Pushkin. Hello, Hello Revisionist History listeners, Happy New Year. Twenty twenty five is going to be a great year for this podcast, and I want to give you a little preview of what to expect. The main event of the year is going to be a multi part series from Alabama true crime, but with a very revisionist history twist, So keep that in mind. Then before we drop that,
we're going to do two other smaller things. If you remember last season, we did a series of interviews with screenwriters on their favorite ideas that never made it to the screen. We're doing another round of interviews this year, half a dozen or so. And then we're also going to do a smaller batch of old school revisionist history episodes, some weird, some funny, some that will break your heart. Over here at Pushkin, we've been hard at work all with the goal of bringing you a little bit of
audio happiness. Stay tuned, everyone, Welcome to Revisionist History. We have a special treat today. I had a chance to sit down with a guy named Diego Rao who worked for years at Apple Way UPI and then left to become the chief Information and Digital officer at Eli Lillian Company. One of the biggest drug makers in the world. Diogo, as you will learn, is irreverent and fascinating and sees a good ten years ahead of the rest of us.
At the end of our conversation, Diego said to me, you know, we never got to AI, which is true. Can you imagine a conversation about technology so interesting that you never get to the subject of artificial intelligence? That's what you're about to hear. We're going to talk about a whole number of things, but I wanted you to start because you're a very unusual figure. You work it for Eli Lily, but you are a very unusual figure at Eli Lilly. Is that a fair statement.
I think I have that reputation of being unusual at least I like to try to do things a little bit differently.
You know, I was talking about your background. Yeah, you you worked in the tech industry for how many years?
I worked in the tech industry Well, really my whole life, But I the last ten years before I came to Lily, I was at Apple, and before that I was doing technical other kinds of technology work and McKenzie and before that I was in the startup world. So I've really spent my whole life in technology.
How many people do you think have moved from Apple to a life sciences company?
About five? I think I know them all.
Do you guys get together reading most of them? And how did So this is a kind of I want to start this little on this little tangent, but how did that work? Exactly? So somebody comes to you and says, have you ever thought to work for a pharma company? Well?
Yeah, And that's the way a lot of these things start. It's you know, there was a recruiter that I worked with who who gave me a call and said, hey, I've got this this opportunity. It's in life sciences, and I was like, I've never done anything in life sciences before.
It's like, that's okay.
So I look at the spec and the spec is, you know, it's pretty interesting. So I'm like, okay, it's worth a phone call. And then I meet our CEO and our head of HR and like, these people are really nice. And so that's like the second thing that I noticed is that they're really, really, really nice. And that's that's a big difference, by the way, coming from versus the tech world. I have to say a little
more about that. And then I start talking to our head of research and development about some of the problems that we're trying to solve in life sciences, and I realized, Wow, this is like a fascinating space. I kind of thought that like everything exciting in the world was happening in tech, and then I then I came to realize, no, actually, there's a lot of exciting stuff that's happening outside of just the tech world.
Yeah, so let's start. So you make this when did you start your job at.
Lily May seventeenth, twenty twenty one.
So go through, just off the top of your head, the most surprising things you learned moving from Silicon Valley to a life sciences company.
Well, the number one thing that I actually saw was actually the nice people parts. But you know, the second thing that I noticed was really long time scales, Like the size in the duration of things is just it is just beyond belief. My first executive committee meeting in twenty twenty one, we were talking about a revenue forecast that was for two thousand and thirty and that was nine years out, like in tech, like, looking like eighteen months out of revenue is ridiculous.
Well wait, wait, so when you see that, what's your what's your reaction?
Oh? Yes, there's no way we can predict our revenues for you know, for nine years from now. And of course, now I realize that I'm in here, that there are a lot of things that you can predict and it is actually very predictable. It's a big bed. If it works, you'll know you'll you'll hit it. But it's much less volatile. It's these time scales are crazy though, because like at our last Executive Committee meeting right before the break, we
were talking about a product launch. I'll ask you a question, when guess when our product launch is that we were talking about in December.
Well, now that you've prime Prime three, it's going to be five, six, seven years.
No, twenty and thirty six, Oh my god. And so there is I can guarantee you that there are zero tech companies right now talking about what they're going to launch in twenty and thirty six.
Yeah. Yeah, and wait there not only so there is certainty that this this product will be approved, but just the the you can be you can be ten years away and be certain will be approved, but know that you still have ten years worth of work to do.
Yes, you can't be certain, of course, that anything is going to be approved, and so we apply a probability of technical success. This phrase I'd never heard of before I got here, But every step ale of the way has probability of technical success, and so you factor it in and you you know, you take all that into account. But you know, when you have a good medicine and
you know what it's going to take. But it just takes ten years to bring a medicine to life, and it's and I don't think that was one of the things that I realized before I came into this, just how long it takes and how much money it takes.
So it is possible that you will work on things that you will never see come to fruish.
In fact, most of our scientists that work here will never see their medicines that they're working on come to life, which is kind of crazy to think of.
And it's affect the culture of organization.
It gives it a really long term perspective, like crazy long term perspective when we when we're talking about things making decisions, we're really not thinking, you know, like at an executive committee level, there are some things that we're doing on a you know, on a this year basis. But there are a lot of things that we're doing that we're really talking about, like the twenty thirties, like just just a much different timescale from from anything else.
And so we're not going to do anything stupid. I think it's one of the one of the good things. We're not going to trade off some of the long term to get a little bit of a benefit in the short term. So I think it makes us much more rational all that way. I guess I would say we play the long game.
But I want to go back to so you come to Lily and I'm curious, so what did they want from you?
My boss, our CEO, gave me a mandate to really change, to bring in technology into everything that we that we did, So it was not a caretaker role, sort of a mandate. You know, we want you to just keep running the things. We want you to really figure out, like what can you do to shake things up? And so that was really that was really the goal. And I think a big part of it was bringing a consumer orientation as well.
And I think this is an industry that has largely worked the same since the nineteen fifties, I mean, if you look at it, the way you get medicines today as a patient is basically unchanged. You go to your doctor, they write a form. Maybe now they submit your prescription electronically. You still have to make sure you can pay for You still have to go to a retail pharmacy in most cases. None of that's really changed since the nineteen fifties,
even though we have so much more. So a big part of what we're trying to do is actually a big part of my mandate is to really bring this into the twenty first century, or at least the late twentieth century.
But is there within the portfolio of things that Lily does, do you touch on everything or just are you? Are you focused on the consumer side of the business. I mean, what's the kind of not to remit?
The great thing is that I get to focus on all of that stuff, So everything that's technology related. I do cover everything from the discovery side through the consumer side, and actually those are probably some of my favorite parts. And I'm going to because of course I shouldn't be say favorites, but you know, I love the discovery side and discovering new molecules and what we can do there a lot of cool stuff, especially with AI, we could
talk for hours about. And the consumer side is also the place where I see where I have a passion coming from my prior life at Apple and just seeing the potential we have to change everything there. I think this whole industry hasn't really focused on, like how do we make it an amazing experience and work backwards. I think the kinds of things that you see at Apple and a lot of other consumer rinan companies just haven't haven't arrived here yet.
And how does putting the customer first in that chain of the h in that chain of kind of interest groups change the way you do business or change the way you think about what you're doing.
That was the most fundamental thing that I learned from my time at Apple. And I think most companies will say, oh, we care about the customer. But you know, whenever you start a project, people will have I don't know, they'll have five pillars or five things they need to go after. Well, maybe there's the business case, the product, the customer, the you know, you know, you'll have like five or six different things. And the way you'd always do things that
Apple was was different. You would always start by like what's the customer the consumer experience that you want to create, and then work backwards and then figure out business. You know, can you make a can you make it a financial case around it? Well maybe you can't, Okay, so we need to maybe we can see how we can change the back and forth. But it really was everything was centered on the customer experience. It wasn't like a pillar of one thing of five. It was like the thing
that was that was guiding everything. And I think that's we're not there yet, but that's like that's the kind of thing we need to do. Like every single time we need to go, uh, we need to go back and see what's what's the customer experience? Like we need to actually focus on like making a customer experience better.
You have a whole table full of goodies over there. We need to pick a goodie and let's let's use uh uh this as a specific walk me through the kind of thinking behind the product, uh, the kind of challenge, the specific challenges, how it represents this process that you've been talking about. You pick great not just so people know this about but a couple of feet from from diego is there, there's about looks like eight to ten. Uh, mysterious boxes that are so.
I have to I have to have to share with everybody that like. Uh, Malcolm and I had a little prep call before, you know, a couple of weeks ago, and it was only about ten minutes because he just said, okay, you know, if you got any toys, any goodies, like, bring them along, and so like, my team gave me a box of goodies here which is all slayed out on the table. And then uh, and then I think you said, okay, and I want to talk too much more, Let's not do any more prep.
Well, the thing is, if you have small children, as I do, you think exclusively in terms of of shiny little gifts, you'd be sprung. I almost said, can you bring snacks? That would be only stop awesome?
All right, so let me grab a box. All right, I'm going to show you something that's that is now. Let me grab that one, yep, and I'm I'm going to hide it here for just a second. Tell you what the what the problem is that we're going after. One of the big challenges in the world right now is medicine and medicine safety. When I was at Apple,
I saw counterfeit iPhones, and I couldn't believe it. You wouldn't know that they were counterfeit until you actually picked them up and played with them for like half an hour. And sometimes we would have to send them in and have them get X rayed to know that they're they're fake. Well, that was on those were on products, you know, that was like a thousand dollars product that Electronics very hard
to make counterfeit, but the economics were there. Medicines are a lot easier to fake or at least make them look fake. All you need to do is copy the box and you know, if it's in a vial, you know, put a label on it something like that. And with some of the medicines that are out there right now, there's a huge financial incentive for people to have to make to say that they're making medicines that they really are not and they're faking them.
What would be just just just fascinating. What is there a particular kind of medicine for which the counterfeiters motivation is greatest?
Well right now, uh, in chronic weight management, we have the g LP one medicines and so above for for us and the other leading maker of g LP one medicines. Counterfeiting is a real, real threat and back to formularities and things like that. A lot of insurance plans do not cover uh, chronic weight loss management. Uh. And so there's a huge financial incentive on the black market to say, hey, we're going to go and.
Some uncertainty about outcomes. So you would take you a while to figure out you're taking a fake correct it.
And I mean it's not only I mean it's not only fake, it's actually many of these cases are risky because once you see, uh, once you see like the sterile environments that these medicines go through to be made, you know that it could in the best case, it's harmless, right, I mean, the best case is you don't get any effect. And so what I've got here as a product, I'm gonna uh, this can be any product and uh it's so don't pay attention to what product this actually is.
And I've got the product right here, and I can tap my phone against it and I will get it in an an NFC tag. And that n f C tag is just like when you do a contact list payment and it will bring up, it'll bring up a page to show you that you could actually verify that the packaging matches something that we've produced. Unlike a QR code,
it can't be copied. It's cryptographically secure. And this is where the technology part gets interesting, because they can copy the box, they could do all kinds of things like that, but they can't copy that tag. There's one and only one tag that you can that you can tap and then we can verify it.
Yeah, so how how how long did it take to develop that particular technology?
So it took uh, this is something we did within my first few months that coming here. Uh, and we haven't launched it yet, so they the designing it is very easy, the developing it is very hard.
So you could you could do. What you're saying is what you have is a technology that could be a platform or for building an interaction between the consumer of the bill, the patient correct and the manufacturer.
That's absolutely right. And you know, we actually don't even care about it necessarily being just for us, Like this is the kind of thing where we'd say, this is a great thing. If adherence can improve for patients across all medicines, all manufacturers, that would be fantastic.
Yeah, how but you've put that RFID tag on the box. Correct, But now there's still a thing inside the box.
Still up staying inside the box. So this is version one, which is on the box, and then version two, which we'll come to later, will be on the individual medicine itself.
What about protecting against an unauthorized use of the medicine? What if the wrong person taps to your phone?
Against absolutely then you could actually make sure that you're taking the right medicine. I also think making sure that you haven't taken your medicine more than once in a day is also an important thing because, you know what, it's actually very easy to do. And I also think that in a hospital environment it also is you know, you could tie it into systems and make sure that
you're actually administering the correct medicine. Uh, not something that you can imagine a work flashing up on on the health healthcare provider's device if it's the wrong medicine.
So this is beta with the box. Yeah, how long how many years before you think you could be actually in the pill itself? The pill itself.
I don't know if we'll ever get past the consumer acceptance of r f I D like if like actually being in the pillow soft. But if we could get there, that's that's not super far out, that's probably you know, probably five years out of Yeah. Yeah, but it's not the technology.
Your better version is that you point your phone at your gut and you find all the stuff that's in there. Goodness, what do they have for dinner?
Yeah? Exactly, it might not be good to find that out.
Pick another wearable because now I'm interested. First of all, has literally ever done a wearable before?
Uh? No, We've not produced a wearable of our our own, and it ends up being a little bit challenging as a manufacturer. Be a lot easier if we didn't make drugs to actually launch a wearable. But because you make drugs and then then and then the question is as well, are you using this too? Does it have to be? Is it required for somebody taking to medicine? So there's a whole host of things that makes it really complicated
for us to do it. So the most, for the most part, where we use these things are in clinical trials.
So how many wearables take me ten years into the future? Yeah, how many wearables am I wearing? If I want to be completely you know, if.
You're a nerd out on all of this. You know, I think it's probably on the scale of two to three. I think I think there are only so many places that that you're willing to put a wearable, you know. I you know, you can imagine there's your ring, there's a watch, and you know that you might be able to if you've ever had like a ziopatch or anything like that, part catch. Those are not terribly uncomfortable insuls.
You know, you could, you could imagine, But after that, you don't have that many more places I think that you would you'd be willing to wear something. So I'll go I'll go with those three tops.
I was gonna say eyes I was reading eyes. Yeah, but really I was really a really fascinating study that was looking trying to figure out what the difference is between a novice police officer and an expert police officer. And they use eye tracking and gave them scenarios and
figured out that they're looking at different things. So you have a scenario of like that guy here and this is happening here, and someone's throwing this here, and we see the experts like looking do do do do do do do doo, and the novice is looking right, Yeah, one spot versus But I'm just curious about, like, you know, my sense is this is kind of once you started going down this road. Yeah, there's lots and lots and lots and lots of things.
No, I thought you were going to go down a different path, which is like the what you might like enhancing your eyes or your hearing or things like that, which is also like that's just another fascinating space of science.
And yeah, yeah, why one of the things you said earlier big more interested when you said that if you're making drugs, and the question, one of the questions that comes up is are you using the something like this a wearable to market the drug? But I'm wondering whether that's there's another way to frame that is. Surely one logical step here is that you start to you're not just giving someone a drug or giving someone a drug in combination with a set of wearables that allow us
to maximize the value of the therapeutic. Right, is that what we're are we gonna be? Are we gonna be? Are you gonna be getting from your pharmacist or your doctor a package of things to take home along with your medication?
We do that with some of our clinical trials, you'll get like, here are the devices to take with you. But if you look at weight loss medications, we've we're already all doing that right now, like because we all have scales in our house, right and so and so. I think that is a great example of like, if you give feedback to the person taking the medicine, they're going to be more likely to stay on. At least
that's one of my hypotheses. I think that if you took away if you took away scales and you took away mirrors, I think a lot of people, a lot more people would drop off the product weight management medicines early on. But the fact is, when you get on the scale and you can see, hey, I lost you know, I lost some weight, you want to stay on it. We don't have anything like that for staffins or anything else, right,
And that's again like why people people drop off. Just imagine if you could just see, oh, hey, actually you know, or I'm taking cholesterol medication and you know what, Hey my cholesterol went down versus yesterday, not versus three months ago.
Yeah, who controls this data? So interesting? You began this conversation in talking about the multitude of steps that exists between the manufacture of some of these medicines and the user. That's right. Now, you're talking about a system where presumably the manufacturer can speak directly to the patient. Correct. Does this mean that you cut out some of the middlemen?
That's my hope. But the data, ultimately the first part of your question. The data really should be with the patient. And I think there's a tendency to say, even still today in this industry, that the data is really for the healthcare provider, and I think that's I think that's a mistake. I think ultimately the data is for the patient, and the patient can choose to share what the healthcare provider, and the healthcare provider.
Can look at it.
But it really is it's really what the abot.
So my mom is an interesting home has archives, yeah, which acts up on and so she moves around a lot. This is a perfect tool for her. So somebody is so does she is the model here that she checks her movements scores and that's a way of and she can choose, she can see, oh this is time to share that my data with a practitioner. Isn't it more efficient for her to have someone who is or same AI or something that's continuously monitoring her.
I think the continuous measurement part is you're you're absolutely correct about it, but I think it needs to be I think she always needs to be able to see the data herself.
Yes, and see that.
And by the way, that's not an that sounds That's one of the things that sounds obvious if you're coming from outside the industry to inside. But inside the industry is you know, it's like, wait, why would you share the data with the patients themselves? You want to you know, that's something that the healthcare provider should see first. I mean, what happens if your mom misinterprets the data without the advice of a healthcare provider.
That's kind of the big.
Caution that would keep keep the industry from from saying your mom should be able to see that data yourself. But I take a very different view on that.
But we're moving. What's interesting, you know a lot of these things. The implication a lot of what you're talking about is we are moving the uh, the primary point of contact from the hospital of the doctor's office to the home.
Right that's if you don't moment going on a tangent on that too. That's one of the reasons why I'm really really excited about like how we can change things too, because if you look at it today, it's there are so many barriers to getting medicine, you know, Like first you have to get a doctor's appointment, which we've all suffered through, like it can take months to get one.
Then even after you have one, then you also have to be able to get it actually get access to the medicine, which is a big problem because I don't know if you've heard these stats before, about forty five million Americans live in pharmacy deserts. Forty six percent of the counties in the country are in pharmacy deserts, where
there's no pharmacy within fifteen minutes of your house. And so I think and so if you add all that together, it can take months from like the moment you say, you know what, I'm not feeling well or there's something I want to change in my life to like the day that you get the medicine. I want to bring
that like down to like the same day. You should be able to say, you know what, today's the day that I want to do something, and you should be able to go in, you know, get get a telehealth appointment and if a medicine is appropriate, get it shipped, and get it a ride delivered. You know this the exact same day.
Well, one last question for you, define what success looks like for you. So you're how old are you?
I just turned fifty.
You're a young man.
I can't take care of that very often.
So you let's assume you retire from Lily at sixty five, okay, and I so take me fifteen years into the future and tell me what would have to happen for you to feel like your time at Lily has been a success.
The biggest thing for me are going to is going to be the consumer side and actually making really cracking this and being able to like get that vision of people saying I want to take a medicine and I'm going to get it the same day, and then I've got the tools to stay engaged with forever. Like that would be. That's millions and millions of lives touched by just getting medicine and staying on this. And that's one side.
The other side where I uh, where I would love to make a mark is on the discovery side and discovering new medicines with particular with AI. Can talk for hours on that, but I think we're going to see medicines no human could have ever imagined coming out over the next decade. Because it takes ten years or more to develop a medicine, it would take about fifteen years for that.
To come to life. Yeah, I was thinking, you know when you were talking in this is maybe a little bit far fetched, but in the world of deterrence. So the question is, if I have a law that punishes you for a certain crime, you're The deterrent value of that law is a function of three things, the certainty of punishment, the swiftness of punishment, and the severity of punish And of the three, we spend the most time thinking about severity, secondly thinking about certainty, and the one
that we neglect is swiftness. Right, it takes years in using us. And the argument that many people make is that swiftness is actually the most potent of the three. If you know you're getting punished the next day, then you're now. It's funny because if you map that onto what you're talking about. You were talking about the idea of getting medicine the same day. What you're saying is the swiftness variable is the neglected one here. And what if if we improve swiftness, do you think we would
change the psychological circumstances around which people use drugs? In other words, would the adherence problem be solved if we address the swiftness problem?
I think so.
Actually.
I think if we got swiftness and you could actually see an effect and know that something was happening, that would change things. You know. And and by the way, I love that model that you that you just mentioned. In the technology world, we have things break all the day time, and what everybody focuses on is like what's the root cause, and like what's the severity and how
you know, how wifely is it? The thing that nobody ever focuses on, which is where I try to get teams to focused on, is swiftness the mitigation time to mitigate. How long did it take you to mitigate that human process of like how quickly did you take the feedback and adapt? That's really you can. You can have all kinds of risks as long as you've got as long as it's reversible and you can switch. Uh, that's great.
So when it comes to medicines. If you can try it and get feedback that it's not working or not training in the right direction and change it, that would be that that would be amazing, and I think you would find that people would people would say, Hey, now I know that you know this medicine I tried wasn't working. I'm going trying a new one today. I can see progress. I'm gonna I'm going to stay on it because i know it's doing something well.
This has been really fascinating. Best of luck with all the work you're doing. I hope next time I see you, I will be have at least three wearables all.
Thank you, Malchael.
Yeah. Religionous History is produced by Lucy Sullivan with Nina Bird Lawrence and ben Adaph Haffrey. Our editor is Karen Schakerji mastering by Jake Korsky. Our executive producer is Jacob Smith. Special thanks to Mount Romano, Eric Sandler and Kira Posey. I'm Malcolm Gladwell.