Yeah.

Thank you. Thank you. Thank you, David. Yeah. Congratulations, my man. I appreciate you. I appreciate it. Take care.