Why People Are Losing Faith in Healthcare

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Uh GLP ones. I just I think this technology every time new data on the technology or, you know, evidence on the technology comes out, it's oh, it r you know, it makes you wanna eat more kale or it makes you nicer to your pets. I mean the This thing is just wild. The way I describe it is scaffolding on our instincts. Our our instincts haven't caught up with the institutional production of things that we traditionally were in short supply and that we develop cravings and even addictions for.

And GLP one's are especi essentially scaffolding out our instincts. Anyways, I'm a big GLP one fan, so I'm excited about that. Uh anyways, with that, I hope you enjoy our conversation.

Created a company that would do something new for the first time. We would list the ingredients of every medicine on the bottle. Which was a novel idea at the time. And then he signed every bottle himself. And that's like the signature of the company. That's the brand of the company now, was his signature. So the idea was quality and like transparency. And his first hire was a scientist.

So it was kind of the first iteration of a modern pharma company a long, long time ago, before the FDA existed, et cetera. Along the way, you know, we reinvented ourselves many, many times. That's sort of how the business worked.

every product we make goes off patent and goes to zero. So we have to keep inventing things to stay relevant. And uh there's been a lot of big inventions through history, including uh today, as you as you mentioned with GLP one therapies, which are making the company famous again.

uh product. Give us the overview or the pitch, if you will, about GLP one's taking the aperture back about this technology, why it's such a big breakthrough. and where you think it's headed, some of the things, some of the uses that people aren't talking about.

more common pattern for medicine. But here, pretty much universally, um, products like Zeppound or New Onfound A, they work. People lose weight. Almost everybody who takes them loses weight. That's an interesting thing. And then of course, People like to lose weight. That's another interesting thing. Uh, most people, when you have a chronic disease and your doctor gives you a medication, you take it.

you feel a little bit worse and you definitely feel a little poorer. But you don't feel any different. Um you're you're told that you're mitigating some long-term thing. But with these drugs, of course they change your chronic disease risk.

or they actually change the chronic disease if you have a comorbidity, but people also like being on them. I think that's a very different property than we're used to seeing. Those things all combined and the fact that obesity is kind of like a nodal health condition for more than two hundred chronic diseases. I think gives us a shot if we can um make enough and get them to people through the channels of healthcare, which we could talk about.

Um, when which are deeply broken, um, then you know, I we can make a huge difference in longevity, uh, life expectancy and suffering.

overweight or obese. And if you look at healthcare costs in Japan at fifty five hundred bucks per person versus the US at thirteen five, they have four percent obesity rate. We have a forty percent And that the industrial obesity complex, whether it's hospital systems, diabetes treatments, statins, kidney dialysis, hip knee replacements that the only way to to address the deficit would be Medicare, Medicaid, vastly reducing the

healthcare costs of Americans. And I can't think of any one silver bullet. And I'll I'll come back to cost because cost is a big issue around these drugs. But my senses, and tell me if I'm drawing too large a connection here, you can't really effectively address a deficit without going after healthcare and there's no way to substantially increase

Or decrease healthcare costs without going after obesity. Do I have that wrong? Am I or I mean I realize this is an ad for Lily, but I genuinely believe that.

um can't happen without changing the obesity rates. I I think that's r roughly right because of the downstream chronic diseases, which are now 80% of all healthcare costs. And the data we use is that about a third of all healthcare Is obesity related, so one point four trillion dollars a year. That's about the size of

the Defense Department proposal that Trump just put in and nobody likes. So, um, could you make it zero? I don't know. That'll take a lot of time, but we certainly should start mitigating it. I and the medicines themselves are quite a bit cheaper than treating the disease. I think that's been demonstrated.

we're gonna exploit more of them in in including double, triple and quadruple acting ones. But anyway, that family of hormones, of course, affects metabolic factors like how you metabolize fat and how much sugar, uh how you process sugar. The second thing is which is interesting is in inflammation. So you could also say, in addition to obesity, America is in a uh inflammatory crisis. Um, if we look at uh asthma, if we look at um psoriasis,

Um if you look at uh arthritis, I mean these are chronic inflammatory conditions. And it turns out that obesity and inflammation are close travel. Um, and we have now done studies, including with our most powerful medicine, which hope we hope to launch next year, the triple acting retatide that. Uh basically demonstrated that for um knee pain, a common, you know, form of arthritis, um, it was the most powerful pain reducing agent ever tested pharmacologically.

Um, and so that's quite interesting because you think of all the people we know in our lives who have pain. back pain, et cetera, and might also be overweight. That that's a a a very interesting target. And then there's these kind of third level or sec you know, two step away things that are hard to

explain fully biologically today, but we know are there. You know, we observe in trials, uh addiction and kind of the consumption of like um hedonic activity and substances, um, smoking, uh, gambling, online shopping are mitigated. Um, it they're not eliminated, which is an interesting thing, um, but they're reduced. And that occurred spontaneously when Novonordisk and Lily were doing studies, and now we're actually studying it pros prospectively.

I think obviously if we could get rid of those kinds of people with the extreme form of those vices. that's gonna be a good thing for society and healthcare costs. And then, you know, I think the final one is cancer, which is uh there's some publications recently that are observational. These are these are gonna be very difficult studies to

kind of do prospectively in a double blinded way because they t they will take very long time. But um it also turns out being obese for several types of cancer really increases your risk. colorectal cancer, breast cancer in particular. Um, and now they've looked backwards and said, it turns out people who've been using GLP1 drugs for treating their diabetes for five or six years seem to have lower rates of cancer. Um, so that's a another extremely positive spillover effect.

than obesity, which shocked me. Um, I guess we talk a lot about alcohol on the show, but talk a little bit about GLP one's impact on just wanting less, specifically as it relates to alcohol and other addictions.

the desire for nutrients, uh, they do the same for alcohol. And it doesn't I think they worry that they this is also like a a joy kill switch on joy. And we could talk about that too. That's not actually what we observe in the data. I think most people have fewer drinks. They just find less pleasure in having one more, if you m if I could put it that way.

Um, and so they don't. And at the end of the day, you know, we've learned also, you know, alcohol is not that great for you. So um it might be nice to have a glass of wine, but do you need five and uh It seems like these drugs curb the desire for the second and third uh glass. Yeah, that's a good thing. We'll we're pursuing a medicine called brinepatide in phase three right now, which will seek to get indicated for alcohol

Use disorder. Is that a bigger market than obesity? I doubt that. I don't know who said that. I I think there are people who do want to drink less. Um, more likely this makes a big impact on the, you know, cost of treatment in our country and maybe even preventing more people from being alcoholics.

Because hopefully we'll have so many people on the medicines for treating chronic other chronic diseases or preventing uh chronic diseases. That's ahead of us, but um that's something we could we could look forward to.

about the downside. And the most obvious one is the cost and also the business model. This feels more like A subscription than a treatment. There is a rebound, or you can gain the weight back when you stop. These products cost five to fifteen hundred dollars. a month. Is that bound what I have here is about eleven hundred dollars a month. I I I think this is no longer true, but I read I think two years ago that the greatest penetration of prescriptions for GLP ones was also the thinnest.

area in America, it was the Upper East Side, that it was getting quite frankly to a group of people that were trying to lose that last ten, not address health concerns. And I recognize you're you're a for profit company in a capitalist society. Your job is to increase shareholder value and not not singularly address the healthcare crisis.

Well one, how do you guys think you oh from a shareholder standpoint, and I'm not a shareholder or Lily, but your shareholders want you to maintain pricing power. At the same time, it would appear that that maybe some of the people that could most benefit from this drug are not getting access to it. Cause I do think there's an inverse correlation between household income and obesity.

But it feels like there are contrarian forces here. And that is one, your job is to maintain pricing power. And two, it feels like there's absolutely an ex an external benefit if we figure out a way to get this drug into the homes that need us need it the most, which quite frankly is probably lower income homes. Talk a little bit about those opposing forces and your view more holistically about it.

Basically, um, the healthcare system without going down a rabbit hole unless you want to, you know, is this system where the biggest actors get the lowest price and the individuals pay the most. It's a totally regressive pricing model. And typically the individuals who have to go outside the system to buy themselves have the lowest quality insurance for a reason. It's because their job is not supporting high quality insurance or they're not don't have a job at all.

So, to address that, we created this direct model where we just said consumers can buy from the company, skip the healthcare system, normal channels. these pharmacy benefit managers and retail pharmacy. And we'll offer you the same price we offer the biggest players. So that price has been falling because those big players negotiate with us. So now it's three ninety nine kind of maximum for Zetbound.

It's come down sixty percent uh since we launched. And Foundado, the oral one we just launched, starts at one fifty nine and goes up to to three forty nine. So the prices are falling kind of markedly and I I suspect that will continue. due to competition and due to capacity. Uh when we launched these drugs, you you may have read we ran out.

There were shortages. It wasn't that we stopped shipping. There was just more demand than supply. We've invested a lot to fix that, uh about fifty billion dollars in new factories in the US, some of which are online, some which will continue to come online in the next couple of years. We shouldn't have a supply problem anymore. So that will allow prices to fall.

And then, you know, the other thing in this conflict narrative, which is generally true for pharma, which is broadly criticized for high prices, but typically for like a I don't know, breakthrough cancer medication or something. For a severe condition, you know, prices are pretty inelastic. People have to buy it. And so there is this sort of conflict that that sets up. It's interesting in this category, we observe something pretty different: that prices are pretty elastic.

that the more we lower the price, the more users we get. And it's not one-to-one. We tend to have done a little bit better by lowering the price. So that's the path we're on, and that's what we want to do. Um, of course, the alignment in the other decision makers in healthcare isn't perfect.

Um, you know, like let's just take state Medicaid. You raised this point. The the largest um obese uh population or percent of p the total uh population is in Mississippi. Seventy-eight, seventy-nine percent of adults are obese. And they also have the highest Medicaid enrollment and they're one of the poorest states in the country.

But we just managed to cut a deal with them to provide um our products in their Medicaid program. I think that's gonna have a profound impact on the health status of Mississippi. And yes, we lowered the price and they found money in the state budget and they bought into a business case that said, okay, within a couple of years we should get start to see a return on this, lower hospital costs, et cetera.

We need to get through that. And I think because of the history of the industry, which is more, I would say, extractive on pricing, as you're pointing out, I think there's a trust gap with some of these players. You know, we've got work to do, uh, no doubt. One big uh group that's gonna turn on July first that I think is a seminal date here is is uh the Medicare uh population. So starting July 1st for$50 out of pocket a month, every senior in America can buy our medicine for$50 a month.

That's gonna change accessibility for seventy million people very quickly. Um, that'll be interesting to watch as well and make a big difference. But we're not done. We gotta keep working working this. But I actually think there's a lot more alignment. than what you portrayed in your question, especially with this category.

Um, and we're happy to be the one that, you know, makes enough to supply that market. And if the price comes down another 50% and we sell two and a half times more, we're happy. Our job isn't to maximize price. It's to drive return. Um and here there's a big volume opportunity.

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W what is the peptide market and what are the commercial applications and if and where is Lily investing a around quote unquote this new peptide craze?

term for something nature uses to signal and do its work. There's nothing special about that word. And um it's been resurrected more recently because online marketing has m has made it sound like there's some extra special thing to using that word. And um I find it fascinating that now you see like Chinese peptides. Like that's a good thing. I don't I don't think that's a good thing. Um mostly mostly I call these unstudied medicines. That's

sort of the best way to put it. Um some are naturally occurring substances that people are um have identified and isolated and are selling as sort of quasi medicine. without clinical trials or safety data, certainly without an FDA approval. Um, I I think we have the FDA for a reason. Back to the origin story of Lily, like what's in it and what does it do? That's sort of why we started the company.

Um, 150 years ago, we don't know the qu the answer to either those questions when you buy peptides online. So we're not a big fan of this. you know, air quote peptide business. We're actually in the real peptide business. Uh you know, terzeptide, the ingredient of Monjaro and Zep down Zep bound is a peptide. But we engineered it to do something very specific.

We spent billions of dollars to study its safety and first animals and uh preclinical models, then humans. Then we proved its efficacy. Then we went to regulators around the world and got it approved. So third parties agree with our data. And now we monitor safety very carefully. And if you have an adverse event, we report it publicly. We're transparent about that. So, you know, these.

people involved in this business, mostly buying, you know, um, unproven things and selling them to individuals online, um, they they don't bear any of those responsibilities. And I I I don't think it's a very good idea, to be honest. Uh now some of them could turn out to do something. Um a number of the popular ones claim to be like mimetics of the human growth hormone. I'm not sure taking that chronically is a great idea, to be honest. Um

Growth hormone is, you know, pro tumor growth as well. So um I'd be concerned about that. And then some of them also, you know, uh have some sort of magic elixir properties. Unproven and unpublished. But you know, just stepping back maybe and just I don't know if you want to get into this, but like w how do people feel about healthcare right now? I think it's sort of the the covet crisis and this phenomenon are sort of two sides of the same coin.

People feel I mean healthcare is pretty much one of the worst consumer experiences we all have, right? We go to somewhere, no one can tell you the price. You gotta wait in line. You you're treated pretty shabbily. And there's all this information asymmetry. So you can't you don't feel informed to make decisions economically or for your own health. And

There's something appealing to people with sort of either rejecting recommendations of authority or taking your own agency and going online and saying, I'm going to take control of my own health. The problem here is You know, n people don't have biochemistry laboratories in their basement. They can't validate what they're reading online. They use these end of one anecdotes to say, oh, it helped me. That's not science. That's not

I mean that we know there's problems with uh relying on that to make decisions. So we need oversight of this to protect consumers. At the same time, I think we have to recognize the current system does a pretty terrible job of meeting people's needs. Um, at least in this feeling of like control, uh financial and um kind of health control. Um and I think people are reacting to that. That's why there's this booming business.

You made a you must have made a big bet when a lot of people weren't making this bet and it paid off. A trillion dollar, you're the first trillion dollar market cap, you're up fivefold in the last five years. Would you would you say w when you have that type of outperformance?

Um what is the barrier of entry there? What is kind of the secret sauce here? Has it been a massive bet in R and D around GLP ones? Has it been IP protection? You have better marketing, better brands, is it better distribution? Like where As at the end of the day you're responsible for outperforming the S and P as a CEO to trying to convince people to come to work for you and invest in your company because they'll get a greater return on their their human and their financial capital.

In your mind, what is Lily's competitive advantage as a culture, as a company? And when you speak to shareholders and say, okay, it's up fivefold, but stick with us, there's more running room because we are Yeah, we are great at X, Y, and Z. How do you differentiate from the rest of your competitors?

So that's one thing, Scott, which is pattern recognition and sort of the, you know, in Wall Street terms, capital allocation. Where do you place your best? And I think we have a little different point of view than most companies about this. Now all those names you're mentioning are buying up GOP one and uh agonists and trying to follow us into this mega market.

Uh of course we're you know trying to extend our lead, but we're spending a lot more time on other markets now. Why? Because by the time a a medicine market is big, it's basically too late to invest. That's our point of view. Maybe we're wrong about that, but in this case we were right. I can guarantee you in twenty eighteen, nobody was talking about the obesity market. Nobody was even investing it.

Really. It was considered a non-market. And the history of the weight loss drugs like Fenfen and these earlier drugs which were withdrawn was not a good one. Um, but we made the bet because we saw profound biology. So that's point number one is like, what is the science telling you? Two is you know, are we working in areas that ha are very common?

And here, like Lily um is sort of at the time and maybe now even even so cuts against the general thesis of the industry, which is to focus on price maximization and serving, you know, really difficult diseases, but maybe diseases that only have a few patients. There was a big theme on that for the last fifteen years in in medicine.

For some good reasons, but I think we're more attracted to, you know, the millions and billions served idea. Uh I think that's the, you know, doing things at scale is hard, and that's what a Lily is for. We're a big company. We should go after those problems. The second thing is speed. So very early in my tenure, we undertook a series of programs to really change the clock speed of RD.

Um, one of the reasons why that capital, the first point is true is that everyone has patent lives. So a patent in the United States is twenty years long. W when I began a CO, it was taking us 11 years to go from invention to the market, which means it took more time to get to the market than the time you had on your patent in total. Which was a kind of a nutty setup. The whole industry was a little bit better than Lily at the time. Well, we've now chopped five years out of our cycle time.

And the rest of the industry's about the same. So we can start an idea later and beat people to market, or we can start at the same time and beat them profoundly. That gives you more time in market with patent protection. It gives you more time to exploit new uses of existing drugs. And of course to give return to shareholders. But by the time those patents expire, basically things go to zero. So like Ozempic.

In 2031 or 2032, their patent will expire in the US. And people will be able to buy this not for$300 a month, but for like$60 a month. That's what's going to happen because the all the RD costs no longer need to be amortized and uh it becomes a commodity business.

So in our business, you have to outrun not only your own patents, but everyone else's. And when a breakthrough like Monjaro or J or Zbound goes generic, all these followers are gonna find it hard to differentiate their drug against something much, much cheaper. So you have to keep raising that bar and then at some point um you can't raise it anymore. But anyway, speed is valuable.

Making good choices, of course, is valuable. And then the final is just the execution. You know, Lily's, I think, the only scaled drug company that's really never had a major merger. We have a very singular culture that starts with that origin story we talked about earlier. We're kind of based where no one else is.

And we do have sort of a shared Midwest nice culture, but also a size of the company. We have less than 50,000 employees where everyone at the leadership level anyway knows each other and we can solve problems without having committee meetings. And I think that's been a benefit to the company as well.

And w uh the way I would describe your industry loosely is slow but steady incremental progress that over the that in the short term is not that dramatic, but over the medium and the long term, just you know, doesn't cure cancer but makes it less likely to die from it. And it just every day a t a touch better. And AI, or at least the proponents of AI, are holding out the promise of this acceleration.

of discovery. Do you think those promises are overhyped, underhyped? And speak to what how Lilly is using AI in its development process. Yeah.

and can predict the next word really well. And then that helps people sort of get to the information faster and faster. We use our scientists use it every day. We're big adopters of, you know, OpenAI and anthropics products and It helps people search things and find connections and literature, et cetera. But the problem we have, the fundamental problem in drug discovery, is the word discovery. is that we we're not synthesizing existing knowledge. We have to create new knowledge.

And probably humans have discovered, I don't know, 10 to 20% of all knowledge of the human body system. Meaning our our underlying data about about biology of of the human body is poor, which means you can create a model that tries to predict the other 80% with the 20 we know. It's terrible at predicting.

Whereas with words on the internet, like we know every word on the internet, it's very good at predicting those connections, to put it simply. We've adopted these AI tools across the company for all the other reasons everybody else has. Fundamentally, what scientists have to do is experiment. They have to create a hypothesis, they have to test it, and then they have to run experiments.

you know, Monjaro or Zet bound to Zepatite is the ingredient. That was like the seven hundredth version of a GLP G I P one inhibitor we actually had to make physically, test in thinking like petri dishes and rodents. uh to determine the one that would be the best to take forward. It was actually the second one we took to humans. The first one failed. That was the two hundredth or something that we had formulated. We went back and did five hundred more before we got a one that was better.

Can we avoid those misses with AI? Not today. We don't we don't even know why those systems, what the rules of those systems are. We are working with NVIDIA to try to solve this problem, but what we need to do is build data sets. that teach the AI the rules of a particular system in biology so it can predict the answers. I think when we have that, it will be very, very helpful at predicting the answers.

And we have some working examples of that in drug discovery. We've actually made them public. We have a thing called Lilly Toon Lab, which I think is the leading kind of workbench. for drug developers in the world because it's free to biotechs, all they have to do is let us use their data to train the models to work better. Um and these are in very discrete tasks

um that it takes to get a drug to market. So think of like the preclinical phase before you test in people, there might be like a thousand steps to go from an idea to a drug you're gonna put in a person. because that's a very dangerous thing to do if you don't know what what you're looking at. And maybe like twenty of those steps we've automated with AI or machine learning. Um so the task ahead of us is to like automate the other nine hundred and eighty.

And that's gonna mean building out a lot of data that doesn't exist in the world and training models to predict what the most likely next outcome is of that system.

Th there's just a lot to do there. So, you know, maybe five to seven years from now, we will skip a lot of laboratory experiments because we're confident in the models. We'll still have to do human experimentation though. I I don't think anyone on earth Is ready, except maybe the peptide buyers online, uh, to just sign up to say, okay, I'll be the first human to use a substance that's not been

rigorously tested and looked at by third parties, not the company making it, so I can really trust what they're saying. That's what clinical trials do, that's what the FDA and regulatory systems do. I'm not sure AI is gonna speed that up anytime soon. We're betting on it, but I think it's Ten year arc, not a two year arc.

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So we just have a few minutes here and our remaining time I wanna m move to I'm gonna segue to some of the more human stuff. You're the CO easily the most important company in Indiana, maybe the most important company in the Midwest. And uh, you know, you're still a relatively young man. We have a lot of uh of young men who listen to the podcast, non-young women, but mostly young men. What advice would you give to your twenty five year old self? Like what

What do you think you've done well? What could you have done better in terms of um professionally, in terms of man well, there's probably not a lot you could do better, but advice to your 25-year-old self.

Things were presented to me and went home, talked to my wife, and we said, let's let's do it. Like we moved to China and I ran Lily China for a while. She's a physician. She had to give up her career and but it was a great experience. You know, try why am I even in the drug industry? I s I was like a Purdue um engineering student and business major and I went to work at IBM and the only reason I arrived here was because

that same girl was going through med school at Indiana University. So I needed a job in Indianapolis. So I joined this company I knew nothing about really. And they said, Hey, we like what you're doing, stay on. And I did. I I think a lot of young people just sort of over program things in their head and then they worry about what the outside world is saying about the next choice versus just being curious and going for it.

And I think we're a little too programmed in our brains about how life actually works, which is like throwing yourself into things, committing, saying yes and seeing what you can learn and figure out. You know, that's one one thing. I think the other is I've really benefited from being at a company a long time, obviously. I do worry that. people jump too much, you know, that jump to the next job offer and for a little more pay without actually learning the industry they're working in that well.

If I jumped from one to the next, I'd become an expert at something that someone's willing to pay me a lot for, but I never actually learn like how the whole industry works. Those are two mistakes I I see people making and I I would I would avoid.

The times when we were actually like in the room together with the kids were limited because I work the work week and my wife tend to work nights and weekends. We're like reacquainting ourselves uh as a couple at the end of all that. But um I think, you know, that those sort of like boring in a way, like uninteresting days where you're just going for a walk or

throwing a nerf ball in the yard or whatever, that's how you really connect and kind of create a kind of a model for your boys in a way. I think they'll be great dads in that regard. All the things I've done at the workplace that were hard, you know, like difficult conflicts and people situations, nothing's harder than that at home to me, because you care so much about the outcome, care too much sometimes to be rational.

And you know, I I I probably was less patient and too demanding at times of my boys. you know, expecting more, you know, growing up is a developmental process. Maybe for men it doesn't end till their mid twenties anyway, where your brain's fully formed and you're kind of a rational executive function kind of human being. Being more patient with that is something I'd tell myself if I had to go back. Um, that's just a process, enjoy the process.

And then, you know, there's no substitute for time. I I think uh maybe related to the first point, but like one thing we like to do is like enjoy the outdoors together and That's a good pastime for dads and boys because like the phones aren't there and you're sort of in the woods, you know, we backpack and camp and so forth.

And you just have time to talk when you're walking along. And uh I think the world could use a little more of that. You know, it's one thing to go to the game and stand on the sidelines. you know, cheer on your kid. That's good to do. But are you connecting? I I'm less sure. And I see a lot of people

um, at least where we live, spending a lot of time doing that versus, you know, participating in something you both enjoy together, side by side. I think men kind of connect side by side. That's um, you know, how you know, why I think

Like people like to golf and fish and walk together. You know, you sort of have a chance to talk while doing something sort of with half your brain. And I think as a dad, that's a good mode to be in with your boys too, especially when they're teenagers and being difficult and very critical of you.