The a16z Show - Why America’s Health Crisis Is an Incentive Problem

Starting point is 00:00:00 You look at our food system today, the majority of what people are eating is ultra-processed crap. The average child spent less time outside than a maximum security prison that people are spending P-plus hours on phone. We are in the midst of one of the biggest problems

Starting point is 00:00:11 of the country. If we don't fix this, like America is going to have even more serious problem. The environment that we exist in is just structurally, just hard to be healthy, which is why you see

Starting point is 00:00:19 the default health outcomes in the U.S. being so cool. Why not just universal basicosemps? Why doesn't that solve the problem? I think now the problem is we're feeding our kids poison and like all of them are sick. I think many of our problems are downstream of the fact that the majority of the country is just sick.

Starting point is 00:00:34 No matter if we get rich or whatever, if most of the country is sick, it's kind of like, what is the point? What if the chronic disease crisis isn't a health care problem, but an environmental one? Justin Marys has spent 15 years building companies around a single idea, that what you eat, how you move, and where you live matter more than the pills you take. His great-grandmother lived to 95 without ever shopping organic or asking for no seed oils. She didn't have to. She grew up in an environment that wasn't actively making her sick. Today, the average American child spends less time outside than a maximum security prisoner. 70% of their diet is ultra-processed food, almost 80% of adults are overweight or obese,

Starting point is 00:01:11 and the health care system will pay hundreds of thousands or millions of dollars to manage a heart attack, but nothing to prevent one. TrueMed is trying to change that math. The company allows people to spend tax-free HSA and FSA dollars on lifestyle interventions, gym memberships, better food, sleep aides that treat, reverse, or prevent chronic disease. The idea is simple. If we're going to fix American health care, we have to make prevention as easy to pay for us treatment. I speak with TrueMed founder and CEO, Justin, about why the 1970s were the turning point for American health, how crop subsidies created a poisonous food system, and why peptide might be the most disruptive thing to hit health care in decades.

Starting point is 00:01:49 You've been on a quest for the last few years to uncover and make a dent in solving our food crisis, our health crisis, our disease crisis. Why don't you trace your journey a little bit into how you became obsessed with this, and then we'll get into what we're up to? Yeah, so Peter Thiel has this idea of like a secret, and I feel like the idea that what you eat, your lifestyle, all these things, they impact your health outcomes, they impact your energy, they impact how you feel. I kind of came across that idea when I was 20, and it felt like this secret where if you look at any data in the U.S., U.S. healthcare outcomes are horrible. They're bad. They're getting worse. Like obesity, heart disease, all of these conditions are basically at record levels and continue to go up. And as I started to read more about our food system, about environmental toxins, about all these sorts of things, I just became more and more convinced that everyone's like, what's going on with our obesity crisis? Why are we so sick?

Starting point is 00:02:45 And the answer is just simply that we exist in an environment that systematically outputs unhealthy people. And that this idea that you could just change your food, change your diet, change your exercise, change your environment, and that would lead to much better health outcomes naturally, feels to me like this secret that, you know, I believed and invested behind and started companies behind for 15 years that still the average person does not totally fully like internalize. And so I just became obsessed with this idea. The first time I came across it when I was like 20 or so. And you yourself have gone out of your way to go against the grain in terms of your own personal life and trying to be healthy. But it's very difficult to be healthy today. It's almost like people used to say when they were canceling people on Twitter all the time, hey, just build your own Twitter. Like just you want your own information.

Starting point is 00:03:31 You can build your own. And similarly, like you have to build your own like food. Totally. Yeah. I mean, in so many ways, I feel like health used to just be an output of the environment that we existed. Like my great grandmother, she lived till she was 95. very healthy until the day that she died. And she never shopped organic. She never, like, avoided and asked for no seed oils at the grocery store. She never did, like, any of the insanity

Starting point is 00:03:52 that I've kind of had to learn, figure out, and do. That's because primarily she lived and grew up in an environment that was not sickness promoting. She was not exposed to 40,000 novel chemical compounds that exist in the U.S. or eating foods that were, like, addictive and made her feel shitty and like impacted her health. And so I think that the environment that we exist in is just structurally just hard to be healthy, which is why you see the default health outcomes in the U.S. being so poor. And how are the Amish exempt from this? It just as an example. Like, what do they do differently? I mean, they do a lot differently. You should go to one of the communities. There's a lot of things they do very differently than you and I. But basically they're eating food that is grown

Starting point is 00:04:32 locally, seasonally all the time. They're outside all the time working with their hands. They're existing in a tight-knit community. And there's like a whole host of environmental and lifestyle differences that the Amish have. So you can argue do you have to live like the Amish to have better health outcomes? But certainly they have much better health outcomes and they live very differently than you or I. But they're not doom scrolling like us. So how do they make it? It's like they might live longer. They're uninformed. They might live longer, but at what cost? So when did things start to get really bad? Or has it just been monotonically for the last century? Or was there sort of a moment where things started to escalate? And what happened? Yeah, things started to get much worse in the 1970s.

Starting point is 00:05:12 My view is that that is around the time when you started to see childhood obesity tick up. You started to see obesity, heart disease, things like this kind of start to move. And in my view, a big reason for that is there was a lot of shareholder and other pressure, specifically geared towards big food companies around that time where basically these companies are today like 150 50 years old. Almost every big food company is shareholder owned. They are not run, controlled, or anything by CEOs. They're basically just like these lumbering corporations that the market is just having them optimized for like earnings per share. And what that means is these companies for the last 50 years have consistently decided to trade a real ingredient for something that's

Starting point is 00:05:53 like kind of a fake version of that. Like they've moved from strawberries to strawberry flavoring or they've moved from sugar to high fructose quart syrup. And you kind of roll this out over a 50 year period, and you look at our food system today, and the majority of what people are eating is ultra-process crap that is, like, addictive, is not nutrient-dense, and is full of, like, environmental toxins, chemical compounds, things like this, that the human body has, in our entire millions of years of evolution, never encountered many of these compounds. And so I think that that shift started in the 70s. It's compounded generationally. It certainly doesn't help today that the average child spends less time outside than, like, a maximum security prisoner.

Starting point is 00:06:31 Like most kids today are eating like 70% of their diet is ultra-processed foods. People are spending eight plus hours on phones. Like all these sorts of things are factors. But I really think that our food system started to become uniquely poisonous in the 70s. And especially in the U.S., that's why you started to see many health care and health outcomes trend in such a negative direction, especially relative to the rest of the world. What are the levers that could make a dent in reversing some of these trends as it relates to the food system? Yeah, from a food system standpoint, I think the biggest thing. lever that we could pull, which would be extraordinarily politically challenging to pull,

Starting point is 00:07:05 is fixing our like crop subsidy system. So if you look, the U.S. government, I think it's the last decade, has spent close to $100 billion on crop subsidies. They're basically subsidizing corn, soy and wheat so that American farmers can grow corn, soy, and wheat. Because it's subsidized, it's artificially cheap. So we grow a lot of it because it's subsidized, it's artificially cheap. And so these big food companies use it and everything. And so these big food companies have basically gone on like a 30-year journey to replace sugar with high fructose corn syrup or to replace olive oil or something like that with soybean oil, which is highly processed and inflammatory, it causes obesity and all sorts of rat and human

Starting point is 00:07:40 models. And I think that this sort of wholesale swapping of let's take the worst ingredients in their most highly processed form and replace them with an ingredient that humans traditionally ate is one of the root causes of chronic disease. Like today, the average American gets almost 20% of their caloric intake from soybean oil. This is historically anomalous. And it's not because anyone once soybean oil, like you're probably not like a big consumer of soybean oil or anything like this. It's just because it's artificially cheap and because it's artificially cheap, it ends up in everything. And I think that that is one of the core kind of root causes of what is going wrong in our food system today. And is that a uniquely U.S. problem?

Starting point is 00:08:18 Yeah. It's a uniquely U.S. problem. I mean, the U.S. our food system relative to like Europe or something like that. Europe, many of their countries are smaller. They tend to lean much more into a local food agriculture system. They also don't have as much of a federal intervention on their food system. The U.S., like in many ways, this sort of subsidy of corn soy wheat, things like that, it had good intent.

Starting point is 00:08:41 I mean, a lot of the crop subsidy stuff started with a farm bill in the 80s where basically like farmers were exposed to inclement weather, bad weather that was like impacting their crop yields. The U.S. government stepped in and was like, okay, we're going to try and keep these farmers solvent. I think that the intent was good, but now here we are, like years later, we have buildings. millions a year going towards these crop subsidies that are making Americans sick. And I think that we used to say, okay, we just need to make sure that we're growing enough calories and make sure that Americans are not dying of starvation. They're not like, you know, make sure our kids have enough to eat. I think now the problem is like we're feeding our kids poison and all of them are

Starting point is 00:09:16 sick. Why not just universal basic ozempic? I mean, why doesn't that solve the problem? Yeah, well, so I think there's two things. One, I think that JLP ones are potentially an incredibly interesting technology. Like, I think that we are in the midst of the worst chronic disease crisis, one of the biggest problems in the country. And if we don't fix this, like America is going to have even more serious problems like 20 years from now. So given that the average American is overweight, we're looking at almost 80% obesity overweight rates, I think that it does make sense to put a bunch of these people on a GOP1, to try and jumpstart them in a direction where they are moving towards health. That said, I don't at all think that giving universal GLP ones to everyone is like necessarily

Starting point is 00:10:01 a universal solve. There's just a very poor history of saying here is an intervention that like is going to solve all of our problems as a species. And I just think that it is quite unlikely that Ozempic is the one thing that is going to be a cure all. Like just to use one example, what is, you know, how does Ozempic work? Is it basically it turns down someone's appetite. So you're just eating less. If you're still eating the same crap that the average American is eating today, but you're on OZempic and eating less of it, like you are almost certainly going to be deficient in protein and micronutrients and a bunch of things that will have like long-term health implications if you like under-eat or get exposed to not enough of those nutrients for a very long period of time.

Starting point is 00:10:44 So I think we fundamentally like have to solve the food issue if we want to have a healthy country. By the way, have we yet updated our food pyramid in the sense that we have an accurate understanding of what we should be getting at a country level in terms of nutrients? Yeah, I mean, the new food pyramid is a tremendous improvement over the old guidelines. I mean, not only is the site super sexy, you know, Joe Gevya did a great job on that. But finally, for the first time, people are saying, like, eat whole foods, eat more vegetables, eat, you know, meats and like other well-sourced sources of protein, vegetables, fruits. It's crazy that it took until now to say maybe we shouldn't be giving kids, you know,

Starting point is 00:11:23 15 servings of whole grain and saying that like sugar is totally fine for kids under two. Like we recommend some amount of sugar for kids on the edge of two, which was the past, you know, past administration's sort of guidelines. So I think they're a tremendous, tremendously positive stuff. And so for people who want to make a difference in the food system, you mentioned that policy recommendation, what about people who want to do something direct that? You obviously, you know, before at TrueMed, you started a bone broth company. What are other big companies that could be built in a space or opportunities to make

Starting point is 00:11:52 a different. Yeah, I think there's a ton of opportunities. I mean, within the space that I, like, I think the core problem is that a bunch of these lifestyle interventions, like eating a healthier diet, exercising, taking certain supplements, taking like peptides, if that makes sense for your sort of individual person in risk profile, all of these things can be considered health care interventions. And yet, if you look at our health care system, nothing in the health care system thinks about someone who is at risk of heart disease exercising as a health care intervention. No payer pays for it. No one incentivizes you to do that. It's just sort of like a doctor is like, yeah, you should like clean up your diet and exercise. And so I think that there is a tremendous,

Starting point is 00:12:32 tremendous opportunity for people that want to make a dent on this problem, figuring out how to make these sorts of lifestyle interventions part of the healthcare system is what we're doing at TrueMed and incentivizing people to actually invest in their health, to invest in prevention, to invest in things move the needle from a chronic disease standpoint. Yeah. So let's get to true med. First trace the idea maze a little bit in terms of, you know, you've been obsessed with this problem, sort of meta problem, this series of problems.

Starting point is 00:13:00 And it's kind of like, where do you even start? I'm sure you, you know, picked over every nook and cranny. How did you settle that? Hey, this was the opportunity. Or maybe some other things you would consider. Yeah. So in growing kettle and fire, basically, when we launched, it was like $16 a carton for 16 ounces of bone broth.

Starting point is 00:13:16 And everyone was like, this is good. but this is like very expensive. And, you know, now nine years in, we're in every grocery store in the country and the average price per box is like $7. People, way more people buy it, but they're also like, this is very expensive. I kind of like had that experience

Starting point is 00:13:31 and then looked at things like Costco and Walmart are the two largest sellers of organic products in the country. To me, that is a signal that like people want to invest in products that are good for them. They want to buy products that leave them off, better, healthier, and like, but it's just cost prohibitive. And then if you look at the healthcare system,

Starting point is 00:13:51 we have this weird dynamic where if I am at risk of cardiovascular disease or heart disease, like I basically can exercise, I can eat well, I can do all of these things that will prevent an acute heart attack or something like that.

Starting point is 00:14:05 And I'm basically not, that's all like cash pay. I'm paying out of pocket, I'm doing all of that kind of stuff totally on my own. Whereas if you take someone that doesn't do any of those things, basically they have a heart attack early

Starting point is 00:14:15 and then the health care system will pay hundreds of thousands or millions of dollars to manage that person's condition, basically for the rest of their lives. And so I think that fundamentally, like, we need to incentivize people to invest in prevention, to invest in, you know, leveraging lifestyle interventions that can make a dent on chronic conditions. And that was kind of the lens through which I was looking at, what's the company that I want to start after a kettle and fire? When I met Dr. Mark Hyman, who is basically, you know, he's a functional medicine doctor, co-founder of he mentioned that something he was doing with a bunch of his patients was for patients that would come in,

Starting point is 00:14:52 he would recommend lifestyle interventions, and he would write them something called a letter of medical necessity, which is basically a letter that the IRS has said for certain people where an intervention matches a lifestyle intervention matches a condition someone's working to treat, reverse, or prevent. They can spend, they can get that letter and use tax-free HSA-FSA dollars on sleep aids, healthy, you know, better diet, supplements, exercise, things like that. And so when Mark Hyman told us kind of about that idea, I was like, this is a really interesting thing. Like, we could basically try and build infrastructure that allows the average person to get one

Starting point is 00:15:33 of these elements if they qualify and use like the telemedicine rails that Hymns Row and other companies have spent the last several years building. But rather than prescribing OZempic or prescribing TRT, we can actually prescribe food interventions, exercise, things like that. So that was kind of the idea and like where it started from. I looked at a whole host of other things like thought about starting a grocery store, thought about starting like a life insurance company that would be aggressive in terms of like helping you live longer and making lifestyle interventions. But ultimately felt like this was the type of thing that had the potential to direct hundreds of billions of dollars towards

Starting point is 00:16:11 lifestyle interventions over the next couple years. And so it felt like it was it was the right thing to do. So, yeah, everyone knows we need to shift more, you know, from chronic to preventive care. And this is basically a way to financially incentivize people to do that. Exactly. Yeah. Exactly. One of your ideas is that the root cause of a lot of issues is this mismatch between our genes and our environment. Why don't you flesh that out a little bit more?

Starting point is 00:16:37 Yeah. So if you look, like, think of an animal in the zoo. Like, an animal in the wild with a few exceptions. They can get, break their leg, get an infection, whatever. But when an animal exists in a species' appropriate environment, that animal tends to be healthy. Like there's a natural match between the health of the environment and the health of an animal. When you take an animal away from its natural habitat and put it in the zoo or something like that, like zoo animals exhibit all of these diseases that their counterparts in the wild just don't get.

Starting point is 00:17:08 They have weird ticks. They get depressed. You know, in some notable cases, like animals have even killed themselves, which is just is something you like don't see in the wild. And they get obese, they get all sorts of things. And so my take and what I think is very true is that the health of an animal is basically a reflection of the health of an animal's environment. If an animal is existing in an environment that is not health promoting, like you're in a season

Starting point is 00:17:32 of drought or there's not a lot of food, that animal gets skinny and dies. You basically can kind of see that that animal is not existing in an environment that's health promoting. I think that over the last 100 years or so, we basically as humans have seen, you know, we've built an environment that is not considering or not underwriting, not thinking about what is the right thing to do for human health. Like how do we promote human health and flourishing? And so I think that so often when we think about health, we think about like what is going

Starting point is 00:18:02 on with you, Eric, with this specific condition, as opposed to thinking about what is the environment that you exist in that leads to you not getting a, thousand steps a day that leads to you spending all day on your phone that leads to you like eating a terrible diet. Not you know, not you know, not you actually, but I mean. So I think that that is like an important idea that people don't think about enough is just how do you shape your environment so that it's naturally health promoting as opposed to, you know, having to like discipline yourself and doing all the stuff that most people frankly fail out, myself included. There's this, you know, there's this Twitter competition for a million dollars for who gets the best article.

Starting point is 00:18:37 And there's this like, so people are doing kind of clickbait stuff. And there's one I was like, you know, how to change your life in a day, how to change your life in an hour, like these kinds of posts. And there was one that went super viral that was how to change your life in one minute. And it was a photo of smashing the phone. That's pretty good. Totally. Okay, so I'm curious for more, you know, you've talked about this idea of, hey, we should take this health crisis as serious as we take sort of our, you know, national security crisis. Like, you know, we as a country to have something of an NRA for health.

Starting point is 00:19:10 or something of a, you know, collective effort because it's a, it's a, you know, problem that, hey, the market might not solve, what isn't solving on its own. In fact, you know, exacerbates. What would, you know, you gave one example of, and the subsidies. What are some of the biggest levers you think? Yeah. So I'll answer that, but like just to frame how I think about the problem, you know, if, for example, like China or one of our adversaries deployed a bio weapon that made 75% of our population, obese or overweight. 45% of kids, obese are overweight. And healthcare, like, the largest costs in the country

Starting point is 00:19:46 all of a sudden because everyone was sick. Everyone in America would be up in arms and trying to figure out, like, how do we solve this? This is an existential crisis. This is like a matter of national security that we make a dent on them. No matter when the eye race, get richer or whatever, if most of the country is sick, it's kind of like,

Starting point is 00:20:02 what is the point? You know, we're not thriving as a nation. I think many of our political problems are downstream of the fact that many, the majority of the country is just sick. And so if I was like able to wave of magic want and do anything, I think fixing the subsidies would be one thing for sure that I would do. Secondly, I would have our healthcare system just invest far more in prevention. You look at other countries that have incredible, like, health outcomes on a per capita basis.

Starting point is 00:20:28 Singapore is a good example. They basically have these people that are not quite doctors, but are like coaches or something like that, that will check in with you and try and like nudge you towards making better, better choices. Then I would take a much stronger stance, one much, much more similar to that that Europe takes when it comes to like certain environmental toxins, chemical regulation, things like that. Like in the U.S., we basically take the approach that if a company makes or manufactures a totally novel environmental chemical, that as long as they tell us under current regulations, something called grass generally recognizes safe,

Starting point is 00:21:05 As long as they tell us, hey, this chemical is safe, we can introduce it into our food system. This is how, like, you've heard of the forever chemicals and stuff like this got into our food system and basically are all over the planet now because 3M invented them something like 60 years ago, and basically they just started using them. In the EU, these novel chemical compounds have to go through something that is much more like what it takes to unleash or, you know, get a pharmaceutical approved in the U.S. today, where they have to do many years of safety testing, they have to show that it doesn't cause acute harm,

Starting point is 00:21:38 and they basically have to approve it before it's allowed on the market. And the end result is we have between like 60 and 80,000 chemical compounds in the U.S. that are not allowed in the EU. And I think that that regulatory approach is one of like the hidden reasons why so many people are sick. And I think it's one of the reasons that, you know, the U.S. Americans are exposed to more toxic compounds and novel chemical compounds than basically any nation in the world.

Starting point is 00:22:06 And I think that is like a big, kind of hidden part of our chronic disease crisis, and it's something you're going to hear a lot more about in the coming years. Yeah, fascinating. I had one college professor, I have no idea if this is even remotely accurate, but they were convinced that Monsanto was evil,

Starting point is 00:22:21 not just in terms of its health impacts, but they thought they were sort of like getting involved in all sorts of foreign wars, like influencing our foreign policy and stuff. And I'd just say that to say, could there be competitors to some of these, like, mega play? Like, could startups even emerge that would begin to, or is it just like structurally

Starting point is 00:22:38 unsound? I think it's really hard structurally. And I think that that doesn't mean that it's not going to happen and hopefully it will. But one of the things that you have seen is with Monsanto, for example, like the pesticide lobby and the chemical and ag lobby is one of the strongest in America. And a big part of what they're doing is like, for example, a couple months ago, Monsanto was lobbying hard, spent tens of millions of dollars to get a rider in a bill that would basically make sure that no one could ever sue them for the potential health impacts of one of their most popular products, glyphosate. That sort of thing is like these companies get big. They provide a bunch of chemicals. Monsanto specifically has done a lot of things that, you know, I think are incredibly, like, morally dubious.

Starting point is 00:23:28 And then once they get big enough, once they like start. selling billions of billions of dollars of these products, they spend a lot of that money on lobbying and making sure that they are immune from any of the harms and health impacts that come from some of these toxic products that they spray everywhere. Like glyphosate is the number one pesticide sprayed in the U.S. and the largest maker of it is spending as much as they possibly can to make sure that glyphosate, which, you know, there's been $14 billion of damages awarded to people that have gotten cancer or other diseases from glyphosate exposure, Monsanto is spending as much as they can to try and buy basically pesticide liability shields

Starting point is 00:24:06 and other things that shield them from competition and that shield them from the actions and the consequences of like the diseases, their compounds of cause. I think that when these companies can kind of rig the game in that way, it becomes very, very challenging for a startup to kind of come along and make a real play at some of these things. You mentioned a grocery store just as a simple idea. What's the opportunity that Whole Foods hasn't done with what they've tried to do? Yeah, I mean, Whole Foods is amazing. And so I think that John Mackey was like a total pioneer and like legendary entrepreneur. I think that the thing that grocery stores have not really done is, and this is kind of the thesis for

Starting point is 00:24:49 Trimed is like think about food as like a healthcare intervention. And to me, I think there's a ton of potential for people to, for example, like, look at their biomarkers and have a grocery store or some other entity that's responsible for improving your health. Like, I think that if you think increasingly about food, grocery as a health intervention, as, like, part of one's health care and, you know, part of the fight against chronic disease, you would think about a grocery, a grocery store very differently than today, which is basically just like, let's figure out the sourcing and then people can buy whatever they want. So I think there's like, you know, My idea was that I think there's a ton of room for a grocery store that is a more active participant in your health, telling you to eat certain things, you know, tracking your macros, like all these sorts of things that I think would solve a lot of problems for people.

Starting point is 00:25:39 Yeah. So let's talk more about if we, you know, fully identified the health crisis as one of our main sort of national priorities. What else we would do? Maybe we could start looking at it in the light of like, what were some of the pillars or main principles and maybe we talk about where they are so far? Yeah. So I think that you have seen across all of health care, across all of food, just corporate capture of our food guidelines, our health guidelines, of all these sorts of things. Like the previous FDA commissioner, you know, their stated goal with running the FDA, their number one goal was to combat misinformation. The current one is to like make Americans healthy. That means grass reform. So cleaning up like how we regulate chemicals. That means fixing school lunches, fixing like military lunches. basically what we feed kids, you know, 80% of schools have contracts with soda companies. These soda companies literally like will pay a school district to put these vending machines all over the schools. It helps fund schools, but it also like comes to the cost of getting

Starting point is 00:26:36 kids sick. So I think like cleaning up school lunches, cleaning up military lunches, cleaning up like the food guidelines. Second thing is like improving and streamlining the way that we look at regulating drugs, make it faster for companies to like lean in and launch innovative therapies. that can make a dent on the chronic disease crisis. And just trying to, like, bring common sense back into the way that we think about health, the way that we think about food, and try and make a dent in the chronic disease crisis. Are some of these ingredients that we're discussing or foods or, you know, soda, like, so addictive or so dangerous or so appeasing that they should be outlawed?

Starting point is 00:27:15 Or so, like, how do we think about it? No, I actually don't think that many of these things should be outlawed. Like, I do actually think that consumer choice is a very important thing. But we have got like specifically with kids, we have guidelines and we already don't think that kids should have free choice. Like we don't let them drink. So I think that there is a place for soda in this country. I just also think that if you want to drink soda all the time, that probably we shouldn't be subsidizing it by subsidizing high fructose corn syrup. Probably we should not have Coca-Cola spending $140 million to influence our nutrition guidelines like they have over the last, you know, 15 years.

Starting point is 00:27:50 And I think that it's things like that where a lot of times the big food companies and people will sort of fall back on this idea of consumer choice. I think it's very important, but we also are like currently grappling with an incredibly important chronic disease crisis. And like if we don't take effort to uniquely like address this thing, I think that the U.S. is like in an incredibly tough spot 10, 20, 30 years from now. I want to ask you about psychedelics. And is that in this discourse at all? Does that move outcomes? Or is that kind of not really not really a piece? I think that if you just look at the data, psychedelics are an incredibly powerful intervention.

Starting point is 00:28:31 Like ketamine therapy, ketamine-assisted therapy works better than SSRIs in many cases, especially for treating things that are very intense, like treatment, resistant depression, PTSD, things like this. I think that for many of our veterans and others that suffer from PTSD and like intense depression, psychedelics should be part of a menu of treatments that we are open to giving people. I think that we probably vastly invest in them. I think that there's a ton of really promising research

Starting point is 00:29:00 around their efficacy and things like this. I think it's an open question of how ready the average American is to think about these things, not as like a group of people dropping acid in Golden Gate Park in the 60s, but as like a vital mental health therapy for people that are really, really struggling. I'm very supportive of, you know, again,

Starting point is 00:29:21 just looking at psychedelics as another therapy that can address the many mental health and depression issues that we have in this country. And if you look at it just as that through that lens, a therapy that has few to no side effects, especially when done, you know, with doctor oversight and things like this, I think these should be part of how we treat and address many of the mental health crises that we see today.

Starting point is 00:29:43 Yeah. Are there any other really big levers that you would focus on if one of your main goals was to target the mental health crisis? I think that we are hugely underestimating the impact of biological health and how that is tied to mental health. Like there's some really interesting studies out there around taking a functional medicine approach where you come in and say you're depressed. And rather than like doing talk therapy and things like this, that statistics show like sort of don't work very well for many people. we focus just on reducing your inflammation and fixing your gut. And there have been studies that show just by focusing and taking a functional medicine approach, you know, focusing on sleep, focusing on gut health, focusing on lowering your inflammation

Starting point is 00:30:25 through diet and exercise, that combination of therapies works better than, you know, just talk therapy and things like that. So I think that we massively underestimate the degree to which we are, you know, human beings or biological organisms and like our mental health is very tightly coupled to our emotional, you know, sorry to our physical health. And so I would have much, I think that we should fund much, much more research along these lines of what's called metabolic psychiatry, which is basically this idea that many diseases that we put in the mental health bucket, thing like epilepsy, depression, schizophrenia, many of these things have causes that are actually metabolic in root. And like, for example, one of the best

Starting point is 00:31:09 for someone that is schizophrenic or epileptic, or even in many cases, bipolar, if you put them on a ketogenic diet, these things will, in many cases, just resolve. That is not a thing that our current, like, mental health world really underwrites. Yeah. Yeah, it reminds me of a conversation I once had with Daniel Gross when he was saying, hey, anytime someone is feeling depressed to behoove them to, you know, before attributing it to some psychological, you know, defect or making some deep-second analysis about it. First, just saying, hey, am I sleeping well? Am I eating well? Yeah. Am I exercising? Totally. Have I been outside recently? Yeah. Totally. I want to shift lastly to another topic that you've just been really curious about for a while, which is consciousness.

Starting point is 00:31:58 What is sort of your driven your hunch or curiosity there and whereas you're thinking, drawn you? Yeah. I think that I have just been interested in this idea of like what what does it mean to be healthy what does it mean to live a life that people are like excited about have energy with you know have energy and are just like what does it mean to like feel great in your body and your in your mind and everything um and i think that consciousness is sort of this root layer of like what does it mean to what is your experience of being a lot of of life uh and frankly like we don't really have a great answer to this right now um you know like a lot of our a lot of our theories and philosophies and

Starting point is 00:32:38 things of like what is consciousness are not great. They're not predictive. And you ask the average person, you ask even like philosophers that have thought a lot about this. And there's not, there's nothing near consensus. And so I think that I don't, it is an area that I'm very interested in. I think we're going to learn a lot about in the next decade. I hope to like have friends and like play somewhat of a role in like exploring and learning more about, about what consciousness is, like how to change it, how to improve it, you know, all these sorts of things. But yeah, I would put it very much in like personal pet interest bucket, not like I'm doing anything around it right now.

Starting point is 00:33:16 Yeah. Well, to that, obviously, you're focused on building true med, we'll close there. But if you could scale yourself, you know, infinitely, like for people listening who are like also obsessed with this problem, is there something else you think is under explored, whether it's a research area or a company idea or some sort of policy thing that not enough people are looking into that we haven't yet discussed that you want more people to spend? Yeah. An idea I've been thinking about recently is, like we mentioned at the beginning that the health

Starting point is 00:33:43 of an organism is like the health of your environment. And in my view, what that means is that if we started thinking about not improving just Eric's health, but improving the health of like all of your friends and community and people around you that exists in the same environment, like intervening and improving your environment could have a much larger impact on health than just like optimizing your own health. And so I think that there's like, potentially interesting models of improving one's environment, whether that's building like a health oriented city or town or like suburb development or something like that, whether that's like group health insurance for people that are deciding to live differently and like make, have different

Starting point is 00:34:23 interventions and invest in in sort of like root cause lifestyle interventions. I think there's a lot of interesting things that could come about when you start thinking about health through the lens of a community or like tens, hundreds of people, not just through the lens of like me as an individual. So if I had copies of myself, I would, I would explore companies in that in that direction. Yeah. I love that. Let's close on on, on, on, on true med and go deeper into it in the sense of where obviously the company's done phenomenally. We're obviously very lucky to, to be a part of it. Same more for for people who are not in terms of the actual product and, and, and the direction in terms of where it's gone. Sure. Yeah. So true med, uh, basically what it is is we,

Starting point is 00:35:02 for people that qualify, we allow them to spend, uh, tax free, HSA and FSA dollars on things. that treat reverse and prevent disease that fall within like the lifestyle intervention category. So like we're partners with eight sleep, we're partnered with Peloton, we're partnered with momentous, lifetime fitness. All of these brands that, you know, for someone that is working at treat reverse and prevent heart disease or obesity or things like this, these lifestyle interventions are healthcare. And so we've built a payment integration that allows people to spend their tax rate, GSA FSA, $8 on these interventions and are scaling that up. Like, I think that where this can go over the next decade is every,

Starting point is 00:35:37 American that is at risk or has some sort of chronic condition should be incentivized. And tax-free money is a great incentive to spend their own money, their dollars, on things that treat reverse or prevent disease. And there's no mechanisms in today's health care system for someone to actually spend, you know, for someone to get like a gym membership for cheaper than the less price or to get a gym membership covered by their employer, by an insurance provider like that. And so that's kind of the thing, the way that I think about what we're building is building infrastructure that allows people and incentivizes them

Starting point is 00:36:09 to invest in lifestyle interventions to stave off and prevent different chronic conditions. Yeah. And I actually have to ask, what do you have some peptides? Any predictions as it relates to it? Oh, man, I think peptides are going to be so disruptive to our current healthcare system.

Starting point is 00:36:25 You know, I think that if you look at peptides, there needs to be way more research. I'm like not totally yet a peptide believer. But there needs to be way more research. But from early signs, and even just like N of 1, people taking these things and using them, this seems like a class of compounds that are very effective. They are not patentable.

Starting point is 00:36:46 You know, like you can basically buy these for fairly cheap. And I would put them in the bucket of like human enhancement companies. Like our current healthcare system and most of our pharmaceuticals are kind of like, don't die. Like, oh, here's a statin. Like don't die. Take this pill. I think that these peptides are in a different class where many of them are like,

Starting point is 00:37:07 give me more energy, improve your sex drive, lower your inflammation, improve your gut health. Like, they're just a different category of compound. And I think that as many people start to experiment with them and try them and things like this, you're going to see, like, really interesting, positive healthcare outcomes from the class of compounds that, like, no one has thought about for a long period of time. I think it's going to be exceptionally disruptive to pharma and to, like, a bunch of other players in the health care system. And I'm also curious, for you or just collectively, like, are we learning more about, you know, optimizing our nutrition? You got into the repeat diet or you were writing about it.

Starting point is 00:37:49 What are your thoughts there more broadly? I think the nutrition science is probably among the worst of the sciences in the U.S. right now. You know, most of nutrition science is funded by a big food company. They outfund the NIH, like 11 and 1 on nutrition science, at least historically. It's hopefully changing. I think that there are all of these different diet tribes out there. The Peters, the Ray P. crowd, I think is one that's particularly interesting that's focused on ramping up your metabolism.

Starting point is 00:38:18 But I think that for many people, you should just kind of try and experiment with the diet where you feel good. Like we now have lab tests that you can get via function or something like that to show how does this diet impact your energy, your biomarkers, things like this. You have wearables that can actually give you feedback. around how is your sleep, how's your HRV, how's your resting heart rate, since switching your diet or since doing things differently. And I think that that combination of, like, getting insight into how these things are actually

Starting point is 00:38:48 making you feel and how they're impacting your biomarkers means that people should be just way more open to experimenting and seeing, like, hey, I'll try a P-D-Ating diet for, like, 90 days and just see how I feel. So I'm very bullish on, like, people doing N of 1 dietary exploration and experimentation, and I think that the Pieding community is probably the most interesting one out there for me right now. And why is that? Because

Starting point is 00:39:13 there is like two schools of thought basically. There's like the Brian Johnson school thought which is we've done all the research, we know that you need to eat a plant-based diet, we know that you need to do caloric restriction all in the name of longevity. That is like the current dog

Starting point is 00:39:29 in many ways. The peters are the exact opposite. And Brian Johnson would say like sugar is bad. You should not eat carbohydrates. all this. The peters are like, you should eat as much sugar as you possibly can, mostly in the form of like honey and fruit and stuff like this. You should try and avoid, like hugely avoid seed oils, hugely avoid things that are going to impair your metabolism. But if Brian Johnson is like, I want to eat less and ramp down my metabolism, it means I can live longer. The peters are like, ramp it up as much as you can. And like the more energy you have, the longer you are able to use

Starting point is 00:40:03 that energy over a long period of time. And so, it is like such a contrarian view to 100 years of nutrition dogma that says sugar is bad should be avoided that I think it's a very interesting idea and a lot of the people in the peating community have seen phenomenal results like I've started drinking orange juice and like eating fruit in the morning and like I feel great my biomarkers have gotten even better from you know I've been doing probably a decade plus of like mostly low carb kind of paleo and so it's just a very interesting different lens that is worth playing with yeah um No, it's interesting. I'll have to check out the Peters.

Starting point is 00:40:37 You know, Brian Johnson's obviously been so interesting on so many topics. One question I was curious. If I, you know, if I get a girlfriend, should I make a launch video? Justin, the company is TrueMed. Thank you so much for coming on the podcast. Thanks for having me off. Lucky of you, people. Thanks for listening to this episode of the A16Z podcast.

Starting point is 00:40:57 If you like this episode, be sure to like, comment, subscribe, leave us a rating or review and share it with your friends and family. For more episodes, go to YouTube, Apple, podcast and Spotify. Follow us on X at A16Z and subscribe to our substack at A16Z.com. Thanks again for listening and I'll see you in the next episode. As a reminder, the content here is for informational purposes only. It should not be taken as legal business, tax, or investment advice or be used to evaluate any investment or security and is not directed at any investors or potential investors in any A16Z fund. Please note that A16Z and its affiliates may also maintain investments in the

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The a16z Show - Why America’s Health Crisis Is an Incentive Problem

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