The Journal. - Trillion Dollar Shot, Episode 4: The Disruptors

Episode Date: June 9, 2024

The rising popularity of GLP-1 drugs could cause all kinds of ripple effects. According to one estimate, 9% of the U.S. population could be on Ozempic or similar medications by 2030. Meanwhile, drugmakers are already developing the next generation of weight-loss drugs and researchers are studying the possible health benefits beyond weight loss and diabetes, including addiction. In the final episode of our series we ask: What could all this development mean for businesses, from the food sector to airlines? And who wins and who loses in the post-Ozempic economy? Guests include: David Ricks, CEO of Eli Lilly; and Mehdi Farokhnia, an addiction researcher at the National Institutes of Health. Listen to Episodes 1, 2 and 3 of “Trillion Dollar Shot” here.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, it's Ryan. This is the final episode of Trillion Dollar Shot, our special series about a new class of drugs like Ozempic, which people are using to lose weight. The first three episodes are already in your feed, and you can find a link to them in the show notes. So Brad, I know you've covered tech for a long time. Five years. So, Brad. Yep. I know you've covered tech for a long time. Five years. Mm-hmm. So, let me ask you, when you think of the term disruptors, what comes to mind?

Oof. I live near Silicon Valley, and I have to hear everyone talk about disrupting everything. It's sometimes true and sometimes a stretch, really, right? Right. I bet it's kind of become like a cliche out in Silicon Valley, right? Everyone's disrupting everything. Yes. Yes.

The scooter people are going to change transportation forever because they have an electric scooter on the road, for example. No offense to the scooter people. Yes. Yes. But, you know, I've been thinking about these new weight loss medications, often referred to as GLP-1s, and there is a world in which we could say they're disruptors. It's one of those cases where it actually applies, like it fits very, very well. Right, because these drugs might be one of the most disruptive advances in science and health in decades. Yes.

But maybe the biggest company in this booming market right now is the pharma giant Eli Lilly. And it's not based in Silicon Valley. It's based in Indiana. I talked to the CEO, Dave Ricks. Indiana's known for only a few things. I talked to the CEO, Dave Ricks. Indiana's known for only a few things, and two of them are universities and Eli Lilly. And Dave has a lot of Hoosier State pride.

Most of my adult life has been in and around Indiana. I was born in Bloomington, where Indiana University is based. I went to undergrad at Purdue, the other big university here. Dave has been with Lilly for 28 years. He's 57, has a boyish face, comes across to me like a friendly high school principal. Except, he happens to be running the world's largest pharma company by market cap. Eli Lilly invented Terzepatide, better known as Manjaro for type 2 diabetes and Zepbound for weight loss. And together, they made Lilly $5 billion last year.

Some analysts say that Terzepatide could become the best-selling drug of all time, even bigger than Ozempic and Wagovi from Novo Nordisk. And Lilly hasn't been doing that much promotion. We haven't even started marketing Zepbound. I mean, we don't even promote it to consumers. We barely promote it to doctors. All the demand is organic right now. So when we start doing that, we'll create more demand and we need to keep up with that. And that's just in the U.S. We haven't really launched anywhere else either. When we have

confidence we can make more, we'll introduce in Europe, which we haven't done, and then start introducing in other parts of the world. What Dave is getting at here is that these drugs have been such a runaway success for Eli Lilly that the medication is in shortage. And Dave says they're years away from making enough to meet demand. So we're all building everything as fast as we can. The bad news is that takes three or four years to build a new plant, get it running safely, prove it's effective, and do it at scale. And then we probably need 10 or 15 of those kinds of plants to even approach the opportunity. So we're building six of them now, but we need to build more, and it takes a long time. It's like these drugs have been so successful that they've disrupted Eli Lilly

itself. Yeah. And supply is just one of the things that's holding these drugs back. You know, we've talked about some of the other ones, price, insurance gaps, debates around body acceptance. Sure. And research also shows that a lot of people stop using these drugs after sometimes just a few months. So there's kind of a retention problem. And of course, there are side effects for some people that can be pretty bad. And they don't work for everyone. Right. In some ways, these drugs are just now breaking through. So we might look back and see these last few years as just the prologue. Like, there's one estimate that stuck with me. About 9% of the U.S. population could

be on GLP-1 drugs by 2030. That's like 30 million people. So companies are paying lots of attention. Yeah, especially because more potent, more accessible drugs are coming. And there's early research showing that the health benefits may go far beyond diabetes and weight loss. This kind of seismic change, it's creating a reset moment for all sorts of industries. And there will be winners and losers in this post-Ozempic world. From The Journal, this is Trillion Dollar Shot. How a new class of drugs is transforming bodies, fortunes, and industries. I'm Jessica Mendoza. And I'm Bradley Olson.

This is Episode 4, The Disruptors. We'll see your next vacation. Ready to kick off? Discover exciting games and events. Plus, find amazing hidden gems in cities full of adventures, delicious food, and diverse cultures. You'll love it so much you'll want to extend your stay beyond the matches. Get the ball rolling on your soccer getaway. Head to visittheusa.com. Looking for a change of scenery?

Come on over. Let us give you the tour. Grab a paddle and explore. Hit the trails and go. When you're ready, kick back and call it a night. New Brunswick, always inviting. Visit tourismnewbrunswick.ca. Brad, we've spent a lot of time talking about how Monjaro changed your life.

Right. I mean, couldn't lose weight for years, finally found something where it was super easy to do, and it's the same for me and so many other people that are taking these drugs. Yeah, and so as these drugs have become super popular, it's shaken up the companies that developed them, like Eli Lilly. They've been a major pharmaceutical company for decades, but even they weren't really prepared for the success of these drugs. I asked Lilly's CEO, Dave Ricks, about that.

Well, they've obviously started to change the company quite a bit because I think we always seek to use science and our expertise to make medicines that can change diseases in a meaningful way. But obesity is a very common condition. And that's really changing the company because we have to grow our manufacturing base. We're serving so many consumers. And we're also in the spotlight with media, people like you. So that's a new thing as well. Oh, is it? New is she? There was probably one other time in our company's history that felt like this. That other time was back in the late 80s,

when Lilly came out with their first ever billion-dollar drug, Prozac. Prozac. Prozac. Prozac. It's been hailed as a wonder drug. It's the most widely prescribed medication for depression. Prozac Weekly is here. Sometimes it feels like we're all living in a Prozac nation.

There's some parallels, actually. In the late 80s, if you had depression and you went to your doctor and said, you're just not right and something's wrong, they would say, well, maybe you're a little sad and you should change things about your life. And I think up until a few years ago, if you were overweight or had obesity, and you went to your doctor and said, is there something you can do?

They said, well, maybe you should change some parts of your life. And now they are saying that less and less, and they're saying, well, no, there's something that can really help you. Prozac looms large at Eli Lilly. Dave was one of two executives I spoke to who brought it up. Because Prozac was a blockbuster. There were news stories about it. It was a cultural reference.

And it became shorthand for a whole class of drugs that treated the same disease. Yeah, this kind of feels like a familiar song. You can sort of see the similarities between Prozac and the hit that they have now with Terzepatide. I still get letters from patients who've been on Prozac for 30 years who say it saved my life. It's definitely changed it. Does that mean it's a silver bullet? It treats everyone? No. And I think that'll be the same for Terzepatide too. It's an amazing drug, treats a lot of people successfully with overweight. We hope to translate that into long-term health outcomes. And, you know, we're betting it will translate, but will it solve the problem for everyone? No. And so we need more

innovation. We need more solutions. I think in mental health, unfortunately, Prozac capitalized on a wave of understanding of these signaling molecules in your brain, but the science kind of stopped. I thought this was interesting. Dave's saying that Lilly didn't seize the moment that Prozac gave them. They created this big drug, but after Prozac, they didn't really develop new drugs building off that science. And once the patent ran out, they lost a huge percentage of market share to

generics. Right. So now they're trying to learn from the past. They want to keep innovating, and they're working hard to come up with the next generation of these diabetes and weight loss drugs, both to keep their patents and to keep their place in the market. And this time, they're moving fast. Oh, yeah. That sounds a little bit like Silicon Valley. Move fast. Exactly. And one of the things they're hustling on is a drug that Lilly's scientists hope could be their most effective yet. It's called retatrutide. Eli Lilly is working on retatrutide, which builds on Zepbound and Mount Jaro.

Yeah. Retatrutide is building on, as you said, the trisipatide idea. It's adding another incretin hormone or gut hormone that affects metabolism. All right, quick review, Brad. Okay. The way these drugs work is they mimic hormones that regulate appetite. I feel a little bit like I'm getting ready for like a biology test or a chemistry test, so let's go.

Okay, semaglutide, that's the main ingredient in Ozempic. It mimics one hormone, GLP-1. Yes. Okay, and terzepatide, the main ingredient in manjaro, mimics two hormones, GLP-1 and GIP. Gold star for Brad.

Outstanding. Outstanding. So this new experimental drug, Reta-Tru-Tide, which isn't out yet, that one mimics three hormones. And the third hormone is glucagon. Which really has a strong effect on visceral fat and liver obesity and other really difficult to treat types of obesity. As a result, you lose even more weight than terzapatide. We have to prove that in a big phase three study, but we expect to. And I think for people who have a higher starting body weight, this could be a really better answer because as amazing as terzapatide is, on average, people lose 21% body weight at the high end. But

if you're starting BMI at, say, 40, which is the edge of what we call morbid obesity, and you lose 21% of that, your ending BMI will be like 32. You'll still have obesity. Whereas if we could do better than that, we could bring people into a more normal range. So that's an important unmet need.

So what's most important to know about retatrutide is that it could become the most effective obesity drug out there. In phase two trials, Eli Lilly reported that the drug led to an average of 24% weight loss. Right. Now, to be clear, retatrutide is still in phase three trials. So it'll be at least a couple of years before it's even up for FDA approval. But Lilly isn't just banking on retatrutide, right? Definitely not. Dave Rick said that they have

almost half a dozen other research projects around obesity. Some of them will work, some of them won't. But I think we really see diseases becoming tractable and fixed in a broad way when we have many ways to attack them. And we're investing heavily in that. And hopefully it'll be successful so that the people who can't benefit from

triseptide or semaglutide can benefit from one of these other newer medicines. So there's a lot in the pipeline. A lot. Yep. Something else in the pipeline is getting an effective medicine in pill form. Right now, the most effective GLP-1 drugs are all injections. Yes. I mean, polls show that more people would be interested in these drugs if they weren't shots, including a me. Exactly. And I learned that the pill version could also help with the shortage because then they wouldn't have to make those injector pens.

And this new pill is called, well, I'm just going to let Dave Rick say this one. The other one we're working on is this terrible to say name called Orforglipron, which is an oral GLP-1 drug that you'll take once a day in a pill and you won't have to inject. This could allow us to make more drugs. So I think there's a lot of production problems, but this won't rely on the same complicated systems that we need to use for triseptide, which has to be injected and all the challenges with that. So just to be clear, it is easier to produce an oral medication? It is a little bit easier, but more importantly, those production systems are already built.

So we have many, many oral drugs in the world, and the systems used to make, or Forbidopron will be quite similar to those, whereas in the case of terzepatide, really it's a specialized way to make a drug. Yeah, and Lilly's not doing this in a vacuum. Their main rival, Novo Nordisk, is also trying to get an effective weight loss pill into the market.

It's called Mecretin. And when Novo announced the results from a phase one trial back in March, the company's stock hit a new high. That's right. And Lilly is, of course, always paying attention to what Novo is doing and vice versa. The two companies have been competing for the last century. Well, I've been in my company for 28 years and every day of the year, we've considered Novo a respected but fierce competitor. And that's how we still see it. You know, we grew up in the diabetes segment, competing with them and insulin and then other types of medicines. They then launched Ozempic, you know, and pushed for higher doses, which showed a breakthrough in weight loss,

which we, you know, then improved upon with Terzapatide. I'm sure they're coming up with something to try to beat us. Beyond just Lillianovo, all these other companies are trying to break in too. There's Pfizer and Amgen and Roche and a whole bunch of others. They're all working on weight loss drugs. And I talked to a venture capitalist who said everyone he knows in biotech right now is investing in GLP-1s or some related category. He said he himself was taking two to five meetings a week connected to obesity drugs. It really is like a GLP-1 gold rush.

I mean, there's all this escalation, sort of the Darwinian nature of competition, all these drug makers one-upping each other, companies trying to get their share. Yes, a gold rush for sure. And of course, that's going to make a lot of money for these companies. But also, it's possible that this type of competition will help bring down prices for patients.

Yeah, we did a whole episode on how big a barrier price can be right now with these drugs, so that's really important. There's also another thing that could really increase access to these medicines, and that's the impact they could have on other health issues. Two clinical trials are currently underway to see if the miracle weight loss drug Ozempic

could help people with early onset Alzheimer's. Ozempic, the diabetic and weight loss drug, can also decrease kidney disease, according to some new research. The manjaro that they're taking is reducing their cravings for alcohol, reducing their cravings for cigarettes and vaping, reducing their nail biting, reducing their desire to go on shopping sprees. If you could use it for all these applications, it would truly be a miracle drug.

You know, it seems like these drugs are potentially going to disrupt a lot in the world of health care. Not only that, but maybe the broader economy too. That's after the break. Looking for a change of scenery? Come on over. Let us give you the tour. Grab a paddle and explore. Hit the trails and go.

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Savor the best taste in tequila. 1800. Taste is everything. Please enjoy responsibly. Okay, so Jess, let me read you a list of conditions that people think that Ozempic and drugs like it could help treat. Okay, hit me. Alzheimer's, Parkinson's, kidney disease, infertility, PCOS, sleep apnea, some liver diseases, and even the whole area of cardiovascular health. In fact, the FDA this year approved the use of Wegovi to reduce the risk of heart disease in overweight or obese adults. And some of the other studies are still in the early phases, but if the research pans out, that would mean a single class of drugs

would hit a whole bunch of different health issues. Yeah. One condition that scientists are looking into that I found really interesting is addiction. And that brought me recently to Baltimore. We went to one of the offices at the National Institutes of Health, which is a medical research agency

run by the federal government. Okay. And once we got there, we walked down this long, nondescript hall, lots of closed doors and hushed voices, and then were ushered into a bar. Ah. We've got Malibu and Kahlua.

There's Bailey's. There's Tito's Vodka, a couple bottles of those. We've got Smirnoff. Okay, it wasn't a real bar. It was a testing center made to look and feel like a bar. Actually, let me play you some of the audio they pipe into the room for some of their experiments. Okay, yeah, now I'm kind of feeling like I'm at a bar. Right?

The scientists there call it the bar lab. And I met the guy who set it up, Dr. Mehdi Farouknia. You don't have to call me doctor, but... Mehdi studies addiction. It took him months to put this bar lab together. I'm originally from Iran, and probably you know alcohol is illegal in Iran, so I did not used to go to bars. Like, I didn't have much information. Did you have to do research?

Yes, and I learned a lot from our students, actually. His students helped him nail down the details of an American bar, the cash register, the dartboard. Mehdi also stocks the fridge with mixers and snacks. Sounds pretty legit. I mean, it was. Except there was one thing I noticed right away. Is this a one-way mirror over here? This is a one-way mirror, yeah.

So we do have an observation room next door. Sneaky. So for months now, Mehdi's team has been giving people with alcohol use disorder, Ozempic, or Wegovi, or a placebo. They want to know if semaglutide can help people drink less. We ask people to sniff their alcohol. So we ask them what's their alcohol of choice. We provide that beforehand. So the participants sit at this fake bar with their drinks, and then they hear a recording. Remember to begin sniffing the alcohol when you hear the high tones, and stop sniffing when you hear the low tones. We will begin now.

So just to smell it, not to drink it. Mm-hmm. That sounds pretty tough if you have alcohol use disorder. I know, but that's kind of the point. And I should say that participants can stop whenever they feel the cravings are too much to handle. So what's the research showing? Is this actually working? They're still in the middle of clinical trials, so we won't see the data for another couple of years. But the researchers are really hopeful.

And it's because we're already hearing a lot of promising anecdotal stuff, including from a couple of people we spoke with for the series. One of them is Kristen Kucyric. She's 37 from Austin, Texas. I did have some brushes with alcohol in my college years where, you know, went through a bad breakup, just kind of stopped caring about life. I did get a couple DWIs in my early 20s. So I don't know if I would call myself an alcoholic.

I definitely haven't had an issue since, but I could definitely say that I've, I'll go through phases where I've abused alcohol. Kristen started taking Ozempic back in February. And almost immediately, she went from being a pretty social drinker. My boyfriend and I would drink for the night and it would be a lot in one setting. ...to saying, no thanks.

I just, I don't, it doesn't sit well. I don't really want to go and have drinks after work. I did read that a lot of people just weren't interested in drinking anymore. And I was just like, that can't be true. Like, first of all, it makes you want healthy food and not want sugar and stuff. And it also makes you not want to drink. But it's like, what are these people talking about? This is wild. Yeah. It's like, this is a miracle drug. So when did you start noticing that taking a Zempik was having this effect on your desire for alcohol?

I can think of only a few times that I've really tried to drink, you know, a friend's housewarming party, a clam bake or an oyster bake, and I've just nursed a glass of wine or a beer the entire time. I don't have that urge anymore. I don't have that urge anymore. So it's both. It's both you don't want it, and then when you do have it, it doesn't sit well. Yeah. It's not just one or the other. Is the experience of it, like, does it still taste good to you?

Like, is it still an enjoyable thing? Not really. It doesn't taste like it did. Like, I actually like the taste of alcohol. I actually like the taste of beer. I know some people don't, but I do enjoy it. I think the last time I really drank much was the Super Bowl, and I felt very sick afterwards, like the next day. Kristen also said she stopped her lifelong habit of biting her nails, and she thinks it's related to Ozempic.

Wow, that's really surprising. I mean, we know these drugs dim the reward centers, you know, the parts of our brain that are linked to addictive substances like fatty foods. So, in a way, it makes sense. Mm-hmm. Novo recently announced that they're also studying the effects of semaglutide on alcohol-related liver disease. And Eli Lilly is looking into what else these drugs could help treat as well,

beyond diabetes and weight loss. These developments might be good news for patients. But Lilly's CEO, Dave Ricks, was pretty blunt about how all these changes might hurt some businesses. We're about to read out a big study in sleep apnea. There's these CPAP machines, which like many people use. And they're quite interested in what's going to happen next. Because the idea here, though, is we will directly displace those things.

Like that's not our strategy, but we are trying to make it better and easier to live with those conditions by losing weight. We're also doing studies in osteoarthritis of the knee. Will that reduce long-term knee replacement? Maybe. And I think that'd be great. But if you make knee replacements, that's not great. But I'm sure there's other health problems they can go work on and make devices for.

So Dave Ricks was basically like, yeah, some of those things are just going to go away. So be it. Yeah, I mean, some things are already taking a hit. So bariatric surgery, which is a weight loss procedure, that's seen a decrease of 10 to 20 percent in the U.S. because of these medications, according to a report that came out last year. That's interesting. And it probably won't surprise you, Brad, that one of the industries that's really

watching these drugs closely is food. you, Brad, that one of the industries that's really watching these drugs closely is food. Oh, yeah, that tracks. Dave said he's had lots of conversations with food companies. So last year, the CEO of Walmart said that people who bought these types of drugs at Walmart pharmacies were buying less food at their stores. You know, we've heard from like Pringles and Cheez-Its. They're studying the impacts of these drugs on dietary behaviors. Are you personally hearing from these companies? And what is it that they want to know?

Well, of course, we talk to Walmart and all our big food stores, which are also big pharmacies for us. And that's how Walmart can do that study. Others have done that kind of study. They haven't been as noisy about publishing, but I can share that it's pretty consistent. But we shouldn't be surprised by that. If you just look at the big phase three study for terzavitide or manjarozeb bound last year, on average, people consume like 600 to 800 calories less a day when they're on the drug. That's about one meal.

So that's a pretty significant reduction in calorie input. And they're going to buy less food if they're not eating it. So I think it's kind of obvious. Dave also pointed out that people tend to eat different kinds of foods on these drugs. So they're eating less and they're eating healthier. Yeah, I definitely experienced that when I was on Manjaro. I mean, it really feels like the conversation about this medicine is sort of penetrating the culture more broadly. One example of that is South Park, the national treasure slash extremely vulgar cartoon. It recently did its own take on these weight loss drugs.

All of us in the sugar business have a big problem. And there's a scene where the head of Big Sugar is like sitting in a boardroom with a bunch of cereal mascots, and he's watching drugs like Ozempic sweep across America. These obesity drugs are an attack on all of us. Even you, Captain Crunch. The drugs are moving in on our turf. We'll all be in trouble soon.

Trix Rabbit, Tony Le Tigre, and Sugar Bear. Obviously, South Park is a satire, but it kind of underscores a big point, right? Which is, a lot of businesses feel threatened right now. Mm-hmm. Though, Dave didn't exactly express concern for the plight of Cap'n Crunch. Lily doesn't have a point of view about this, but I do personally, which is I think our food system could be healthier. And so if they're worried about salty snack foods, high in fat, saturated fat, are selling less,

I'd say, well, why don't you make healthier ones? Or if you're worried about fast food volumes or whatever, then maybe make healthier fast food that has smaller portion sizes. You know, these are options they could explore. The reality is we've gotten really good as a society at making food abundant and cheap. And what we haven't gotten as good at is making it high quality. So that's the conversation I have with those CEOs.

Yeah, it seems like Dave Ricks and I are on the same page about America's food system and all its problems, you know. Yeah. But, you know, that brings up a question for me. How is the food industry responding to all this? To find out, we talked to our colleague, Jessie Newman. She covers food companies. So, Jessie, it seems like food companies are paying a lot of attention to these weight loss drugs. Oh, absolutely. Anytime that diet and appetite suppression is something that is being discussed among consumers and is in the culture. You know, food companies are going to take notice because at the end of the day, they exist to sell us food and to make us eat. Who have you heard from about these drugs? A number of executives acknowledge that this is potentially a pretty seismic shift.

Mark Schneider, who is the CEO of Nestle, told analysts on a call in February that these drugs called GLP-1s are a really important new trend. I think he actually said, diets are cool again. So I would say Nestle was one of the first food companies that came out and said that it was planning to work, to create, to develop what they're calling companion products. These are products that drug patients can take while they're on Ozempic or Wegovi to address some issues that they may be facing. Nestle is trying to prepare itself for this lower-calorie future. Nestle has already introduced these so-called companion products for people on GLP-1s.

They're high in protein, and the company emphasizes their nutritional value. And I talked to an executive at Conagra Brands, another big food company. They make Slim Jims and Ready Whip. And he said that they're doubling down on high-protein snacks and portion-controlled meals like frozen foods. I mean, I can see why companies would want to take advantage of this moment. I definitely ate a lot more protein and fewer carbs when I was on the medicine. Mm-hmm. And beyond food companies, Wall Street is still trying to make sense of it all. Investors are figuring out who's going to be a winner and who's going to be a loser in the future of GLP-1s. So food is a big part of that. But for instance, one analyst made waves last year when she said that airlines could save

millions on fuel if their passengers weighed less due to these drugs. That sounds a little far-fetched or maybe a little premature, but maybe. I mean, maybe this analyst will be laughing at me in 10 years. I mean, I'm with you on that. Maybe they'll be laughing at us in 10 years. But the big takeaway is that a lot of industries are bracing for changes. Meanwhile, one clear winner in all this is Eli Lilly. It's jockeying with Novo Nordisk to become the first pharmaceutical company to be valued at a trillion dollars. So right now, Lilly is hovering

in the $750 billion range for market cap. Who do you think will be the first to $1 trillion, which would make history? Is that a goal? It's not a goal for me. I think the companies that can produce better medicines will create more value and that'll make them more valuable. So it's just a function of products. We're a product business. We invent molecules. We study them to prove their value. We make them

and then we have to get them through the healthcare system to people. If we do that well and do it over and over again, I think we'll be worth a lot. Lilly's got a lead and we plan to exploit that lead, you know, for the benefit of patients in the end. When you reflect on the impact of these drugs, how sweeping do you think they will be? Yeah, well, you know, it's very early innings here. We're a few years into this development. I'm pretty sure at this later stage in my career that I'll never work on a more important medicine than terzapatide. Wow.

Super proud of that. So what we're seeing here is that this is just the ground floor, you know, the early days, which kind of makes you, Brad, an early adopter, you know, the early days. Which kind of makes you, Brad, an early adopter. You know, I hadn't thought of it that way, but I guess that's true. Yeah, clearly we're still in the middle of the story. It's sort of easy to think of this moment as the peak of these drugs, but it's not.

Like we've said, there's so much more coming. Drug development, maybe some undiscovered health outcomes, even changes in how we talk about obesity. And of course, lots and lots of money to be made. Yeah, for sure. And, you know, that's just the bigger picture. I still can't help thinking about all the people we talked to throughout this series, people who have struggled for years to manage their weight. Those stories are continuing. And I think that's really whether they're using the medicine or not. Right. And I mean, speaking of stories, Brad, I kind of want to get back to yours. You know, it's been five months since you stopped Manjaro. Where are you now? I mean,

it's interesting. You know, my weight is the same as in January. I had a period where I gained about five pounds, but I'm not sure if that was from the high protein diet I had or the weightlifting I was doing. But I'm back down to the same weight, which is about 192. But it's hard. I had a doctor's appointment and I looked at my smartwatch to tell them how much I've been exercising. And it said it was an average of an hour and 40 minutes a day.

Wow. You know, that includes walking, but that's a lot of time, you know? Yeah. And I think a lot more about food, you know? I think about food a lot. Yeah, I mean, an hour and 40 minutes. That's a lot, like even with walking. Sounds really hard to maintain.

It is. I'm trying my best to keep it up, but a part of me kind of wonders if it's sustainable. You know, there are a lot of strange things where you feel like you don't inhabit the same space as you did before. You know, my wedding ring kind of slips off, right? More and more pants are too big. And then I'm kind of in the very beginning

of just rethinking food completely. And, you know, what brought me here when I started taking the medicine was really that relationship that I had with food, and there's a lot to unpack there. And I think I'm still in the early innings of figuring that out. Yeah. What's been the biggest change for you? Oh yeah you know. Didn't want to take my shirt off when I would go in the water in front of people.

Didn't want to go to weigh in at the doctor's office because I didn't want to get a lecture. I've just been discovering new things that I didn't let myself do, And so I don't want to do that anymore, no matter what happens, no matter if I gain weight back or if I don't, I just do not want to live that way. Just going to be in the present and try new hard things and remember not to kind of live in that land of woulda, coulda, shoulda, you know? Yeah. So, Brad, what's next for you?

What's up ahead for the summer? I'm training for something pretty big right now, actually. I'm going to try to summit Mount Whitney. It's the tallest mountain in California, and I'm actually going to try to do it in one day. Wow. As a one-day hike, it's definitely kind of a beast. It's above 14,000 feet,

and it's hard enough that I really don't know if I'm going to be able to do it. I've been training with my wife, and we've been walking together mostly in the evenings. All right, so we're just going on a little hike in some of the woods and trees around our neighborhood. Characteristically, she's walking much faster than me. I've got longer legs. And that's kind of fun. It's fun to kind of say, I'm not sure I'll be able to do it,

but I'm gonna give it a shot and see. And I think I have a pretty good chance. It's just a perfect NorCal day. Kind of East Bay NorCal day too, you know? Because we know that in a couple months it's gonna be like kind of hot. But right now it's perfect. But right now, it's perfect. Let's walk a little faster. No. No. Thank you. with help from Jivika Verma. The series is edited by Catherine Brewer. Fact-checking by Sophie Hurwitz.

Sound design and mixing by Peter Leonard. Music in this episode by Peter Leonard and Emma Munger. Our theme music is by So Wiley and remixed by Peter Leonard. Special thanks to Maria Byrne, Stephanie Ilgenfritz, Kate Leinbaugh, Peter Loftus, Enrique Perez de la Rosa, Sarah Platt, Jonathan Rockoff, Jonathan Sanders, Nathan Singapak, Leying Tang, and Griffin Tanner. We also want to thank all the people who spoke to us and shared their experiences about weight loss and the drugs. And thanks to the rest of the journal team. Victoria Dominguez, Pia Gadkari, Rachel Humphries, Ryan Knutson, Annie Minoff, Laura Morris,

Alan Rodriguez-Espinosa, Heather Rogers, Piers Singhy, Lisa Wang, Catherine Whalen, and Tatiana Zamise. If you enjoyed Trillion Dollar Shot, The Journal has way more where this came from. Follow us at The Journal on Spotify or wherever you get your podcasts. Thanks for listening.